Surgical Services

At Advanced dermatology of Southeast Missouri, we treat a variety of skin conditions, including, but not limited to:

  • Mole and benign skin lesion removal
  • Laser Surgical Procedures
  • Skin cancer removal including Moh’s Micrographic Surgery
  • Scar revision
  • Electrodessication and curettage

Unlike a plastic surgeon or other type of surgeon, board certified dermatologists are specifically trained in the treatment of skin cancer and can provide options other than surgery.  However, if surgery is required, our practice offers the most current treatments available to provide you with the highest cure rates.  Below we have detailed some of the more common surgical services that we provide, specifically skin biopsies and a specialized technique for skin cancer removal called Mohs Micrographic Surgery. Both Dr Limbert and Dr Moon have completed a fellowship with the American Society of Mohs surgery.  This designation as  Fellow, ensures that our providers are experts in the treatment of skin cancer and the Mohs procedure."

What is involved with a Skin Biopsy?

The skin is an incredibly complex organ and sometimes a skin biopsy may be required. A biopsy is a sampling of skin to determine if you have skin cancer or to more accurately diagnose a problematic rash.   The biopsy procedure itself is relatively quick but does require a small injection to numb the skin. Sometimes a small stitch is required to close the defect created from the procedure.  Most of the skin biopsies that are done, do not require stitches and only a small Band-Aid is placed.   If you have had a biopsy, please click her detailed instructions on the care of the biopsy site. 

After the biopsy is taken, the specimen is processed in a lab with special equipment and qualified personal.  This process takes about 24 hours and results in tiny sections that are placed on glass slides for evaluation under the microscope. The sample size is usually smaller than a pencil eraser, but a tremendous amount of information is obtained by analyzing a skin biopsy under the microscope.  At Advanced Dermatology of Southeast Missouri, we have a laboratory that is certified by the state of Missouri, much like you would find in a hospital.  This allows us to more quickly process your biopsy render a timely diagnosis

We understand that accurate and timely diagnosis of your skin disease is important. As board certified dermatologists, both Dr. Moon and Dr. Limbert are trained in dermato-pathology and will interpret the biopsy specimen under the microscope.   Occasionally a second opinion may be sought for certain rashes or skin cancers that are challenging to diagnose.  By knowing you as a patient and then seeing the biopsy under the microscope, your dermatologist is able to render a more accurate diagnosis and institute appropriate treatment.

What is Mohs Micrographic Surgery?

Mohs surgery is a highly specialized treatment to remove skin cancers with the least amount of scar and the highest cure rate.  The procedure is named for Dr. Fredrich Mohs, the surgeon who pioneered the technique.  This procedure allows complete removal of the skin cancer in 99% of cases, while sparing damage or removal of normal surrounding tissue.  Therefore, the Mohs technique is ideal for skin cancers on the face, nose, ears, scalp, hands, feet, fingers, or in other locations where the tumor may be large or poorly defined. 

Mohs surgery is an outpatient procedure performed in the office under local anesthesia.  The tumor is removed with narrow margins to avoid excess removal of normal tissue.  The specimen is then processed and viewed under a microscope, which takes as little as 30 minutes or as long as two hours.  During this time, we apply a bandage and have you relax in our waiting room.  The anesthetic that numbs the skin typically lasts for about two hours, so you should not feel pain while waiting.  If it appears that some of the tumor remains, then more tissue is removed and again viewed microscopically.  This process is repeated until the cancer is completely removed, usually in one to three surgical stages.  Some cases can take longer.  Although this is a time-consuming, tedious process, it provides the highest cure rate and the least amount of scarring.

With Mohs surgery, what happens after the tumor is removed?

Once the tumor has been completely removed, your surgeon will determine the best way to repair the surgery site.  Often the wound can be repaired immediately in the office with stitches.  Occasionally, you may be referred to a reconstructive surgeon for the repair.  The best method of repair cannot be predicted prior to removal of the skin cancer.

Where do I go for the Mohs procedure?

There is no hospitalization with Mohs. The procedure is performed in our outpatient surgical suites. The tissue is examined in the office. Since the area around the tumor is numbed with local anesthetic, the procedure is safer than having conscious sedation or general anesthesia.  Also by having the procedure performed in the outpatient setting, the cost is much less. 

What are the advantages of Mohs Micrographic Surgery?

Highest cure Rate (98-99%)

The unique way in which the tissue is processed allows the surgeon to look at 100% of the margin.  By, using the microscopic examination of the tissue as a guide, the Mohs/ Dermatologic surgeon is better able to remove all of the skin cancer.

Smallest Visible Scars  

The procedure utilizes microscopic margins as opposed to standard margins which may be a quarter of an inch or larger.  That’s a big deal when we are talking about areas like the nose or ears, where excellent cosmetic outcomes are a must.  Also, by carefully mapping out the tumor, the surgeon removes only cancerous tissue and leaves behind as much normal skin as possible.

Cost effective

Having a skin procedure in a surgical center or hospital operating room increases your costs by about $3000 to $5000 due to anesthesia and operating room fees.  This does not include the surgeon or pathology fees either.  This cost is in contrast to a Mohs procedure that is usually in the hundreds of dollar range.

Will My Insurance Cover Surgical Procedures?

Under most circumstances your carrier will pay for dermatologic surgery, including the Mohs technique.  If you are a member of an HMO, it may be necessary to obtain a referral or authorization from your primary physician. If you are in doubt about your particular coverage, please check with your insurance representative prior to your appointment. If you have specific questions regarding insurance or billing matters, please contact our office at 573-335-7546 (SKIN)

If you have a skin cancer that requires surgery, please review this detailed handout that further outlines what to expect when the procedure is done.

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