MOHS MICROGRAPHIC SURGERY
At Swann Dermatolgy Surgery, our skin cancer team is led by a board-certified dermatologist who is fellowship trained in Mohs skin cancer surgery. Dr. Michael Swann completed a fellowship in Mohs micrographic surgery at Scripps Clinic in La Jolla, California. Our staff is dedicated to the highest level of procedural dermatology care including advanced skin cancer management, Mohs surgery, reconstructive surgery, laser & cosmetic dermatology. Dr. Swann is the only physician in the ozarks with fellowship training in Procedural Dermatology, which includes advanced training in Mohs micrographic surgery, reconstructive surgery, advanced cosmetic procedures including cosmetic lasers and leg vein treatments.
Mohs Micrographic Surgery is the most advanced and effective treatment procedure for skin cancer available today. The procedure is performed by specially trained surgeons who have completed at least one additional year of fellowship training (in addition to the physician’s three-year dermatology residency) under the tutelage of a Mohs College member.
Initially developed by Dr. Frederic E. Mohs, the Mohs procedure is a state-of-the-art treatment that has been continuously refined over 70 years. With the Mohs technique, physicians are able to see beyond the visible disease, to precisely identify and remove the entire tumor layer by layer while leaving the surrounding healthy tissue intact and unharmed. As the most exact and precise method of tumor removal, it minimizes the chance of re-growth and lessens the potential for scarring or disfigurement.
Because the physician is specially trained in surgery, pathology, and reconstruction, Mohs surgery has the highest success rate of all treatments for skin cancer - up to 99 percent. The Mohs technique is also the treatment of choice for cancers of the face and other sensitive areas as it relies on the accuracy of a microscopic surgical procedure to trace the edges of the cancer and ensure complete removal of all tumors down to the roots during the initial surgery.
ABOUT MOHS MICROGRAPHIC SURGERY: EFFECTIVENESS
Mohs Micrographic Surgery is an effective and precise method for treating basal cell and squamous cell skin cancers. Because the Mohs Micrographic Surgery process features a systematic microscopic search that traces skin cancer down to its roots, it offers the highest chance for complete removal of the tumor while sparing the normal tissue surrounding it.
Clinical studies conducted at various national and international medical institutions - including the Mayo Clinic, the University of Miami School of Medicine and Royal Perth Hospital in Australia - demonstrate that Mohs surgery provides five-year cure rates up to 99 percent for new cancers, and 95 percent for recurrent cancers.
Why Does My Skin Cancer Need Mohs Surgery?
Mohs Micrographic Surgery is primarily used to treat basal and squamous cell carcinomas, but can be used to treat less common tumors including melanoma.
Mohs Surgery is appropriate when:
- the cancer is in an area where it is important to preserve healthy tissue for maximum functional and cosmetic result, such as face, eyelids, nose, ears, lips, fingers, toes, genitals
- the edges of the cancer cannot be clearly defined
- the cancer had aggressive features under the microscope
- the cancer was treated previously and recurred
- scar tissue exists in the area of the cancer
- the cancer is large
- the cancer is growing rapidly or uncontrollably
The Mohs Micrographic Surgery Process
Mohs surgery is usually an outpatient procedure performed in a physician’s office. Typically, it starts early in the morning and can be completed the same day, depending on the extent of the tumor and the amount or reconstruction necessary. Local anesthesia is administered around the area of the tumor so the patient is awake during the entire procedure.
MOHS SURGERY RECONSTRUCTION- REPAIRING THE WOUND
Dr. Swann is also trained in reconstructive procedures and often will perform the necessary reconstruction to repair the wound.
As soon as the affected area is declared cancer-free, the Mohs surgeon discusses post-surgical options with the patient such as:
a small, simple wound may be allowed to heal on its own.
a slightly larger wound may be closed with stitches.
larger wounds may require a skin graft or a flap.
if the tumor is very large, another surgeon with special skills may be called upon to assist with reconstruction.
Mohs Micrographic Surgery Post-Surgical Management
Post-surgical check-ups are recommended in order to monitor the patient’s progress and spot any possible cancer recurrence in a timely manner.
Since two of five patients with one skin cancer will develop another within five years, follow up is extremely important for early detection of any new lesions.
As the incidence of skin cancer soars, greater focus is currently being placed on the cost effectiveness of treatment. Over the past decade, studies have been conducted to calculate and compare the costs of Mohs Micrographic Surgery with those of traditional surgical methods. Studies cited in Journal Watch Dermatology show that Mohs surgery is no more costly than standard excision and less expensive than radiation therapy or excision in an ambulatory surgery center. Because the process of Mohs Surgery minimizes the risk of recurrence, it reduces and frequently eliminates the costs of larger, more serious surgery for recurrent skin cancers.
Mohs Micrographic Surgery is named after its founder and originator, Frederic E. Mohs, MD. As a medical student from 1929 to 1934, Dr. Mohs conducted cancer research projects while working for his mentor and zoology professor, Michael Guyer. Dr. Guyer was familiar with the preparation of frozen tissue for producing microscopic slides and had authored a book explaining how to harvest and process tissue for microscopic examination. The book focused on the need for examining, drawing and documenting discoveries that were made with the microscope.
These microscopic techniques were later used by Dr. Mohs to map out cancer around nerves, blood vessels, muscle and bone. The cancers he examined were removed by shave or saucerizing excision, a technique that removed cancer as a thin disc of tissue so that the tumor and the inflammatory white-cell infiltrate surrounding the cancer could be examined with the microscope. Dr. Mohs trained several dermatologists in the field, including Dr. Swann's fellowship director. Dr. Swann has been practicing in Springfield since 2008.
Patients often do not have concern about a specific skin issue, but would like to have surveillance of their skin by the most qualified experts. There are many reasons for having routine skin examinations by a dermatologist, but the goal is to catch skin cancers early so they can be treated the most efficiently with the least amount of scarring. In addition, pre-canceous lesions can be treated at routine visits thereby preventing progression. Although this is not an exhaustive list, a few of the most common reasons for scheduling a routine examination of your skin are listed here:
- personal history of any skin cancer
- personal history of pre-cancerous lesions (actinic keratoses)
- a weak immune system (organ transplant patients or patients with lymphoma)
- family history of melanoma
- extensive outdoor work or lifestyle
- living a significant part of life at altitude or in very sunny climates
- pale or fair skin
- prior tanning bed use or excess sun exposure
- moles that are asymmetric, have irregular borders or colors, are large or changing
- exposure to radiation (particularly acne treatment as a child)
- exposure to certain substances, such as arsenic (can be found in well-water)
If you have an examination scheduled, it’s best to either come to your appointment without anything on your skin, including foundation or makeup. This can be removed at your appointment, but you should a lot time to replace any makeup afterward, if necessary. Before you come see us, take a glance at your skin in a full length mirror and make note of any areas that stand out or cause you concern. Dr. Swann recommends that patients routinely do self-examination once per month after bathing in front of a full-length mirror. Even without knowing much about skin disease, patients are very good at finding changes in their skin.
Our paperwork will question you about your history of sun exposure, sunburns, etc. and if any specific spots have been bothering you. Then we’ll have you change into an exam gown. Skin cancers can occur where the sun doesn't shine. We can examine you with your underwear on, but would prefer you to have you remove your socks. If you prefer a limited exam (just the waist up, most intense sun damaged skin or only certain moles) we can accommodate.
During the exam, we may use alcohol on the skin and sometimes use magnification or special lighting. Your physician or physician assistant will be dictating their findings out loud to a medical assistants who makes sure that everything is documented in your medical record. The medical assistant may document some areas with photos during the exam. Routine skin checks might seem cursory to a patient, but even if a skin check seems quick, we take our examinations very seriously and spend time on areas of concern. These may be subtle to most patients, but this is our interest and passion.
Dr. Swann and our staff realize that sometimes after your skin check, you worry something has been missed and it is important for us to relieve any concerns or take appropriate action on areas that may be a concern to us. When we come to a spot that you are worried about, don't hesitate to point the area out it out us so that your concerns can be addressed.
During the examination, we may identify an area that requires treatment. After discussing the diagnosis and treatment with you, they will generally take care of the minor procedures right then and there. The two most common treatments are:
- Cryotherapy – A quick spray of liquid nitrogen is used to remove lesions that sit on the surface of the skin (for example, pre-cancerous actinic keratoses.
- Skin biopsy – A small sample of a suspicious lesion is removed under local anesthetic. It is then sent to a lab to be examined under a microscope to determine if further treatment is needed.
Many people have lots of spots on their skin that are not worrisome (for example, skin tags, sunspots and benign moles). Although these can be treated if they are causing discomfort, or if there is a cosmetic concern, our team gives their initial attention to any spots that have the potential to be cancerous. If you have something on your skin that bothers you cosmetically, let the doctor know and they can talk to you about treatment options. Simple cosmetic concerns can often be treated at the time of your skin exam if there is time and you will be given a price to cover these non-medical, cosmetic concerns. Payment for cosmetic-related procedures are expected in full at the time of service. We do offer Care Credit and can take credit cards should are expected.
To schedule a skin check with someone on our team, call 417-888-0858.
BOTOX® Cosmetic is a remarkable treatment that erases frown lines, worry lines, and crow’s feet. It also maximizes and extends the results achieved through laser skin treatments. Treatments are nearly painless, and effects last 3-6 months.
I’VE HEARD BOTOX® COSMETIC IS THE SAME AS BOTULISM TOXIN. IS THAT TRUE?
Not exactly - BOTOX® Cosmetic is the purified toxin produced by the botulism bacteria! It works by selectively relaxing muscles that contribute to frown lines and certain other facial wrinkles. So why don’t you get botulism? The amount of BOTOX® Cosmetic I would need to inject all at once to give you botulism is over 100 times the amount given in an average session, and there is no cumulative effect from session to session.
WILL I LOSE NORMAL FACIAL EXPRESSION?
No. Great BOTOX® Cosmetic means looking younger and more relaxed - not looking frozen. When properly placed, BOTOX® Cosmetic relaxes the muscles that cause frown lines or other wrinkles but does not otherwise limit your range of normal facial expressions.
WILL BOTOX® COSMETIC ERASE ALL WRINKLES?
No - BOTOX® Cosmetic is best for wrinkles that form as a direct result of muscle contraction. Frown lines and crows’ feet are the best examples. With continued use, these wrinkles soften over time and may even disappear. Wrinkles in other areas of the face, such as the smile lines, cheeks, or undereyes, are usually better suited for chemical peels or injectable fillers.
WILL I HAVE TO USE IT FOREVER?
BOTOX® Cosmetic usually lasts 3-4 months, by which point the muscles that cause the frown lines or other wrinkles are fully active again. Most people choose to repeat the treatment at that point to maintain their results. For those who do not, however, their facial expressions and muscle motion continue stay normal, just like before they ever had BOTOX® Cosmetic.
OTHER INJECTABLE MUSCLE RELAXERS?
BOTOX® Cosmetic was the first approved facial injectable for reducing fine lines on the face by relaxing muscles, but others exist including Dysport and Xeomin.
Lasers and light sources have revolutionized cosmetic and medical dermatology. At Swann Dermatology, we are laser experts. Dr. Swann is fellowship-trained in laser and cosmetic dermatology by preeminent cosmetic dermatologist E. Victor Ross at Scripps Clinic. Dr. Swann did investigational research including clinical studies on many of the devices used clinically today including fractionated carbon dioxide, erbium 2940, intense pulsed light, vacuum-assisted diode and more. Swann Dermatology is not another medical spa. We offer 417-area's only dedicated cosmetic dermatology clinic with cutting-edge treatments that are scientifically proven. Our staff is led and trained by Dr. Swann himself. We do not support gimmicks and we are not driven for sales, we are driven by achieving excellent results for our patients. We offer a variety of proven technologies for medical, surgical and cosmetic results.
KTP LASER TREATMENTS
The single most effective laser wavelength (532nm) for treatment of facial red spots and blood vessles in a single treatment is available in Springfield only at Swann Dermatology. Sun damage or other inflammatory conditions,such as rosacea can lead to proliferation of shallow blood vessels. Dr. Swann owns Southwest Missouri’s only high-powered Gemini KTP laser which efficiently treats blood vessels with low downtime. The bright green laser light is absorbed selectively by hemoglobin in shallow blood vessels which are gently headed. This is followed by denaturing of shallow blood vessels. Some blood vessels disappear on contact with the laser.
What is the Gemini Treatment?
The Gemini KTP Laser is the most powerful green-light laser available and has been designed to target collections of melanin, which lead to brown pigment in the skin, and excess blood vessel proliferation in the skin. The Gemini laser is a true laser, meaning it has a single wavelength (532 nanometers) instead of the more common IPL (intense pulsed light) which is filtered light. IPL is effective for some patients with light skin and dark spots, but tends to take 3-5 treatments for the sort of lasting results that can be achieved with a single KTP treatment. Alghough IPL is commonly used by nurses in Springfield, Dr. Swann operates the only Gemini KTP laser in Southwest Missouri. Our KTP laser’s narrow wavelength allows us to target facial capillaries much better than IPL with less risks and fewer treatments.
The goal in treating the skin with the Gemini KTP Laser is significant improvement of broken blood vessels leading to more even skin tone and improvements in skin texture. Additional improvements can be seen in brown spots using this laser. This can be performed with minimal downtime (2-3 days of mild swelling) and is relatively painless.
What can I expect during Gemini Treatment?
The KTP treatment begins with 45-60 minutes of topical anesthetic, which can be obtained ahead of time or applied in the office while you wait. Treatment of a full face requires approximately 25 minutes. Although patients do improve when additional treatments are added, usually patients only require a single treatment on their face. Sometimes a touch-up procedure is required, depending on their desired result.
Protective eye shields will be placed over your eyes. Cold, clear gel is applied to your face as a coupling agent for the laser. You will be given the wand of a Zimmer chiller. The Zimmer blows cold air and the airflow will be directed at the treatment site. During the treatment, you will be able to feel each pulse of the laser energy shine into your skin, as it gently warms blood vessles and brown spots. Most patient’s report their pain as being 2-4 on a scale of 1 to 10, but certain areas may be more sensitive, like the upper lip and nose. After the treatment, the nurse will pass you the Zimmer wand to keep your face chilled immediately after treatment while they remove the gel from your face and take off your laser eye shields.
What will my recovery be like?
Immediately after treatment, your skin will be blotchy for approximately 30 minutes. Although you may notice some mild swelling the evening of the procedure, generally the main part of the swelling begins the morning after the Gemini procedure. There are no breaks in the skin and no bleeding or sores after Gemini treatment. Swelling will continue for 2 to 3 days after treatment which is more noticeable in the morning and can be significant in some patients. Swelling is the main side effect of treatment. Swelling is usually the most prominent in the eyelids. This can be minimized by staying cool (ice-packs), antihistamines before the procedure (zyrtec every night starting 3 nights before the procedure). Brown discolorations treated with the Gemini Laser will immediately darken with a grayish hue. This is not impressive, but be immediately covered with makeup if you desire.
When can I expect results?
Immediate improvement in vessels is noticed, although improvements in blood vessels continue over the next 4-6 weeks. For patients with numerous vessles or background redness without vessels, more treatments will continue to help. Brown spots immediately turn gray-brown and appear more shallow within the skin. Make-up can cover these areas up, but the brown spots will flake off subtly over the next week with normal care.
How much does it cost?
Dr. Swann has done extensive training with the Gemini KTP laser and is fellowship trained in laser and cosmetic procedures. Our pricing is based on Dr. Swann’s time and expertise required to treat your skin condition. He will perform the laser treatment himself. Trust your skin to a dermatologist.
Single focused area $300, full face $800, neck $400, chest $500.
To learn more about the treatment of age spots or photoaging and to find out if a treatment is right for you, please contact us today at (417) 888-0858 to schedule a consultation with Dr. Swann.
Laser Resurfacing CO2 Laser
Dr. Swann now offers Springfield’s first fractionated carbon dioxide laser. Although other procedures remove aging spots and help with skin texture, DOT Therapy with the SmartXide DOT CO2 laser offers the ultimate in skin rejuvenation. DOT Therapy is ideal for the treatment of sun damage, brown spots, fine lines, wrinkles, skin laxity/texture and acne scars. Not only does the DOT offer amazing results, but it does so safely and quickly with little downtime. The secret is out and the benefits of DOT Therapy speak for themselves:
- Rapid healing with minimal downtime (4-6 days)
- Quick procedure with low risk
- Treatment tailored by Dr. Swann
- Minimally invasive
- Freshened, renewed skin
- Treatment of multiple issues at once
- CO2 treatment without being put to sleep
What will fractionated CO2 laser therapy do for me?
If you have spent years in the sun, especially without adequate sun protection, then you know what it can do to your skin. Wrinkles, skin discoloration, sun spots, skin laxity all creep up with age, but are more pronounced in areas of sun damage. Although prevenative measures like sunscreens and hats are the best way to age gracefully, it is often impractical. Fractionated CO2 lasers significantly reduce the damage caused by years of sun in just one treatment. Also, if you have scars from acne or other skin injuries, then you may also be a candidate for this procedure. Now, using DOT Therapy, an innovative, new laser technology, an hour treatment by Dr. Swann may restore your skin’s youthful appearance. While the aging process cannot be stopped, with proper care you can maintain your rejuvenated skin’s appearance for many years!
DOT Therapy is a pioneer in the world of CO² laser resurfacing treatments. Before DOT, many patients endured long, often painful laser resurfacing procedures with lengthy recoveries in order to achieve skin rejuvenation. Historically, many procedures involved vaporizing an entire layer and surface of skin, resulting in significant downtime, discomfort and prolonged redness. In addition, old CO² lasers could not treat non-facial areas like the neck and décolletage easily because skin in these areas did not heal as well as the face.So how is DOT Therapy different or better? The DOT utilizes a ‘dot’ pattern to create thousands of microscopic perforations in the skin while leaving the areas around each ‘dot’ intact. This fractional laser allows for the skin to heal more quickly from the edge of these tiny ‘dots’. The overall procedure is safer, faster and more efficient. Doctors also have more control to customize treatment specifically to the patient and even modify treatment during the procedure for various skin challenges or problem areas.
DOT Therapy SmartXide Laser Traditional CO2 Lasers
Minimal recovery time (3-5 days) Lengthy recovery time (weeks)
Rapid healing due to DOT pattern Delayed healing due to ‘blasting’ away layer of skin
Adjustable settings to achieve customized treatment No flexibility to customize treatment
Minimal discomfort Patient discomfort and pain
No bleeding Possible bleeding
Target various types of damage Nominal flexibility
Treat beyond the face (eyelids, neck, hands) Safely treat the face only
No adverse reactions Risk of adverse reactions and side effects
If you think you might be a candidate for a resurfacing laser procedure, Dr. Swann is the only dermatologist in southwest Missouri fellowship-trained in procedural dermatology with laser & cosmetic experience. Call our office at 417.888.0858 to schedule a consultation.
Facial lines have long been viewed as the sign of facial aging, but volume restoration has changed the way we treat the face to look younger. For decades a skin excising facelift was the standard procedure for making someone look younger, but without volumization this led to tightly pulled faces that had less lines and did look ‘different’, but not necessarily more beautiful. There are 8 distinct areas of the face, both deep and more shallow, that facial volume is critical.
Dermatologists began to realize that the facial lines are not generally a result of the skin just stretching out, but of overall volume loss. Adding overall volume to the deflated areas of the facewould help correct the aging face and maintain a youthful appearance, so we began the use of fat transfers. These work fairly well for some people, but necessitate additional procedures of extracting the fat from another part of the body and then preparing and reinjecting in the face. Although fat transfer sounds nice because it is replacing fat loss with a patients own fat, only about 50% of the fat injected usually remains longterm and many patients are unhappy after this procedure.
Radiesse is a dermal filler which really does a nice job of volumizing the deep tissues to restore a naturally volumized face and it does have nice longevity. Dr. Swann reported this filler lasting up to 6 years in the skin. Although more permanent products, such as Artefill, have been available for many years, permanent solutions using fillers fail over long periods of time because volume in the face should change with age.
Juvederm Voluma has revolutionized volume restoration in the face with soft natural results that can last up to 2 years. We all lose volume in the triple-process of collagen loss, fat loss and bone loss. A robust yet natural feeling and natural appearing filler is the perfect instant solution. Dr. Swann, Autumn Courntey PA, and Jennifer Ott RNP all have advanced training in Juvederm Voluma and can help you achieve excellent predictable results.
The Liquid Facelift is a great way to rejuvenate the face and gain a more youthful appearance. It offers many of the benefits of a traditional facelift without a single incision. Liquid Facelifts restore lost volume, deminish lines and wrinkles, redefine the jawline and cheekbones, and lift sagging brows. The Swann Dermalogy staff customizes each procedure to suit the patient’s particular needs and to target specific areas of concern.
Some patients require cosmetic fillers to provide volume and to fill in wrinkles, while others may need a heavier use of dermal fillers to significantly contour the facial structure. In addition to fillers, products may be used to relax specific muscles in the face to reduce lines around the brows or mouth. A combination of these treatments may be used to enhance the overall look of the face, specific to the patient’s needs.
The results obtained by undergoing a Liquid Facelift will vary patient to patient because each treatment is so individualized. It will often depend on which particular products are used. Some products will have immediate results, while others may take a little longer to see a noticable difference. This procedure will give patients a more refreshed, youthful appearance rather than the look of having a procedure done. Patients can get touch-ups over time to maximize results.
Some of the products used in a Liquid Facelift include JUVÉDERM® VOLUMA, RADIESSE®, BOTOX®, and DYSPORT®.
Please call Swann Dermatology at 417-888-0858 or email email@example.com for questions or to schedule a consultation.
Leg Vein Sclerotherapy
What is sclerotherapy?
Although Dr. Swann sometimes uses lasers to treat leg veins, sclerotherapy
is a more effective therapy for most leg veins. Sclerotherapy is a minimally invasive
procedure done used by Dr. Swann to treat uncomplicated spider (red) veins and uncomplicated reticular (blue) veins. The treatment involves the injection of a solution into the affected veins. Dr. Swann uses the liquid and advanced foaming technique depending upon the vein diameter and amount of clinical venous backflow (reflux).
What are varicose veins?
Varicose veins are large blue, dark purple veins. They protrude from the skin and many times they have a cord-like appearance and may twist or bulge. Varicose veins are found most frequently on the legs.
What are spider veins?
Spider veins are very small and very fine red or blue veins. They are closer to the surface of the skin than varicose veins. They can look like a thin red line, tree branches or spider webs. Spider veins can be found on the legs and face and may cover a small or large area.
What are reticular veins?
Reticular veins can also be known as feeder veins. They are the blue and green veins beneath the surface of the skin.Reticular veins enlarge because of increased pressure in the vein. They can be caused by heredity. You may have reticular veins alone but you may also have spider veins at the same time.
What causes spider and reticular veins?
Spider and reticular veins can be caused by many factors.
Heredity. Having a family member with prominent veins may increase the risk of you developing them. Approximately half of the people who get varicose veins have a family history of them.
Age. The normal wear and tear of aging may cause valves in the veins to weaken and not work as well.
Gender. Women are two to three times more likely to develop varicose veins than men. Up to half of American women have varicose veins. Changes in hormones due to puberty, pregnancy, menopause, or taking birth control pills may increase a woman’s risk of developing varicose veins.
Pregnancy. During pregnancy, the growth of the fetus increases the pressure on the veins in the legs. Varicose veins that occur during pregnancy usually improve within 3 to 12 months following delivery.
Overweight and obesity. Having extra weight on the body can put additional pressure on the veins.
Prolonged standing or sitting. This is particularly true with legs bent or crossed. When standing or sitting with legs bent or crossed, the veins have to work harder to pump the blood up to the heart.
Other possible causes for varicose veins are race, posture, occupation, hormones such as estrogen and progesterone, primary valvular incompetence, and incompetent perforating veins.
Dr. Swann is a board-certified dermatologist with extensive fellowship training in leg veins. He is an active member of the largest venous organization in the United States called the American College of Phlebology. He is trained in simple liquid sclerotherapy and also in more advanced procedures including ambulatory phlebectomy (surgically taking out veins), endovenous ablation (laser threaded inside of larger veins) and foam sclerotherapy.
If you have unsightly or tender leg veins or symptoms of heavy swollen legs, we invite you to have a consultation with Dr. Swann. Call 417.888.0858 for an appointment and more information about leg vein treatment.