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SKIN CANCER DIAGNOSIS

Unified Mohs Surgery

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    SKIN CANCER DIAGNOSIS

    Unified Mohs Surgery

      Request medical consultation

      Fill out this form and we will contact you to advise you

      Unified Mohs Surgery
      Pablo Umbert Cutaneous Oncology Institute
      Immediate diagnosis of skin cancer with Mohs surgery
      A precise, effective, and conservative surgical procedure
      Mohs surgery is one of the most effective treatments currently available for certain types of skin cancer. Thanks to its precision and real-time histological control, it allows the removal of tumor tissue while ensuring maximum preservation of healthy skin. This procedure is usually performed on an outpatient basis, under local anesthesia, with minimal disruption to the patient’s routine.
      At the beginning of January 2008, we initiated a new diagnostic technology in the early diagnosis of inflammatory skin lesions and tumors. Society demands greater attention and reliability in medical practice. Dermatology is continuously advancing in diagnostics and therapeutic solutions.

      For three decades, the methodology of classical skin biopsy, which required a minor surgical room and suture material to close the excised tissue, was simplified with the arrival of the “punch.” The “punch” allows obtaining a sample 3 to 5 mm in diameter, usually without the need for sutures. The tissue is processed in the dermatopathology laboratory for subsequent histopathological reading after 3–4 days.

      In oncologic surgery, the tissue is frozen, cut and this cut in the cryostat will determine within a few minutes if the excised lesion is tumor free. In cutaneous oncology, this procedure compared to the classic process using paraffin shows a reliability index of 85%
      Today, Mohs surgery is considered the most reliable technique against high risk cutaneous and recurrent tumors. The ability to immediately freeze tumor tissues using horizontal cuts allows the removal of selective tumor tissue giving the patient guarantee of success over other techniques. We have used this technique in over five thousand interventions and call it our star technique.

      The DIC uses extraction most of the time with the “punch” system, which is compatible with other extraction procedures such as “shaving” or excision.

      The methodology is similar to that of Mohs surgery in which the tumor tissue is freezed. A perpendicular cut in the center is also made. The tissue with the problem is tainted for an immediate histological examination. All the remaining material is processed with the conventional paraffin method 5 days later as a dual control. Up to date we have conducted 250 DIC exams in tumoral melanocytic and epithelial pathology as well as inflammatory disease pathology.

      Preliminaty Results

      · The DIC has a reliability index of 90% (±4) in carcinomatous lesions.

      · n melanocytic lesions, although useful in most cases, the problem lies in the possible diagnosis of malignant cutaneous melanoma. The entire tissue must be examined, with sufficient quality, to provide a diagnosis.

      · The DIC allows ruling out other possible diagnoses immediately, while a classical histopathological examination is needed for a definitive diagnosis.

      · In inflammatory pathology, we are in a preliminary phase of material collection, having collected some material.

      Immediate skin cancer diagnosis (DIC)

      null
      Experts in the technology
      null
      Non-therapeutic diagnostic procedure
      null
      Immediate diagnosis (15 minutes)
      null
      Indications: lesions suspected to be a possible tumor
      null
      Reliability: 90%(+-4) in cutaneous carcinomas
      null
      Double check at 5 days
      null
      Not indicated in the diagnosis of melanocytic lesions
      null
      Preliminary phase in inflammatory pathology

      Unified Mohs Surgery

      Pablo Umbert Cutaneous Oncology Institute

      Immediate diagnosis of skin cancer with Mohs surgery

      A precise, effective, and conservative surgical procedure
      Mohs surgery is one of the most effective treatments currently available for certain types of skin cancer. Thanks to its precision and real-time histological control, it allows the removal of tumor tissue while ensuring maximum preservation of healthy skin. This procedure is usually performed on an outpatient basis, under local anesthesia, with minimal disruption to the patient’s routine.
      At the beginning of January 2008, we initiated a new diagnostic technology in the early diagnosis of inflammatory skin lesions and tumors. Society demands greater attention and reliability in medical practice. Dermatology is continuously advancing in diagnostics and therapeutic solutions.

      For three decades, the methodology of classical skin biopsy, which required a minor surgical room and suture material to close the excised tissue, was simplified with the arrival of the “punch.” The “punch” allows obtaining a sample 3 to 5 mm in diameter, usually without the need for sutures. The tissue is processed in the dermatopathology laboratory for subsequent histopathological reading after 3–4 days.

      In oncologic surgery, the tissue is frozen, cut and this cut in the cryostat will determine within a few minutes if the excised lesion is tumor free. In cutaneous oncology, this procedure compared to the classic process using paraffin shows a reliability index of 85%
      Today, Mohs surgery is considered the most reliable technique against high risk cutaneous and recurrent tumors. The ability to immediately freeze tumor tissues using horizontal cuts allows the removal of selective tumor tissue giving the patient guarantee of success over other techniques. We have used this technique in over five thousand interventions and call it our star technique.

      The DIC uses extraction most of the time with the “punch” system, which is compatible with other extraction procedures such as “shaving” or excision.

      The methodology is similar to that of Mohs surgery in which the tumor tissue is freezed. A perpendicular cut in the center is also made. The tissue with the problem is tainted for an immediate histological examination. All the remaining material is processed with the conventional paraffin method 5 days later as a dual control. Up to date we have conducted 250 DIC exams in tumoral melanocytic and epithelial pathology as well as inflammatory disease pathology.

      Preliminaty Results

      · The DIC has a reliability index of 90% (±4) in carcinomatous lesions.

      · n melanocytic lesions, although useful in most cases, the problem lies in the possible diagnosis of malignant cutaneous melanoma. The entire tissue must be examined, with sufficient quality, to provide a diagnosis.

      · The DIC allows ruling out other possible diagnoses immediately, while a classical histopathological examination is needed for a definitive diagnosis.

      · In inflammatory pathology, we are in a preliminary phase of material collection, having collected some material.

      Immediate skin cancer diagnosis (DIC)

      null
      Experts in the technology
      null
      Non-therapeutic diagnostic procedure
      null
      Immediate diagnosis (15 minutes)
      null
      Indications: lesions suspected to be a possible tumor
      null
      Reliability: 90%(+-4) in cutaneous carcinomas
      null
      Double check at 5 days
      null
      Not indicated in the diagnosis of melanocytic lesions
      null
      Preliminary phase in inflammatory pathology
      Technique:
      Treatment of skin cancer with Mohs surgery
      A precise, effective, and conservative surgical procedure
      Mohs surgery is one of the most effective treatments currently available for certain types of skin cancer. Thanks to its precision and real-time histological control, it allows the removal of tumor tissue while ensuring maximum preservation of healthy skin. This procedure is usually performed on an outpatient basis, under local anesthesia, with minimal disruption to the patient’s routine.
      Before the intervention:

      Patient preparation

      The patient arrives at the consultation with all the necessary information about therapeutic options, possible side effects, and the intervention protocol. In coordination with their doctor, usual medications are adjusted, and certain drugs are recommended to be avoided in the days prior. Most patients come after having breakfast, and if necessary, a mild anxiolytic is administered for comfort.

      Technique:

      Treatment of skin cancer with Mohs surgery

      A precise, effective, and conservative surgical procedure
      Mohs surgery is one of the most effective treatments currently available for certain types of skin cancer. Thanks to its precision and real-time histological control, it allows the removal of tumor tissue while ensuring maximum preservation of healthy skin. This procedure is usually performed on an outpatient basis, under local anesthesia, with minimal disruption to the patient’s routine.
      Before the intervention:

      Patient preparation

      The patient arrives at the consultation with all the necessary information about therapeutic options, possible side effects, and the intervention protocol. In coordination with their doctor, usual medications are adjusted, and certain drugs are recommended to be avoided in the days prior. Most patients come after having breakfast, and if necessary, a mild anxiolytic is administered for comfort.

      Step-by-step surgical procedure

      Application of local anesthesia

      Anesthetic blocks are applied to ensure a prolonged effect for more than 90 minutes, allowing the intervention to be performed safely and without discomfort for the patient.

      Layered excision

      Mohs surgery is organized in brief phases combining tissue removal with immediate microscope analysis. Each skin layer is examined instantly, allowing highly precise detection of tumor cells.

      Personalized surgical technique

      The tumor is visually and tactilely delineated using tangential lighting and specific dyes to mark visible margins. First, a superficial removal of the affected area (debulking) is performed. Then, a layer of tissue is removed with an angled incision that respects both the epidermis and the tumor base, maintaining a continuous structure for analysis.

      Real-time histological analysis

      The great advantage of this technique is that the entire base and margins of the excised tissue are examined instantly. This is done with very thin sections (5 microns) stained with special dyes such as toluidine blue and processed in a low-temperature cryostat. Thanks to a photographic mapping system, areas with persistent malignant cells can be precisely identified, guiding further excision only where necessary.

      Step-by-step surgical procedure

      Application of local anesthesia

      Anesthetic blocks are applied to ensure a prolonged effect for more than 90 minutes, allowing the intervention to be performed safely and without discomfort for the patient.

      Layered excision

      Mohs surgery is organized in brief phases combining tissue removal with immediate microscope analysis. Each skin layer is examined instantly, allowing highly precise detection of tumor cells.

      Personalized surgical technique

      The tumor is visually and tactilely delineated using tangential lighting and specific dyes to mark visible margins. First, a superficial removal of the affected area (debulking) is performed. Then, a layer of tissue is removed with an angled incision that respects both the epidermis and the tumor base, maintaining a continuous structure for analysis.

      Real-time histological analysis

      The great advantage of this technique is that the entire base and margins of the excised tissue are examined instantly. This is done with very thin sections (5 microns) stained with special dyes such as toluidine blue and processed in a low-temperature cryostat. Thanks to a photographic mapping system, areas with persistent malignant cells can be precisely identified, guiding further excision only where necessary.
      Immediate reconstruction after Mohs surgery
      Oncological precision, minimal invasion, and maximum aesthetic recovery
      Once the Mohs surgery procedure is completed and total tumor removal is confirmed, reconstruction of the treated area is performed. This stage is essential to ensure not only functionality but also the most aesthetically satisfactory outcome, especially in visible areas such as the face.

      Confirmation of tumor removal

      When histological analysis in the final phase shows no malignant cells, it confirms that the skin cancer treatment has been successful. This technique offers cure rates above 97% in primary basal cell carcinomas and around 93% in recurrent tumors previously treated by other methods.

      Specialized microscopic evaluation

      The precision of this treatment largely depends on correct histological interpretation of fresh tissue. Therefore, it is essential that the analysis is performed by a dermatopathologist experienced with these types of samples, capable of distinguishing normal structures from potential histological mimics that could lead to diagnostic errors (false positives or negatives).

      Immediate reconstruction after Mohs surgery

      Oncological precision, minimal invasion, and maximum aesthetic recovery
      Once the Mohs surgery procedure is completed and total tumor removal is confirmed, reconstruction of the treated area is performed. This stage is essential to ensure not only functionality but also the most aesthetically satisfactory outcome, especially in visible areas such as the face.

      Confirmation of tumor removal

      When histological analysis in the final phase shows no malignant cells, it confirms that the skin cancer treatment has been successful. This technique offers cure rates above 97% in primary basal cell carcinomas and around 93% in recurrent tumors previously treated by other methods.

      Specialized microscopic evaluation

      The precision of this treatment largely depends on correct histological interpretation of fresh tissue. Therefore, it is essential that the analysis is performed by a dermatopathologist experienced with these types of samples, capable of distinguishing normal structures from potential histological mimics that could lead to diagnostic errors (false positives or negatives).

      Key benefits of Mohs surgery

      Maximum therapeutic efficacy

      It is the treatment with the highest cure guarantees for skin carcinomas, thanks to immediate microscopic control and the possibility of acting only where tumor cells persist.

      Preservation of healthy tissue

      Thanks to its millimetric approach, it allows removing only the affected tissue while preserving as much healthy skin as possible. This is particularly important in functionally or aesthetically sensitive areas.

      Careful aesthetic reconstruction

      Once the tumor is removed, the area is repaired with surgical techniques adapted to each case: from simple closures to more complex flaps or grafts. The goal is to minimize scar visibility and restore harmony to the treated area.

      Key benefits of Mohs surgery

      Maximum therapeutic efficacy

      It is the treatment with the highest cure guarantees for skin carcinomas, thanks to immediate microscopic control and the possibility of acting only where tumor cells persist.

      Preservation of healthy tissue

      Thanks to its millimetric approach, it allows removing only the affected tissue while preserving as much healthy skin as possible. This is particularly important in functionally or aesthetically sensitive areas.

      Careful aesthetic reconstruction

      Once the tumor is removed, the area is repaired with surgical techniques adapted to each case: from simple closures to more complex flaps or grafts. The goal is to minimize scar visibility and restore harmony to the treated area.
      Dr. Pablo Umbert Millet dermatologist and dermatopathologist Barcelona

      Dr. Pablo Umbert Millet

      Director of Instituto Pablo Umbert · Dermatologist and Dermatopathologist

      Dr. Pablo Umbert is one of the leading experts in clinical dermatology, dermatopathology, and Mohs micrographic surgery in Spain. With over 30 years of experience, an international career at the Mayo Clinic and Saint-Louis Hospital in Paris, and more than 100,000 biopsies signed, he remains active as an emeritus professor at Hospital Universitario Sagrat Cor, where he supervises clinical cases and trains new generations of dermatologists.