For any patient dealing with skin cancer, the main priorities are a successful diagnosis of the cancer, followed quickly by the successful removal of the cancer cells. To facilitate the most precise diagnosis, the AboutSkin Dermatology team sends slides out to third-party pathologists who are well-known authorities and specialize specifically in pathology of the skin (dermatopathology). Once a diagnosis of a basal cell carcinoma (BCC) or a squamous cell carcinoma (SCC) is made, there are only about 15 dermatologists in Colorado who are FULL fellowship-trained in the cutting-edge procedure of Mohs surgery. Denver’s Dr. Joel Cohen is one such accomplished and well-published physician, trained by the accredited American College of Mohs Surgery, which offers one- to two-year training programs.
Dr. Cohen performs Mohs surgery at our Greenwood Village medical dermatology office in the heart of the Denver Tech Center and has published more than 255 articles (many of which are on skin cancer and reconstruction) and three academic textbooks. He has lectured all over the world on Mohs surgery and reconstruction of skin cancer defects, as well as scar minimization strategies with laser resurfacing.
Known as “Mohs micrographic surgery,” this highly specialized technique involves Dr. Cohen taking a thin slice of tissue from the treatment area, then closely examining it under a microscope. If he finds cancer cells, he takes another slice—always moving in the direction where the malignancy is detected. In this way, he can work his way precisely to the tumor’s border, stopping only when there are clear margins (meaning no cancer cells are visible).
Mohs surgery differs from the traditional form of excision in a few ways. Traditional excision involves removing a tumor and a generous amount of surrounding tissue. This has long been an established method, but the tissue is literally sectioned like “slices of bread”—so in between the slices, the tissue edges are not visualized, and a tumor can be missed. Mohs surgery takes a narrower margin, as it processes the skin with a much more complete margin analysis (much like looking at a wrapper of a chocolate candy), so Mohs can have a better chance of precisely removing residual cancer than traditional excision. Mohs surgery is thus a more conservative treatment designed to remove the cancer while leaving more of the surrounding healthy tissue intact.
Mohs allows for the viewing of almost 100 percent of the margins of a lesion (much like viewing the entire crust of a pie, including the sides and bottom), which is not possible with traditional excision (where, as noted above, bread-loaf slices of tissue generate a higher risk of missing an intervening tumor between those slices).
In addition, Mohs surgery allows for frozen section microscopic evaluation of excised tissue, accelerating the process so the patient can literally wait in the office for the tissue to be processed.
With a more complete margin analysis and precision, studies show Mohs surgery can have up to a 99-percent cure rate for new cancers (such as basal cell carcinoma), and a 90- to 95- percent cure rate for recurring cancers.
Removing a cancerous tumor is obviously the top goal of any treatment. That said, many patients also desire for the surgery to make as minimal a cosmetic impact as possible, especially if the cancerous lesion is on the face.
Not only does Mohs surgery maximize border analysis and minimize taking adjacent normal skin, it also allows for same-day reconstruction of the skin cancer defect in many cases. Dr. Cohen has extensive training in reconstruction of skin cancer defects through his rigorous FULL fellowship with the American College of Mohs Surgery, and he also rotated through plastic surgery for several months with his internship in general surgery, and subsequently in his residency and fellowship programs.
Dr. Cohen has been performing Mohs surgery in Denver since 2001, treating and reconstructing hundreds of cases each year. Through this experience, Dr. Cohen has lectured regularly at dermatology and skin cancer meetings throughout the world. Dr. Cohen has co-edited a facial skin cancer reconstruction textbook (published by Blackwell-Wiley) and has published many scientific articles/chapters about skin cancer surgery and reconstruction.
Dr. Cohen’s training through the American College of Mohs Surgery was more comprehensive and academic than surgeons who may have trained through societies. Although Mohs surgery training is available in very condensed courses, it is only through a full American College of Mohs Surgery fellowship that a physician is guided through at least 500 cases of supervision over a one- to two-year period.
Dr. Cohen received his extensive training through the American College of Mohs Surgery, studying the removal of skin cancer, histologic evaluation of skin cancer tissue, and reconstruction of the defect in the skin. He is also trained in the most innovative strategies for scar minimization techniques and has published important articles on combination laser treatment of skin cancer scars.
As director of AboutSkin Dermatology, the nationally renowned Dr. Cohen oversees the practice.READ MORE
Dr. Stoler has provided medical and surgical services at AboutSkin Dermatology since 2011.READ MORE
Dr. Ho joined AboutSkin Dermatology in 2012, and provides medical and surgical services.READ MORE
Dr. Fettig came to AboutSkin in 2019 after completing her Boston University residency.READ MORE