Dr Steven Goulder Dr Steven Goulder

Procedures & Treatments

Mohs Micrographic Surgery and Reconstruction

Mohs Micrographic Surgery is a highly specialized state-of-the-art procedure for the precise removal of skin cancer. Guided by the microscope, the Mohs surgeon removes the skin cancer as a disc of tissue. This specimen is then mapped and within approximately one-hour, microscope slides are processed and read by the Mohs Surgeon. 100% of the margins (both the deep and surrounding skin edges) are evaluated. No other surgical technique for the removal of skin cancer examines the entire margins of surrounding skin to ensure that the highest cure rate is obtained. If all margins are free of cancer, as examined under the microscope, the resultant skin defect is typically repaired that day. If a focal area demonstrates residual cancer, a second stage is taken only in the area that showed cancer cells, thereby preserving as much healthy tissue as possible. Again microscope slides are made and read by the Mohs surgeon. This process continues until all margins are free of tumor. While every case is unique, Mohs surgery provides a cure rate up to 99% for primary skin cancers (those that have not been treated in the past).


Square Procedure for Melanoma on the Head and Neck

To obtain tumor-free margins of melanomas located on the head and neck can be challenging with standard excision techniques. The “Square” Procedure (also referred to the “Frame” Procedure) more precisely tracks the outer edges of the tumor. A key advantage of this technique over a standard excision is the ability to more accurately evaluate the peripheral margins of the tumor under the microscope. With this technique, a picture frame around the tumor is removed in strips and each frame edge is analyzed under the microscope to aid in obtaining cancer free margins. Each frame is submitted to our off-site pathology laboratory where special analysis can be performed. After this relatively short procedure, under simple local anesthesia, the patient will go home with a bandage covering the wound, while the frame specimens are analyzed. Surgical repair of the defect will take place as soon as all margins are clear of tumor. In some instances, more invasive tumors may require a Multidisciplinary Team approach and this will be coordinated for your convenience and to expedite your care.

Photodynamic Therapy

Photodynamic Therapy (PDT) is a new state-of-the-art in-office procedure for the treatment of larger areas of sun damaged skin that have numerous precancerous lesions called Actinic Keratoses (AKs). A photosensitizing medication (a medication that becomes activated by a light source) is applied to the affected area and allowed to incubate for approximately one hour. The area is then exposed to a safe blue- wavelength-light (the updated new BLU-U) for fifteen minutes, which activates the medicine and treats the precancerous lesions. After treatment, moderate redness and peeling can occur for about one week and is typically proportionate the degree of sun damage of the treated skin. Ultimately, the skin typically appears rejuvenated and the risk of future skin cancers is decreased. This procedure is also FDA cleared to treat moderate inflammatory acne vulgaris and is especially beneficial for those patients who prefer to avoid oral antibiotics.

Skin Exams and Skin Cancer Screening

An annual total body skin exam is an important preventive measure for all patients. These exams are performed in a dignified respectful manner. For your convenience, if a biopsy is recommended it will typically be performed the same day as your skin exam.

Scar Revision and Laser Treatments

Numerous procedures including laser treatments, dermabrasion, injections, soft tissue fillers and surgical scar revision can be performed to ensure optimum cosmetic results and improvements in both new and old surgical scars.

With state-of-the-art light-based technologies, vascular lesions such as broken blood vessels, vascular birthmarks and cherry angiomas can be safely and effectively treated, as can the redness and flushing associated with rosacea.  These light-based treatments are also especially helpful in reducing the red or pink hues of new blood vessel growth that can frequently surround new surgical scars.

Science, medicine and technology combine to diminish tan to brown pigmentation and age spots, rejuvenating the skin of the face, neck, chest, décolletage, arms and hands. FotoFacials performed with the most sophisticated brand new Intense Pulsed Light (IPL) technology dramatically improve lentigines, blotchy pigmentation and redness – all with minimal downtime.  This technology can also be used to permanently reduce excessive unwanted hair growth and hair transferred following reconstructive surgery with skin flaps.

Prior to any laser or light-based treatment, it is paramount that the desired treatment area is carefully examined to ensure that no lesions concerning for skin cancer or pre-malignancy exist.