Advanced Dermatologic Surgery Blog & Resources

Understanding Surgical Dermatology: Your Complete Guide to Skin Procedures

Tue, 28 Apr 2026 05:00:00 GMT

When your skin health requires more than topical treatment, surgical dermatology provides precise, evidence-based solutions designed to treat both medical and cosmetic skin concerns with accuracy and care.

At Advanced Dermatologic Surgery, a national referral center for melanoma and high-risk skin cancer located in Overland Park, Kansas, patients receive specialized care from Dr. Thomas L. Hocker—a triple board-certified dermatologist, dermatopathologist, and Mohs micrographic and reconstructive surgeon.

This guide is designed to help patients and referring providers understand:

What surgical dermatology is
Which procedures may be recommended
Who is an appropriate candidate
What to expect before, during, and after treatment

Our goal is simple: deliver exceptional outcomes through precision, safety, and patient-centered care.

What Is Surgical Dermatology?

Surgical dermatology is a highly specialized field focused on diagnosing and treating skin conditions through procedural and surgical techniques. It extends beyond routine dermatologic care to address:

Skin cancers, including melanoma, basal cell carcinoma, and squamous cell carcinoma
Precancerous lesions such as actinic keratoses
Benign growths including cysts, lipomas, and atypical moles

Unlike general surgery, dermatologic surgery is performed by physicians with advanced expertise in the structure, function, and healing properties of the skin. This specialization allows for:

Greater surgical precision
Tissue preservation
Improved cosmetic outcomes
Evidence-based decision-making on when surgery is appropriate

At Advanced Dermatologic Surgery, treatment decisions are guided by both clinical excellence and a commitment to individualized care.

Common Surgical Dermatology Procedures

1. Mohs Micrographic Surgery

Mohs surgery is the gold standard for treating basal cell carcinoma and squamous cell carcinoma. This technique involves removing cancer layer by layer with immediate microscopic evaluation until all cancer cells are eliminated.

Patients choose Mohs surgery because it offers:

The highest cure rates (up to 99% for primary tumors)
Maximum preservation of healthy tissue
Real-time margin control
Ideal outcomes for cosmetically sensitive areas such as the face, ears, and hands

2. Skin Excision

Skin excision is used to remove both malignant and benign lesions, including melanoma, cysts, and atypical moles. The lesion is removed along with a margin of surrounding tissue and closed with precise suturing techniques.

This approach allows for:

Complete removal and diagnosis
Effective treatment of deeper or more aggressive lesions
Single-visit procedural care in most cases

3. Skin Biopsy

A biopsy is often the first step in diagnosing a skin condition. A small sample of skin is removed and analyzed to determine the nature of a lesion.

Types of biopsy include:

Shave biopsy for superficial lesions
Punch biopsy for deeper skin conditions
Excisional biopsy for complete lesion removal

4. Reconstruction and Repair

Following skin cancer removal, reconstruction may be necessary to restore both function and appearance.

Advanced techniques include:

Local flaps using adjacent skin
Skin grafts from donor sites
Precision linear closure
Natural healing through second-intention when appropriate

Dr. Hocker’s combined expertise in surgery and pathology allows for comprehensive, single-episode care with optimal aesthetic outcomes.

5. Electrosurgery and Curettage

This minimally invasive procedure removes superficial lesions using a curette followed by controlled electrical energy to eliminate residual cells and achieve hemostasis.

It is often used for:

Low-risk skin cancers
Benign lesions
Areas where rapid treatment is appropriate

6. Cryosurgery

Cryotherapy uses liquid nitrogen to destroy abnormal or precancerous skin cells.

Common indications include:

Actinic keratoses
Warts
Superficial lesions

This treatment is quick, effective, and requires minimal downtime.

Who Should Consider Surgical Dermatology?

You may benefit from evaluation at Advanced Dermatologic Surgery if you have:

A confirmed or suspected skin cancer diagnosis
A changing or irregular mole
Persistent or unusual skin growths
A history of significant sun exposure or prior skin cancer
Genetic risk factors for skin malignancy

Even when surgery is not required, expert evaluation ensures that the right treatment plan is chosen at the right time.

What to Expect During Your Visit

Consultation

Your visit begins with a comprehensive evaluation, including medical history, skin examination, and discussion of treatment options. Every recommendation is based on clinical evidence and individualized patient goals.

Procedure

Most procedures are performed under local anesthesia in a state-of-the-art surgical suite. Patients remain comfortable and awake throughout.

Mohs surgery may take a full day due to its staged approach, ensuring complete cancer removal.

Recovery

Patients receive detailed post-operative instructions to support optimal healing. Follow-up care includes:

Suture removal (if applicable)
Pathology review
Long-term skin monitoring

Why Choose Advanced Dermatologic Surgery?

Patients and referring physicians trust Advanced Dermatologic Surgery for:

Expertise of Dr. Thomas L. Hocker, one of the few physicians with triple board certification in dermatology, dermatopathology, and Mohs surgery
A national reputation in melanoma and high-risk skin cancer treatment
On-site pathology for immediate and accurate diagnosis
Advanced reconstructive techniques for superior cosmetic outcomes
A patient-first approach focused on education, transparency, and trust

Frequently Asked Questions

Take the Next Step

Your skin health deserves expert care backed by precision and experience. Whether you have a diagnosis, a concern, or simply want clarity, our team is here to help.

Schedule your consultation today:
www.advanceddermatologicsurgery.com

Medical Disclaimer: This content is for educational purposes only and does not replace professional medical advice. Always consult a qualified healthcare provider regarding your specific condition.

About the Author

7 Sun Protection Mistakes That Increase Your Skin Cancer Risk

Tue, 21 Apr 2026 05:00:01 GMT

Most people believe they are protecting their skin.

In reality, small mistakes significantly increase long-term damage and cancer risk.

At Advanced Dermatologic Surgery, Dr. Thomas LH Hocker sees the consequences of these mistakes every day.

Here are the most common ones.

1. Applying Too Little Sunscreen

Most people use only 25 to 50 percent of the recommended amount.

Correct use
One ounce for the body
Nickel-sized amount for the face

Anything less reduces effectiveness dramatically.

2. Not Reapplying

Sunscreen breaks down after about two hours of UV exposure.

If you are outdoors, reapplication is not optional.

3. Relying on Sunscreen Alone

Even perfect sunscreen use does not provide complete protection.

You need additional layers like clothing and hats.

4. Wearing the Wrong Type of Clothing

Regular summer clothing often provides far less UV protection than expected.

UPF-rated clothing offers consistent and measurable protection.

5. Wearing a Baseball Cap Instead of a Wide Brim Hat

Baseball caps protect only the nose.

They leave the ears, cheeks, and neck exposed—areas where skin cancer frequently develops.

6. Ignoring Preventive Supplements

Nicotinamide has been shown to reduce the incidence of non-melanoma skin cancers in high-risk individuals.

Yet many patients have never heard of it.

7. Assuming Your Skin Tone Protects You

Skin cancer affects all skin types.

In darker skin tones, melanoma is often diagnosed later and at more advanced stages.

What These Mistakes Have in Common

They all come down to incomplete protection.

Small gaps repeated over years lead to cumulative damage.

What to Do Instead

Adopt a layered approach
Use mineral sunscreen daily
Wear UPF clothing when outdoors
Choose wide-brim hats
Consider supplements if high risk

Prevention is not about one product—it is about a system .

About the Author

The Best Sun Protection Strategy According to a High-Volume Skin Cancer Surgeon

Mon, 13 Apr 2026 15:59:40 GMT

Most people think sunscreen is enough. It’s not.

If you want real protection against skin cancer and premature aging, you need a layered strategy—one that addresses ultraviolet exposure from multiple angles.

At Advanced Dermatologic Surgery, Dr. Thomas LH Hocker teaches a four-layer approach to sun protection based on both scientific evidence and high-volume clinical experience.

The Four Layers of Effective Sun Protection

Layer 1 Mineral Sunscreen

Zinc oxide sunscreen with SPF 30 or higher forms the foundation. It provides broad-spectrum protection against UVA and UVB rays and should be applied to all exposed skin. Reapply every two hours and after sweating or swimming.

Layer 2 Sun Protective Clothing

UPF 50-plus clothing blocks more than 98 percent of UV radiation. Unlike sunscreen, it does not wear off. Blended fabrics provide better protection than standard cotton garments.

Layer 3 Wide Brim Hat

A brim of at least 3 inches protects high-risk areas like the nose, cheeks, ears, and neck. Baseball caps leave these areas exposed.

Layer 4 Oral Supplements

For patients at higher risk, nicotinamide 500 mg twice daily may help reduce the risk of non-melanoma skin cancers. Polypodium leucotomos extract may provide additional antioxidant support.

Why Layering Matters

No single method provides complete protection.

Even in well-controlled studies, sunscreen alone reduced melanoma risk by about 50 percent—not 100 percent. Combining multiple methods significantly improves outcomes.

Real-World Insight from Surgical Experience

Dr. Hocker has performed more than 23,000 Mohs surgeries, including over 2,400 melanoma cases. That level of experience reveals patterns most clinicians never see.

He sees exactly where skin cancers develop—and why.

The most common locations

Ears
Cheeks
Nose
Neck

These are also the areas most often left unprotected.

The Bottom Line

If you are relying on sunscreen alone, you are under-protected.

A complete sun protection strategy includes

Sunscreen
Protective clothing
A wide-brimmed hat
Targeted supplementation when appropriate

That combination dramatically reduces your long-term risk.

About the Author

How Many Melanoma Mohs Cases Does Your Surgeon Perform Each Year? Why Volume Matters

Thu, 19 Mar 2026 10:15:00 GMT

Surgical volume is one of the strongest predictors of melanoma recurrence after Mohs micrographic surgery. According to a 2021 study in JAMA Dermatology by Cheraghlou et al., patients treated at high-volume facilities had significantly improved long-term survival compared to low-volume centers — yet 90% of facilities performing Mohs for melanoma treat fewer than 8 cases per year. At Advanced Dermatologic Surgery — a national referral center for melanoma and high-risk skin cancer located in Overland Park, Kansas — Dr. Thomas L.H. Hocker, M.D., M.Phil. performs 300 melanoma Mohs cases annually, exceeding the published volume of every academic medical center in the peer-reviewed literature. Dr. Hocker is triple board-certified in dermatology, dermatopathology, and Mohs and reconstructive surgery — one of fewer than 30 physicians worldwide with this credential combination and the first African-American male in U.S. history to achieve this distinction. As an Iron Surgeon lecturer at the American College of Mohs Surgery and a Harvard Medical School graduate trained at Mayo Clinic (renowned for facial plastic surgery excellence), he brings a combination of surgical volume, training, and outcomes unmatched in the published literature.

Why Does Surgical Volume Matter for Melanoma Mohs Surgery?

Higher surgical volume correlates directly with better melanoma outcomes. A 2021 study in JAMA Dermatology by Cheraghlou et al. analyzed 4,062 patients across 462 facilities and found that treatment at high-volume centers was associated with significantly improved long-term survival after Mohs surgery for invasive melanoma.

The reason is straightforward: melanoma is among the most technically difficult cancers to track under a microscope. Unlike basal cell or squamous cell carcinoma, melanoma cells can appear nearly identical to normal skin cells on standard frozen sections. Identifying "skip areas" — where melanoma extends beyond visible margins — requires pattern recognition sharpened by thousands of cases.

The Cheraghlou study defined the top decile of facility volume as ≥8 melanoma Mohs cases per year. Dr. Hocker performs 300 — nearly 38 times that threshold. This volume of repetition refines the visual interpretation skills that separate complete tumor clearance from missed margins.

How Does Dr. Hocker's Volume Compare to the Leading Academic Centers?

No published single-practitioner volume in the peer-reviewed literature matches Dr. Hocker's 300 melanoma Mohs cases per year. The table below compares his annual institutional volume (AIV) to every major published melanoma Mohs center worldwide.

Sources: Valentín-Nogueras et al., Dermatol Surg, 2016; Etzkorn et al., JAAD, 2015; Cheraghlou et al., JAMA Dermatol, 2021; Beal et al., JAAD, 2023; Nosrati et al., JAMA Dermatol, 2017; Trischman et al., JAAD Int, 2024

The only practices approaching Dr. Hocker's volume — Mayo Clinic and Zitelli & Brodland Clinic–have long been considered the world's two most experienced melanoma Mohs centers.

About the Author

Mohs vs Plastic Surgery

Wed, 11 Mar 2026 15:58:56 GMT

Do Mohs Surgeons or Plastic Surgeons Perform Better Facial Reconstruction After Skin Cancer Removal?

Mohs micrographic surgeons perform approximately 75% of all facial reconstructive procedures in the United States and achieve infection rates five to eight times lower than hospital-based surgery. According to Dr. Thomas L. Hocker, M.D., M.Phil ., a triple board-certified Mohs surgeon at Advanced Dermatologic Surgery , a national referral center for melanoma and high-risk skin cancer in Overland Park, Kansas, surgical outcomes are driven primarily by procedure volume rather than specialty title. Mohs surgeons perform facial repairs daily, often completing 10–15 facial reconstructions per day.

This analysis reviews Medicare data, infection rate studies, and blinded cosmetic outcome trials to address a common patient question:

Should facial reconstruction be performed by the Mohs surgeon, or should patients be referred to a plastic surgeon?

Who This Article Is For

Patients diagnosed with facial skin cancer who are evaluating reconstruction options
Individuals seeking to understand differences between Mohs and plastic surgery reconstruction
Referring physicians assessing appropriate reconstruction pathways for their patients

Key Takeaways

Mohs surgeons perform 75.3% of all facial reconstructive procedures in cosmetically sensitive areas, based on 2023 Medicare data.
Published Mohs surgery infection rates range from 0.7% to 2.0%, depending on anatomic site and risk factors. Hospital-based procedures report infection rates between 2.5% and 8.7%.
Advanced Dermatologic Surgery maintains an infection rate of 0.43% by performing reconstructions in an AAAHC-certified ambulatory surgery center under sterile operating room conditions and local anesthesia.
Dr. Hocker performs 22 paramedian forehead flaps annually, more than double the volume of most facial plastic surgeons.
Blinded studies demonstrate no statistically significant difference in cosmetic outcomes between Mohs surgeons and plastic surgeons for facial reconstruction.
Same-day reconstruction by the excising surgeon reduces information loss, lowers wound-care burden, and decreases the total cost of care.

Who Performs the Majority of Facial Reconstruction in the United States?

A 2023 Medicare analysis found that Mohs surgeons performed 75.3% of all cutaneous reconstructions in cosmetically and functionally sensitive areas, including the face, ears, nose, lips, and eyelids. Earlier Medicare data from 2004–2009 showed dermatologic surgeons accounted for:

75.1% of complex repairs
60.8% of intermediate repairs
55.5% of local tissue rearrangements
57.5% of full-thickness skin grafts

Why Surgical Volume Matters

The volume–outcome relationship is well established in surgical literature. Surgeons who perform procedures more frequently demonstrate lower complication rates, shorter operative times, and greater technical precision. A Mohs surgeon performing 10–15 facial reconstructions per day gains more experience in one month than many surgeons accumulate in an entire year.

The Paramedian Forehead Flap: The Gold Standard for Nasal Reconstruction

The nose is the central focal point of the face, making nasal reconstruction one of the most demanding tasks in facial surgery. The paramedian forehead flap is widely regarded as the gold standard for large or complex nasal defects due to its superior tissue match, vascular reliability, and reconstructive versatility.

A 2024 national survey found that over 60% of facial plastic surgeons perform 10 or fewer forehead flaps annually, while Dr. Hocker performs 22 per year, reflecting his high-volume referral practice for complex skin cancer reconstruction.

Safety: Outpatient Mohs Surgery vs. Hospital-Based Reconstruction

Outpatient Mohs surgery demonstrates significantly lower infection rates than hospital-based reconstruction. Published studies report Mohs surgery infection rates between 0.7% and 2.0%, compared with 2.5% to 8.7% for hospital-based procedures.

At Advanced Dermatologic Surgery , reconstructions are performed in a sterile ambulatory surgery center under local anesthesia, avoiding hospital-acquired organisms and the infection risks associated with general anesthesia. This model supports an exceptionally low infection rate of 0.43%.

Cosmetic Outcomes: Mohs Surgeons vs. Plastic Surgeons

Blinded clinical studies consistently show no statistically significant difference in cosmetic outcomes between Mohs surgeons and plastic surgeons. Scar quality is determined by surgical technique, tissue handling, wound tension management, and patient healing factors—not by specialty designation alone.

Advantages of Same-Surgeon Reconstruction

When the same surgeon performs both cancer removal and reconstruction, continuity of care is preserved. This approach:

Eliminates information loss between providers
Reduces the need for multiple visits
Lowers overall costs
Avoids prolonged open wound care

When Referral Is Appropriate

Referral to another specialist may be appropriate for:

Extremely large defects
Cases requiring bone or cartilage replacement
Free tissue transfer
Situations requiring general anesthesia
Patient preference after informed discussion

These decisions should be based on clinical complexity, not assumptions about specialty superiority.

Skin Cancer After Organ Transplant | Advanced Dermatologic Surgery

Wed, 25 Feb 2026 16:47:35 GMT

Skin Cancer After Organ Transplant: What Every Recipient Should Know

If you’ve had an organ transplant, your risk of developing skin cancer—especially squamous cell carcinoma (SCC)—is dramatically higher than average. Research shows transplant recipients may develop SCC at 65 to 250 times the rate of the general population due to long-term immunosuppressive medications.

At Advanced Dermatologic Surgery, Dr. Thomas Hocker specializes in caring for high-risk patients, including organ transplant recipients. When skin cancer is detected early, outcomes are excellent—but early detection requires more frequent skin exams, often every 3–6 months, not just once a year.

For transplant patients, skin cancer screening is not optional—it’s an essential part of lifelong care. Working with a dermatologist experienced in transplant-related skin cancer can significantly reduce complications and improve long-term outcomes.

Medically reviewed: December 2025

About the Author

Squamous Cell Carcinoma After Transplant

Wed, 18 Feb 2026 20:44:31 GMT

Why Squamous Cell Carcinoma Is the Greatest Skin Cancer Threat After Transplant

In the general population, basal cell carcinoma is the most common skin cancer. After an organ transplant, that pattern changes. Squamous cell carcinoma becomes more common—and more dangerous.

Transplant recipients often develop multiple SCCs over time, increasing the risk of spread to lymph nodes or other organs. This is why Mohs micrographic surgery is recommended for high-risk tumors. Mohs surgery allows for complete margin evaluation and the lowest recurrence rates—critical for patients who may need repeated treatments.

At Advanced Dermatologic Surgery , transplant patients receive individualized surveillance and treatment plans designed to manage both current cancers and long-term risk.

Medically reviewed: December 2025

About the Author

Skin Cancer After Organ Transplant: What Your Transplant Team May Not Have Told You

Mon, 29 Dec 2025 21:42:51 GMT

The Short Answer

If you've had an organ transplant, your risk of developing skin cancer—especially squamous cell carcinoma—is 65 to 250 times higher than the general population. This isn't a typo. It's one of the most dramatic cancer risk increases in all of medicine. Yet, many transplant recipients don't hear about it until they're sitting in a dermatologist's office with their first skin cancer.

The same anti-rejection medications keeping your organ alive are also suppressing the immune system that would normally destroy abnormal skin cells before they become cancerous.

The good news: when caught early, these cancers are highly curable. With the right specialist and a tailored surveillance plan, you can stay ahead of them.

If you've had a transplant, you need regular skin checks with a dermatologist who understands transplant skin cancer—ideally every 3-6 months, not just once a year.

Key Takeaways

Your risk is real and substantial.
Transplant recipients develop squamous cell carcinoma at 65–250 times the rate of the general population—making skin cancer the most common malignancy after transplant.
The ratio flips .
In most people, basal cell carcinoma outnumbers squamous cell carcinoma about 4:1. In transplant patients, that reverses to 1:2 or 1:3—and squamous cell is the more dangerous of the two. Risk varies dramatically by organ. Heart and lung recipients face the highest risk (~200×), followed by kidney (~120×), then liver (~30×). The more immunosuppression required, the greater the skin cancer burden. Lifetime risk approaches certainty for many. 70–80% of fair-skinned transplant recipients will develop at least one skin cancer within 20 years.
Mohs surgery is the gold standard for high-risk tumors .
Mohs achieves local recurrence rates of approximately 3%, compared to 8–20% with standard excision—critical for patients who may need dozens of surgeries over a lifetime.
Not all "prevention" strategies work in transplant patients.
Large randomized trials have shown that nicotinamide (Vitamin B3) provides no benefit for transplant recipients, despite helping the general population.
Specialized screening saves lives.
Transitioning from annual skin checks to 3–6-month surveillance with a transplant-experienced dermatologist can mean the difference between removing a small spot and treating metastatic disease.

What You'll Learn in This Article

By the end of this article, you'll understand:

How much your skin cancer risk increases after transplant—and why
Which organs and medicationscarry the greatest danger
Why squamous cell carcinomabecomes your primary threat
How Mohs surgery and field therapies fit into a long-term management strategy
What national guidelines actually recommend for transplant recipients
The exact steps you should take next to protect yourself

You're a Transplant Recipient Reading This...

First, take a breath.

Learning about this risk can feel overwhelming—especially if you're years post-transplant and no one ever mentioned it. You might be thinking

"Why didn't my transplant team tell me this earlier?"

"Have I already missed something?"

Here's what I want you to know: awareness is the first step, and it is never too late to start proper surveillance. The fact that you're reading this means you're already taking your health seriously.

The decisions in front of you are actually straightforward:

Find a dermatologist who understands transplant skin cancer. Not every dermatologist has training in this subspecialty. Look for someone familiar with ITSCC (International Transplant Skin Cancer Collaborative) guidelines and high-risk patient management.

Get on a screening schedule that matches your risk . For many transplant recipients—especially fair-skinned patients and thoracic (heart/lung) recipients—this means every 3–6 months, not once a year.

Learn to recognize warning signs. You see your skin every day. A spot that's growing, bleeding, crusting, or not healing after a few weeks deserves prompt attention.

Don't panic about every bump —but don't ignore persistent changes either. Part of my job is teaching you which spots are "noise" and which are signals we act on immediately.

The path forward is manageable. It just requires the right team and the right approach.

What I See in My Practice

I trained at Mayo Clinic in Rochester, Minnesota, under Dr. Clark Otley —one of the world's foremost authorities on transplant dermatology. Mayo has one of the largest transplant dermatology specialty clinics anywhere, caring for an enormous population of organ transplant recipients. That experience permanently changed how I practice medicine.

Last spring, a 58-year-old kidney transplant recipient drove four hours from rural Missouri to see me at Advanced Dermatologic Surgery. He'd had his transplant eleven years earlier. In all that time:

His nephrologist had checked his creatinine and immunosuppressant levels meticulously
His primary care doctor monitored his blood pressure and cholesterol religiously
No one had ever done a full-body skin exam

On his first visit, I found 14 actinic keratoses (precancers), 3 squamous cell carcinomas, and one lesion on his ear that had already invaded deeply—flirting with his lymphatic system. We caught that ear tumor just before it spread to his lymph nodes.

Stories like his are why I do what I do.

My path to becoming a transplant skin cancer specialist has been shaped by a simple conviction: the more I learn, the more good I can do for patients facing difficult diagnoses.

I was blessed to begin my medical journey at Yale, where I studied biology and developed a deep curiosity about how the body works at the molecular level. A Churchill Fellowship gave me the opportunity to study organic chemistry at Cambridge University in England, which opened my eyes to the broader world of scientific inquiry. At Harvard Medical School , I had the privilege of conducting melanoma research under Dr. Hensin Tsao —an experience that taught me how much we still don't understand about skin cancer biology, and how much that knowledge matters for patients.

After medical school, I completed my internship at Santa Clara Valley Medical Center (Stanford's affiliated county hospital), where I learned to care for underserved populations. I then returned to Mayo Clinic for my dermatology residency—drawn back by the culture of putting patients first. I pursued further subspecialty training with a dermatopathology fellowship at the University of Michigan , home to one of the world's largest melanoma specialty centers. There, I developed expertise in rare tumors that would later prove invaluable. I then completed a second fellowship back at Mayo Clinic in Mohs micrographic surgery and facial reconstruction, where I was fortunate to train under Dr. Clark Otley and the transplant dermatology team. Dr. Otley became a mentor and showed me what truly dedicated care for transplant patients looks like.

Each stop taught me something I couldn't have learned anywhere else. Harvard gave me research depth. Michigan gave me rare tumor expertise. Mayo gave me transplant dermatology and the philosophy that patients deserve unhurried, thoughtful care from physicians who never stop learning.

What drives me now is bringing everything I've learned back to the Kansas City area. At Advanced Dermatologic Surgery , I work alongside an exceptional team—nurses, medical assistants, and histotechnologists who share my commitment to treating every patient the way we believe they deserve to be treated. We've built something special here: a place where transplant patients from across Kansas, Missouri, Nebraska, and the broader Midwest can receive truly world-class care without traveling to a distant academic medical center.

I'm a member of the International Transplant Skin Cancer Collaborative (ITSCC) , which allows me to stay connected with colleagues worldwide who are equally dedicated to this patient population. I also serve as founding division chief of dermatologic surgery at the University of Missouri-Kansas City and University Health , where I have the privilege of training the next generation of dermatologists to care for complex patients.

I've been humbled to receive recognition including the Castle Connolly Top Doctor designation (2024, 2025) and the Ingram's Top Doctor Award (2025) . But honestly, what matters most isn't the awards—it's knowing that the training I've been blessed to receive translates into better outcomes for the patients who trust us with their care.

What the Evidence Says

How Much Does Your Risk Increase?

The numbers are staggering.

A landmark 2011 analysis in JAMA by Engels and colleagues examined the entire U.S. transplant registry and found that solid organ transplant recipients have a 65 to 250-fold increased risk of squamous cell carcinoma compared to the general population.

For perspective: smoking increases lung cancer risk by about 15–30 fold. Your post-transplant skin cancer risk dwarfs most other known cancer risk factors in medicine.

A 2017 study in JAMA Dermatology by Garrett et al. confirmed this in U.S. patients:

Population SCC Incidence (per 100,000 person-years)

General population ~3–5

Transplant recipients ~812

That's more than a 200-fold difference in absolute incidence.

Why Squamous Cell Becomes the Dominant Threat

In people with normal immune systems, basal cell carcinoma (BCC) is far more common than squamous cell carcinoma (SCC)—roughly 4:1.

After transplant, that ratio reverses to 1:2 or 1:3, with SCC dominating.

Population BCC:SCC

Ratio General population 4:1 (BCC more common)

Transplant recipients 1:2 to 1:3 (SCC more common)

This matters enormously because SCC is more likely to metastasize than BCC. Early SCC is highly curable, but advanced SCC can spread to lymph nodes and distant organs—and can be fatal.

Risk by Organ Type

Not all transplants carry equal skin cancer risk. L arge registry studies, including Krynitz et al. (2013) in the International Journal of Cancer, demonstrate clear stratification:

Organ Type Approximate SCC Risk vs. General Population

Heart/Lung ~200× increased

Kidney ~120× increased

Liver ~ 30× increased

The difference is driven by immunosuppression intensity. Hearts and lungs are highly immunogenic organs; they demand heavier immunosuppression to prevent rejection, and the skin pays the price.

The "Tumor Burden" Problem

A 2019 meta-analysis in the Journal of the European Academy of Dermatology and Venereology by Genders et al . found something that surprised even researchers:

The metastatic risk of any individual SCC in transplant patients is not dramatically higher than in non-transplant patients with the same stage tumor.

So why is skin cancer mortality still higher in transplant recipients?

Volume .

Many transplant patients develop dozens of SCCs over their lifetime. Some of my highest-risk patients at Advanced Dermatologic Surgery develop 10, 20, even 50+ cancers per year. If each tumor carries a 2–4% metastatic risk, having 50 tumors becomes a statistically brutal game.

This "catastrophic carcinogenesis" is why aggressive surveillance is essential.

Why Your Medications Drive Risk

Your anti-rejection drugs aren't generic "immune suppressors"—some have specific effects on your skin:

Medication Mechanism of Skin Cancer Risk

Azathioprine Acts as a photosensitizer; incorporates into DNA and reacts with UVA to

cause specific cancer-promoting mutations

Calcineurin inhibitors (tacrolimus, cyclosporine) Impair UV damage repair; may prevent damaged cells from undergoing

normal programmed cell death

Voriconazole (antifungal) Dramatically increases photosensitivity; linked to aggressive, rapidly

growing SCCs, especially in lung recipients

For transplant patients, sun protection isn't cosmetic advice—it's part of your medical treatment plan.

Guidelines and Real-World Practice

Multiple major guideline bodies recognize transplant recipients as a distinct high-risk population requiring specialized care:

Guideline Body Key Recommendations

NCCN (v1.2025) Flags immunosuppressed patients as "very high-risk"; recommends Mohs surgery

for high-risk SCCs; more frequent surveillance

AAD (2018) Strong recommendation for Mohs or complete margin assessment in

immunocompromised patients

ITSCC/SCOPE (2019) Defines "high-risk" more strictly in transplant recipients; recommends

dermatology screening within 2 years of transplant for high-risk Caucasian

patients

KDIGO (2020) Recommends annual skin exams; suggests considering mTOR inhibitors for

patients with recurrent skin cancer

Yet in real-world practice, many transplant recipients never see a dermatologist at all. Transplant teams focus—understandably—on organ function: rejection, creatinine, ejection fraction. Skin often gets overlooked.

That gap is exactly what my practice at A dvanced Dermatologic Surgery works to close.

How We Approach This at Advanced Dermatologic Surgery

My clinic in Overland Park has become a regional referral center for transplant patients across the Midwest. Here's our approach to your care:

Comprehensive Baseline Examination

Your first visit includes a meticulous full-body skin exam with detailed assessment of every suspicious lesion. I document everything with high-resolution photography, creating a baseline map to compare against at future visits.

Risk Stratification and Surveillance Schedule

Not every transplant patient needs the same follow-up schedule. I assess your specific risk based on:

Organ type and time since transplant
Immunosuppressive regimen (azathioprine, calcineurin inhibitors, mTOR inhibitors, voriconazole use)
Skin type, sun exposure history, and prior skin cancers

Based on this assessment, we establish a personalized surveillance plan:

Risk Level Typical Surveillance Interval

Very High Risk Every 3 months

High Risk Every 4–6 months

Moderate Risk Every 6–12 months

Lower Risk Annually

Mohs Surgery for High-Risk Tumors

When you develop a skin cancer—especially on the head, neck, hands, or other critical sites—I treat high-risk tumors with Mohs micrographic surgery.

Why Mohs matters for transplant patients:

Feature Mohs Surgery Standard Excision

Margin examined 100% <1%

Recurrence rate ~3% 8–20%

Tissue removed Minimum necessary Wider margins

Same-day clearance Yes Often days for pathology

For patients who may undergo dozens of surgeries over a lifetime, you cannot afford a "cut-and-guess" approach. At Advanced Dermatologic Surgery, I personally examine every margin, ensuring the cancer is completely removed while preserving as much healthy tissue as possible.

Same-Day Reconstruction

My fellowship training at Mayo Clinic included advanced facial reconstruction techniques. After Mohs removes your cancer, I reconstruct the wound the same day—using flaps, grafts, or other methods tailored to preserve both function and appearance.

If you're going to need multiple facial surgeries in your lifetime, reconstruction quality and tissue conservation aren't luxuries—they're essentials.

Field Therapy for Precancerous Damage

Many transplant patients have "field cancerization"—entire zones of precancerous change (actinic keratoses) covering the scalp, face, or forearms. At Advanced Dermatologic Surgery , I use layered strategies including topical 5-fluorouracil and photodynamic therapy to clear these fields and reduce the pipeline of future cancers.

Coordination With Your Transplant Team

When your skin cancer burden becomes severe, I communicate directly with your transplant nephrologist, cardiologist, or pulmonologist to discuss whether medication changes—such as switching to an mTOR inhibitor like sirolimus—could safely reduce your cancer risk without endangering your graft.

These decisions are complex and individualized, but they can be lifesaving for patients with catastrophic carcinogenesis.

What About Prevention?

Strategies That Have Demonstrated Benefit

Acitretin (Systemic Retinoid)

Randomized trials in transplant recipients, including the landmark 1 995 study by Bavinck et al. in the Journal of Clinical Oncology, demonstrate approximately 50% reduction in new SCCs while on therapy.

Limitations:

Benefit disappears quickly after stopping
Side effects: dry skin/lips, elevated lipids, liver enzyme changes
Teratogenic (cannot be used in pregnancy)

Switching to mTOR Inhibitors (Sirolimus/Everolimus)

The TUMORAPA trial (Euvrard et al., 2012, New England Journal of Medicine ) showed approximately 50% reduction in new skin cancers when kidney transplant patients switched to sirolimus.

However, meta-analyses suggest trade-offs including higher cardiovascular events in some patients. This decision must be made carefully with your transplant team, typically reserved for patients with severe, recurring skin cancer burdens.

Rigorous Photoprotection

For transplant patients, sun protection is essential:

Broad-spectrum sunscreen (SPF 30+) every day, year-round
Wide-brimmed hats and UV-protective clothing
Avoiding peak sun hours (10am–4pm)

Think of this as daily medication for your skin, not an optional accessory.

Strategies That Have Not Shown Benefit in Transplant Patients

Nicotinamide (Vitamin B3)

In the general population, nicotinamide reduced new skin cancers by approximately 23% in one Australian trial. However, the Phase 3 ONTRAC trial (Allen et al., 2023, New England Journal of Medicine) —conducted specifically in transplant recipients—found no significant reduction in new skin cancers compared with placebo.

This is critical information. Many transplant patients take nicotinamide based on outdated recommendations. Current high-quality evidence does not support nicotinamide for skin cancer prevention in solid organ transplant recipients. If you're taking it only for this purpose, discuss discontinuation with your physicians.

What You Should Do Next

Find a dermatologist with transplant expertise.
Ask: "How many organ transplant patients do you care for? Are you familiar with ITSCC guidelines ? Do you use Mohs surgery for high-risk tumors?" If you're in the Midwest, my team at Advanced Dermatologic Surgery specializes in exactly this population.
Schedule a comprehensive skin exam.
If you're more than a year post-transplant and haven't had a full-body skin exam, you're overdue.
Establish your surveillance schedule .
Based on your risk factors, your dermatologist should recommend specific intervals—typically every 3–6 months for high-risk patients.
Learn self-examination
Monthly self-checks help catch changes early. Any new, growing, bleeding, or non-healing spot deserves prompt attention.
Communicate with your transplant team.
Ensure they know you're receiving dermatologic surveillance and ask whether any medication adjustments might lower your skin cancer risk.
Treat sun protection as medical therapy .
Sunscreen, hats, protective clothing—every day, automatically.

Frequently Asked Questions

Medically reviewed: December 2025

About the Author

What Is Surgical Dermatology?

Tue, 16 Dec 2025 16:16:38 GMT

Understanding Surgical Dermatology

Surgical dermatology involves precise medical and reconstructive procedures performed on the skin, hair, nails, and surrounding tissues. These procedures are typically used to remove skin cancers, benign growths, cysts, and other lesions while maintaining both function and appearance.

Unlike general surgery, which often takes place in a hospital setting, most dermatologic surgeries are performed safely and comfortably in an outpatient clinic, often under local anesthesia.

At ADS, we specialize in procedures that combine medical excellence with meticulous attention to cosmetic outcomes—helping patients heal well and look natural.

Common Surgical Dermatology Procedures

Our practice offers a comprehensive range of dermatologic surgeries, including:

Mohs Micrographic Surgery
A tissue-sparing technique used to precisely remove skin cancer while preserving as much healthy tissue as possible. It offers the highest cure rate for basal and squamous cell carcinomas.
Reconstructive Surgery
Following skin cancer removal, reconstruction restores both function and aesthetics. Our team tailors each reconstruction plan to minimize scarring and enhance natural appearance.
Excision of Benign Lesions
Moles, cysts, lipomas, and other non-cancerous growths can be removed for comfort, function, or cosmetic reasons.
Scar Revision and Repair
Procedures designed to improve the appearance or function of scars resulting from injury, surgery, or previous treatment.

Why Expertise Matters

Surgical dermatology demands more than just precision—it requires deep understanding of skin biology, cancer behavior, and aesthetic restoration. Dr. Thomas Hocker, is a fellowship-trained, triple-board-certified dermatologist, dermatopathologist, and Mohs & reconstructive surgeon . His training and experience ensure that patients receive comprehensive, evidence-based care from diagnosis through recovery.

Each surgery performed at ADS is supported by a highly trained staff focused on comfort, safety, and continuity of care.

What to Expect From Surgical Dermatology Care

Evaluation & Diagnosis
Each journey begins with a detailed consultation and review of your biopsy or skin concern.
Surgical Treatment
Procedures are performed on-site in our state-of-the-art surgical suites.
Reconstruction (if needed)
We provide reconstruction that restores both form and function with a natural appearance.
Follow-Up & Healing Support
Our team provides clear wound care instructions and ongoing communication with your referring or primary physician to ensure optimal healing.

Why Patients Choose Advanced Dermatologic Surgery

Nationally recognized expertise in Mohs and reconstructive surgery
Personalized, concierge-level care and communication
Seamless coordination with your dermatologist and primary care team
A compassionate environment focused on comfort, education, and long-term skin health

At ADS, surgical dermatology is not just about removing disease—it’s about restoring confidence and peace of mind.

Dr. Thomas Hocker Named to Ingram’s Top Doctors 2025

Tue, 18 Nov 2025 20:30:45 GMT

Celebrating Excellence in Skin Cancer Care in Kansas City

Ingram’s Magazine has released its 2025 Top Doctors: Health Care KC – What Makes It Special feature—honoring the region’s most exceptional physicians. We are proud to share that Thomas Hocker, MD, Medical Director at Advanced Dermatologic Surgery (ADS), has been selected as one of Kansas City’s Top Doctors.

This recognition reflects Dr. Hocker’s unparalleled expertise in Mohs micrographic surgery, melanoma treatment, reconstructive dermatologic surgery, and complex skin cancer management.

About the Award:

The honor is now in its 29th year .
Only about 350 physicians have received this recognition since its inception.
Dr. Hocker is just the fifth dermatologist ever to be named.

This recognition reflects Dr. Hocker’s unparalleled expertise in Mohs micrographic surgery, melanoma treatment, reconstructive dermatologic surgery, and complex skin cancer management.

A Nationally Trained Expert Bringing World-Class Care to Kansas City

Dr. Hocker’s journey is extraordinary—from Yale to Cambridge, Harvard Medical School, Mayo Clinic, and the University of Michigan—leading to triple board certification in:

Dermatology
Dermatopathology
Mohs Micrographic Surgery & Reconstructive Surgery

Very few physicians in the United States hold this combination of training and certifications.

Since joining Advanced Dermatologic Surgery in 2014, Dr. Hocker has performed thousands of Mohs procedures, including high-complexity melanoma surgeries not commonly performed in community settings.

Why Ingram’s Recognition Matters for Kansas City Patients

Ingram’s highlighted Kansas City’s unique mix of compassion, clinical skill, and accessible regional care.

Dr. Hocker embodies these values through:

Exceptional cure rates with Mohs surgery
Precision-guided melanoma treatment
Expert reconstructive outcomes following cancer removal
A patient-centered, compassionate approach
Same-day diagnosis, surgery, and reconstruction for many cases

His inclusion in Ingram’s list reinforces Kansas City as a growing hub for national-level dermatologic oncology.

What Makes Advanced Dermatologic Surgery a Regional Leader?

ADS was designed to provide comprehensive skin cancer care under one roof.
Patients benefit from:

1. Complete Skin Cancer Pathway

Dermatologic evaluation
In-house dermatopathology
Mohs surgery
Reconstructive surgery
Post-operative wound management

2. Expertise Built on High-Volume Mohs Surgery

ADS is one of the highest-volume Mohs centers in the USA, improving:
Accuracy
Efficiency
Outcomes

3. Top 3 worldwide in Mohs Melanoma Expertise

Dr. Hocker treats 300 melanoma cases per year with Mohs surgery. This volume is top 3 worldwide.
ADS is one of the few dermatology practices in the Midwest performing Mohs for melanoma in situ AND early-stage invasive melanoma
Specialized lab techniques
Aesthetic facial reconstruction

4. Patient Convenience

Located in Overland Park/Leawood, ADS gives Kansas City residents access to top-tier skin cancer specialists without requiring travel to academic centers.

A Win for Patients, a Win for Kansas City

Dr. Hocker’s recognition affirms what patients and referring physicians already know:

Kansas City has access to national-caliber Mohs surgeons
ADS provides comprehensive, compassionate, high-precision care
Patients with melanoma or advanced skin cancers can stay close to home
Referring physicians have a trusted partner for complex dermatologic oncology

For Referring Providers

ADS welcomes referrals for:

Melanoma
Basal cell carcinoma
Squamous cell carcinoma
Rare adnexal tumors
Reconstructive dermatologic surgery
Second opinions

We provide fast scheduling, transparent communication, and detailed pathology reports.

Experience the ADS Difference

Dr. Hocker’s inclusion in Ingram’s 2025 Top Doctors list is a celebration of commitment—to surgical excellence, to skin cancer outcomes, and to the Kansas City community.We are honored to continue advancing dermatologic care for the region.

Learn more or schedule an appointment:
www.advanceddermsurgery.com

What Do I Do If I Have Skin Cancer?

Sat, 15 Nov 2025 19:15:00 GMT

Answers, options, and a path forward.

Hearing “You have skin cancer” can feel overwhelming—but you are not alone. With early detection and the right plan, outcomes are overwhelmingly positive. At ADS, Thomas L. Hocker, MD and our team guide you through diagnosis, treatment, reconstruction, and follow‑up with a calm, coordinated approach in our certified ambulatory surgical center. We maintain exceptionally low infection rates and often complete cancer removal and reconstruction the same day.

Step 1: Don’t Panic—Most Skin Cancers Are Treatable

Basal cell and squamous cell carcinomas are commonly slow‑growing and highly curable when treated early. Melanoma requires prompt attention; caught early, it is also highly treatable. Your team will outline a clear plan tailored to your diagnosis.

Step 2: Confirm the Diagnosis

If a spot is suspicious, your dermatologist will perform a biopsy. This quick procedure removes a small sample for microscopic evaluation. Once confirmed, we discuss type, location, size, and depth—the details that drive the safest, most effective treatment.

Step 3: Learn About Your Treatment Options

Treatment depends on the cancer type, location, and size:

Mohs Micrographic Surgery – For many facial or high‑risk sites, Mohs provides highest cure rates with maximum tissue preservation by checking 100% of the margin during surgery.
Standard Excision – Removing the tumor with a margin of normal skin; appropriate for many lesions.
Electrodesiccation & Curettage (ED&C) – Scraping and cauterizing select small, superficial cancers.
Topical medications or radiation – Used in select cases based on diagnosis and patient factors.

At ADS , Dr. Hocker specializes in Mohs and advanced reconstruction. For melanoma in situ and select T1a melanomas in cosmetically sensitive sites, we frequently use Mohs with melanoma immunostaining (e.g., MART‑1) to achieve precise clearance while sparing healthy tissue.

Step 4: Address Reconstruction, If Needed

After cancer removal, some patients need reconstruction to restore both function and appearance. Options include primary closure, local flaps, and skin grafts; complex cases may incorporate cartilage support or staged techniques. At ADS, reconstruction is planned from the start and performed the same day whenever feasible, reducing stress and additional visits. Our triple board‑certified approach unites clinical, pathologic, and surgical insight to aim for durable, natural‑looking results.

Step 5: Prevention and Monitoring

Once you’ve had skin cancer, your risk of another is higher. Protect your skin and keep follow‑up on track:

Daily SPF 30 +, reapply outdoors.
Protective clothing; avoid tanning beds.
Monthly self skin checks and routine professional exams (every 6–12 months, or more often if directed).

Our team provides clear wound‑care guidance, scar‑care tips, and a follow‑up schedule tailored to you. Melanoma Priority Access: treatment ≤30 days; ≤14 days if high‑risk (insurance dependent).

Support Every Step of the Way

At ADS, we treat every patient like family. Thomas L. Hocker, MD is Harvard and Mayo‑trained, triple board‑certified, and among fewer than 30 surgeons worldwide with this distinction. He has performed 2,400+ melanoma Mohs cases (top three worldwide by volume) and serves as Founding Director of Dermatologic Surgery at UMKC . You will have a clear plan, a caring team, and expert hands from diagnosis through healing.

Contact ADS to review your options and move forward with confidence.

Do I Have Skin Cancer? What You Need to Know

Mon, 03 Nov 2025 19:15:00 GMT

Know the signs. Know your next steps.

If you’re unsure about a spot, get it checked . Skin cancer is common, and when detected early, it’s highly treatable. At ADS, Thomas L. Hocker, MD — triple board‑certified , Harvard and Mayo‑trained , and among the top three worldwide by melanoma Mohs volume —provides precise diagnosis and Mohs micrographic surgery when appropriate, often with same‑day reconstruction in our certified ambulatory surgical center . Our exceptionally low infection rates support safe healing.

Common Types of Skin Cancer

Basal Cell Carcinoma (BCC): often a pearly bump, shiny pink growth , or sore that doesn’t heal.
Squamous Cell Carcinoma (SCC): may appear as a rough, scaly patch, firm red bump , or sore that bleeds or crusts.
Melanoma: the most serious type; can arise in an existing mole or a new dark spot with irregular borders, uneven color, or changes over time.

Less common types exist as well; your dermatologist can advise on specific findings.

Warning Signs to Watch For

Use the ABCDE rule for moles (Asymmetry, Border, Color, Diameter, Evolving) and look for non‑healing sores, scaly/rough patches, or bumps that bleed easily . Any rapidly changing spot deserves prompt evaluation.

 Risk Factors

Fair skin, light hair, or light eyes
History of frequent or blistering sunburns
Tanning bed use
Family or personal history of skin cancer
Weakened immune system or certain medications

Organ transplant recipients on immunosuppressive therapy

What to Do If You’re Concerned

Schedule a skin exam with a board‑certified dermatologist .

Biopsy any suspicious lesion for a definitive diagnosis.

Discuss treatment options. For many BCC/SCC and select early melanomas in sensitive sites, Mohs surgery offers the most precise removal with maximum tissue preservation.

At ADS, care is coordinated end‑to‑end —from exam to pathology to same‑day reconstruction when needed—so you can move forward quickly and confidently. Melanoma Priority Access: ≤30 days to treatment, ≤14 days if high‑risk (insurance dependent).

Bottom line: if you’ve wondered, “Do I have skin cancer?”, the safest answer is to be seen . Early detection changes everything. Schedule your skin exam with Dr. Hocker and take the first step toward lifelong skin health.

Mohs vs. Image-Guided Superficial Radiation Therapy (IGSRT): Why Surgery Still Leads for Most Non-Melanoma Skin Cancers

Wed, 15 Oct 2025 19:15:00 GMT

Mohs remains the gold-standard, guideline-preferred option for skin cancer patients.

Short answer: When a patient is a reasonable surgical candidate, Mohs micrographic surgery remains the guideline-preferred, margin-controlled, tissue-sparing treatment with the strongest long-term cure data for basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). IGSRT can be useful when surgery isn’t appropriate, but its evidence base is newer, shorter-term, and lacks histologic margin control. ( Medscape )

1) Mohs gives you real-time, 100% margin assessment

Mohs removes the cancer in thin layers and examines all peripheral and deep margins immediately, repeating until clear—so you know the tumor is out before you leave. Radiation (including IGSRT) cannot provide histologic margin confirmation at the time of treatment. That fundamental difference is why surgery is the preferred approach in major guidelines for most BCC/cSCC. ( Medscape )

2) Best long-term cure rates (with 5-year outcomes)

Mohs consistently reports excellent 5-year control, often cited around ~2–3% overall recurrence for high-risk BCC cohorts, with higher—but still favorable—results in recurrent tumors. These are long-horizon data that matter in cancer care. ( Medical Journals ) By contrast, supportive IGSRT studies are retrospective and typically report shorter follow-up (often 2–4 years). Several recent series report low early recurrence, but the data are still maturing and may include selection and industry-affiliation biases. Short-term “superiority” claims versus Mohs at 2 years don’t replace 5-year histology-verified outcomes. ( PMC )

3) Tissue-sparing + immediate reconstruction

Because Mohs removes only what is cancer while confirming clear margins, it maximizes healthy-tissue preservation—crucial on the eyelids, nose, lips, ears, and hands—and allows same-day reconstruction by the treating surgeon. Radiation can yield good cosmetic results for select lesions, but there’s no immediate histologic endpoint, and late skin changes (atrophy, telangiectasias, pigment changes) can occur. Guidelines continue to favor surgery for cosmetically and functionally critical sites when feasible. ( Medscape )

4) Fewer visits, faster resolution

Mohs is typically a single-day outpatient procedure. IGSRT requires many fractions (commonly over several weeks) to deliver a curative dose. For busy patients—or tumors needing a timely, definitive margin-controlled result—one day often beats dozens of visits. (ASTRO’s practice guideline outlines definitive RT fractionation across 10–30+ sessions.) ( ASTRO )

5) Where IGSRT fits (and where it doesn’t)

Radiation (including IGSRT) is appropriate for patients who cannot or should not undergo surgery, or for specific anatomic/clinical scenarios at the clinician’s discretion. Even radiation-oncology guidance frames RT as a good option when surgery isn’t ideal. Conversely, RT is generally avoided in certain genetic radiosensitivity syndromes (e.g., Gorlin), in previously irradiated fields, in some connective-tissue diseases, and younger patients due to late effects and second-cancer risk. ( ASTRO )

6) What do major guidelines say right now?

NCCN & dermatology guidance: For most localized BCC/cSCC, surgery—preferably with comprehensive intraoperative margin control (i.e., Mohs) in high-risk settings—is the preferred curative modality. RT is a reasonable alternative when surgery is contraindicated or unsuitable. ( Medscape )

ASTRO (radiation oncology) guideline: Defines when RT is appropriate, typical doses/fractionation, and cautions about patient selection—reinforcing RT as one of several tools, not the default first-line when surgery is feasible. ( ASTRO )

Coverage climate: Some Medicare contractors have proposed limited-coverage LCDs and scrutiny around SRT/IGSRT utilization and daily image guidance—highlighting ongoing debate about appropriate use and billing. ( CMS )

Bottom line

If a patient can safely have surgery, Mohs remains the gold-standard, guideline-preferred option for most BCC and cSCC because it proves clearance at the time of treatment, preserves tissue, and has long-term cure data. IGSRT is a valuable tool when surgery isn’t appropriate or is declined—but its evidence base is still catching up and it does not offer histologic margin control. ( Medscape )

Medical note: Treatment should always be individualized by a board-certified dermatologist (often in collaboration with radiation oncology and other specialists). This article is educational and not a substitute for medical advice.

Selected references: NCCN and AAD guidance on BCC/cSCC; ASTRO skin cancer RT guideline; long-term Mohs outcomes; contemporary IGSRT series and reviews. ( NCCN )

The Importance of Self Skin Checks in Detecting Skin Cancer Early

Wed, 15 Oct 2025 18:00:00 GMT

Melanoma Mastery. Mohs Precision. Better Healing.

Skin cancer is the most common cancer in the U.S.—and when detected early, it is also among the most treatable. Dr. Thomas Hocker emphasizes that patients play a key role in their own skin health. A monthly self-skin check takes 10–15 minutes and often leads to earlier diagnosis, less invasive treatment, and better cosmetic outcomes. Combine self-checks with regular professional exams for the strongest protection.

Why Self Skin Checks Matter

Basal cell carcinoma, squamous cell carcinoma, and melanoma often begin as subtle changes . Catching them early can mean a simpler repair and faster recovery . Self-checks complement your dermatologist’s exam; they do not replace it.

How to Perform a Self Skin Check (Step‑by‑Step)

Set a recurring reminder each month. Use a full‑length mirror, a hand mirror, and good lighting. Consider taking reference photos to track changes over time.

Face & scalp

Examine nose, lips, ears (front/back), and hairline. Use a blow‑dryer and hand mirror to part hair for a thorough scalp check.

Hands & nails

Palms, backs of hands, between fingers, and under nails.

Arms & underarms

Include elbows, forearms, and sides of arms; lift arms to view underarms fully.

Torso

Neck, chest, abdomen. Women should check under breasts.

Back & shoulders

Use a hand mirror to inspect upper/lower back, shoulders, and back of the neck. Ask a partner to help if possible.

Legs & feet

Front and back of thighs and calves, ankles, tops and soles of feet, between toes, and under toenails.

What to Look For: The ABCDEs of Melanoma

● A – Asymmetry: one half doesn’t match the other.

● B – Border: irregular, ragged, or blurred edges.

● C – Color: multiple colors or uneven shades.

● D – Diameter: larger than 6 mm (pencil eraser)—though smaller lesions can be concerning if changing.

● E – Evolving: any change in size, shape, color, or symptoms such as bleeding or itching.

Also note the “ugly duckling ” —a spot that looks different from your other moles. For non‑melanoma cancers, watch for persistent red/scaly patches, pearly or shiny bumps, sores that do not heal, or growths that bleed easily.

Partnering With Your Dermatologist

Annual full‑body skin exams for most adults.
More frequent checks if you have fair skin, a history of sunburns, organ transplant/immunosuppression, or prior skin cancer.
Immediate evaluation if you notice anything new, changing, or symptomatic.

At ADS , Mohs surgery and same‑day reconstruction are available on site when needed. Dr. Hocker is Harvard‑ and Mayo‑trained, triple board‑certified , and among the top three worldwide by melanoma Mohs volume (2,400+ cases) . Our exceptionally low infection rates reflect careful technique and thorough after‑care. We treat every patient like family.

Take charge of your skin health. Do your monthly self-check and schedule your professional exam with Dr. Hocker.

Why More Mohs Surgeries at Advanced Dermatologic Surgery Means Better Patient Outcomes

Wed, 01 Oct 2025 18:00:00 GMT

Global Expertise, Hometown Care.

When choosing a specialist for skin cancer treatment, experience matters. High-volume Mohs programs develop refined techniques, efficient workflows, and reliable, coordinated reconstruction procedures. At ADS, under the leadership of Thomas L. Hocker, MD—Harvard and Mayo‑trained, triple board‑certified, and among the top three worldwide by melanoma Mohs volume (2,400+ cases)—patients receive margin‑controlled surgery and same‑day reconstruction in our certified ambulatory surgical center with exceptionally low infection rates.

The Significance of High Mohs Volume

Mohs surgery is the most effective technique for removing many basal cell and squamous cell carcinomas. Because the surgeon maps, removes, and reads tissue margins in real time, high‑frequency practice sharpens judgment at every step:

Proven expertise – Performing Mohs regularly builds fluency with complex tumor patterns and challenging anatomic sites.
Streamlined care – Efficient, well‑rehearsed processes reduce time in the office and improve comfort.
Advanced reconstruction – Frequent exposure to complex wounds enhances the ability to deliver durable, natural‑looking repairs.
Continuous quality improvement – High‑volume teams rigorously review outcomes, reinforcing best practices and safety.

At ADS, in‑house histology and, when appropriate, melanoma immunostaining support precise margin assessment.

Dr. Thomas Hocker: Double Fellowship‑Trained, Triple Board‑Certified

Dr. Hocker brings years of specialized training, a unique combination of clinical dermatology and dermatopathology expertise, and thousands of successful Mohs procedures to every case. As Founding Director of Dermatologic Surgery at UMKC, he teaches the next generation while continually refining our program’s protocols to keep patients safe and comfortable.

Why Patients Choose ADS

Our commitment goes beyond numbers—we deliver excellent outcomes with compassionate care:

Highest cure rates available for many NMSC when treated with Mohs.
Same‑day reconstruction to reduce repeat visits and downtime.
A certified ambulatory surgical center for hospital‑level safety in a calming outpatient environment.
Personalized plans based on your diagnosis, goals, and lifestyle.
Exceptionally low infection rates supported by careful technique and after‑care.

Melanoma Priority Access: treatment ≤30 days; ≤14 days if high‑risk (insurance dependent).

Experience you can trust—clear margins, careful reconstruction, confident healing.

The Importance of Skin Checks for Solid Organ Transplant Patients

Wed, 01 Oct 2025 14:30:00 GMT

Faith‑Driven. Science‑Perfected.

Receiving a solid organ transplant is life‑changing. Along with the benefits come unique challenges—one of the most significant is increased skin‑cancer risk. At ADS, Thomas L. Hocker, MD and our team help transplant recipients protect their skin health with regular screenings, prevention strategies, and advanced treatment when needed, including Mohs micrographic surgery with same‑day reconstruction in our certified ambulatory surgical center . Our clinic’s exceptionally low infection rates are especially important for patients on immunosuppressive therapy.

Why Transplant Patients Are at Higher Risk

After transplantation, anti‑rejection medications suppress the immune system. While essential, they reduce the body’s ability to detect and clear abnormal cells. As a result:

Skin cancers are up to 65 times more common in transplant patients compared to the general population.
Squamous cell carcinoma is the most frequently diagnosed skin cancer in this group, often more aggressive than in non-transplant patients.
The risk increases with the length of time on immunosuppressive therapy.

These facts underscore the importance of vigilant prevention and early detection .

The Role of Regular Skin Checks

Early detection is critical. Most skin cancers are highly treatable when caught early, but in transplant patients, they may progress faster. Dr. Hocker recommends:

Full‑body skin exams every 3–6 months for all transplant recipients (more often if prior skin cancer or additional risk factors).
Monthly self‑exams to identify new or changing spots, sores that do not heal, or unusual growths.
Immediate evaluation for any concerning change, especially on sun‑exposed areas like the scalp, face, ears, neck, forearms, and hands.

Prevention Strategies

While regular checks matter, prevention is the first line of defense:

Daily broad‑spectrum sunscreen (SPF 30+) , reapplied every two hours outdoors.
Sun‑protective clothing , wide‑brim hats, UV‑blocking sunglasses.
Avoid tanning beds and minimize peak midday sun exposure.
Partner with your dermatologist to personalize prevention and discuss any medication‑related skin effects.

ADS: Comprehensive, Coordinated Care

At ADS, screening, diagnosis, and treatment happen in a coordinated pathway. When skin cancer is detected, Mohs surgery offers precise margin control while preserving healthy tissue—especially valuable for cosmetically or functionally sensitive areas. As a triple board‑certified dermatologist and dermatopathologist, Dr. Hocker aligns clinical and microscopic findings to guide the safest plan. Post‑operative care instructions are tailored for transplant patients to support low infection risk and smooth healing.

Protecting your gift of life includes protecting your skin. With routine checks, thoughtful prevention, and expert treatment, you can lower complications and keep living fully after transplant. If you’re due for an exam—or notice a new or changing spot— schedule with ADS .

Dr. Thomas Hocker to Speak at the 2025 Hoeper Primary Care Conference

Fri, 26 Sep 2025 17:54:43 GMT

Mohs Surgery: History, Value, and Referral in Skin Cancer Care

Advanced Dermatologic Surgery is pleased to share that Dr. Thomas Hocker will present at the 2025 Hoeper Primary Care Conference on an essential topic for front-line clinicians: “Mohs Surgery: History, Value, and Referral in Skin Cancer Care.” His session is designed to give primary care providers (PCPs) practical, clinic-ready takeaways to help patients move from suspicion to diagnosis to definitive treatment—efficiently and compassionately.

Mohs in Brief: A Proven Approach with Practical Roots

Developed nearly a century ago and refined over decades, Mohs micrographic surgery removes skin cancer layer by layer, analyzing 100% of the surgical margins in real time. This method pairs two advantages patients care about most:

Highest cure rates for many basal cell and squamous cell carcinomas
Maximal tissue preservation , which supports better cosmetic and functional outcomes—especially on the nose, eyelids, lips, and ears.

At Advanced Dermatologic Surgery, Mohs removal and same-day reconstruction are coordinated in our certified ambulatory surgical center, streamlining care, improving outcomes, and reducing repeat visits.

Why It Matters to Primary Care

Skin cancers are often first recognized in primary care—during wellness checks, chronic-disease follow-ups, or when a patient mentions a “new spot.” Early recognition and a clear referral path shorten time to treatment and reduce anxiety for patients. Dr. Hocker’s talk focuses on what busy PCPs can use the same day:

Pattern recognition: nonhealing or bleeding lesions, rapidly growing nodules, pearly/translucent papules with surface vessels, scaly or tender plaques that persist, and pigmented lesions meeting ABCDE criteria
Risk context: immunosuppression (including transplant), prior skin cancers, radiation sites, or lesions in the facial “H-zone”
Right-sized next step: when a same-day surgical consult is preferable to in-office biopsy (e.g., cosmetically/functionally sensitive sites)

Referral Essentials: What Speeds Care

A complete referral helps patients get treated sooner and minimizes back-and-forth:

Lesion details: location, size, duration, recent change, symptoms (bleeding, pain, itch)
Clinical photo (if permitted), even a smartphone image with good lighting
Pertinent history: anticoagulants, immunosuppression, prior skin cancers or treatments, cosmetic/functional concerns (airway, eyelid closure, lip competence)
Ask: biopsy vs. surgical consult; level of urgency if rapid growth or pain is present
Our team prioritizes urgent lesions and high-risk patients with rapid-access scheduling.

After Mohs: Advanced Dermatologic Surgery Shares Care for Recovery and Prevention

Outcomes improve when PCPs and dermatologic surgeons share a clear plan:

Wound care & medication guidance patients can follow at home
Timely communication of pathology and margins back to the referring PCP
Surveillance cadence tailored to risk (often every 6–12 months, individualized)
Prevention counseling —sun protection, self-skin checks, and medication considerations for transplant or other immunosuppressed patients

A Note from Dr. Hocker

“Primary care physicians are the first line of defense against skin cancer. When we combine your vigilance with Mohs precision and coordinated reconstruction, patients benefit from faster answers and thoughtful outcomes. Partnerships with PCPs are central to how we care for people.”

Join the Conversation at Hoeper 2025

Join Dr. Hocker’s session at the Hoeper Primary Care Conference for practical, ready-to-use tools—referral checklists, exam cues, and patient-friendly counseling language.

Primary care referrals & curbside questions

Phone: 913 – 661 - 1755

Secure Fax: 913-242-6921

Advanced Plastic Reconstruction After Mohs Surgery

Mon, 15 Sep 2025 20:35:03 GMT

World‑Class Cancer Care. Family‑Level Compassion.

When it comes to treating skin cancer, removing the cancer is only part of the journey. Ensuring that patients experience excellent healing and natural‑looking results is equally important. At Advanced Dermatologic Surgery (ADS), Thomas L. Hocker, MD— Harvard and Mayo Clinic–trained and triple board‑certified in dermatology, dermatopathology, and Mohs & reconstructive surgery —combines Mohs micrographic surgery with advanced plastic reconstruction to provide comprehensive care in one setting. Our certified ambulatory surgical center is designed for safety, precision, and comfort, and our clinic maintains exceptionally low infection rates compared with published dermatology and reconstructive literature. Most patients complete cancer removal and reconstruction the same day.

What Makes Our Approach Unique?

Mohs surgery offers the highest cure rate for many basal cell and squamous cell carcinomas by removing cancer layer by layer and evaluating 100% of the margin in real time. Once the cancer is fully removed, many patients require reconstruction to restore both function and appearance—especially in cosmetically and functionally sensitive areas such as the nose, eyelids, lips, and ears. Dr. Hocker’s fellowship training and triple board certification allow him to plan the reconstruction from the start, preserving healthy tissue and optimizing outcomes. He has performed over 2,400 melanoma Mohs cases, placing him top three worldwide by volume, and he regularly teaches residents and medical students as the Founding Director of Dermatologic Surgery at UMKC.

Advanced Reconstructive Options

Reconstruction is customized to the size, location, and depth of the defect, as well as your skin quality and goals:

Primary closures

A straightforward approach when the wound can be closed with minimal tension, carefully oriented along natural lines to reduce visibility over time.

Local skin flaps

Using nearby skin to cover the site while preserving natural contours and critical functions like eyelid closure or lip competence.

Skin grafts

Transferring skin from a donor site (often behind the ear or the upper inner arm) when additional tissue is needed; graft type (split‑ vs. full‑thickness) is chosen to balance color/texture match and durability.

Because reconstruction is integrated with Mohs planning, we aim to protect function, minimize additional procedures, and reduce downtime. Complex cases may include cartilage support, staged flaps, or selective dermabrasion/polishing in a later visit to refine results.

Patient‑Centered Care in One Setting

A single, coordinated setting reduces anxiety and logistical burden. At ADS you benefit from:

Same‑day cancer removal and reconstruction in a certified surgical environment.
Reduced anxiety and fewer appointments, with clear communication at each step.
Personalized attention from a fellowship‑trained, triple board‑certified Mohs surgeon and a dedicated nursing team.
Exceptionally low infection rates supported by meticulous sterile technique and after‑care education.

Our faith‑driven, patient‑first culture guides everything we do—we treat every patient like family.

Restoring Confidence After Skin Cancer

Skin cancer can affect how you look and how you feel about yourself. Dr. Hocker’s reconstruction is designed to restore both function and appearance so you can return to life with confidence. For eligible melanoma cases (e.g., melanoma in situ and select T1a lesions on the head/neck, hands, feet, or genital skin), we frequently use margin‑controlled Mohs with immunostaining to maximize precision while sparing healthy tissue, followed by tissue‑sparing reconstruction in the same setting. Melanoma Priority Access: treatment within 30 days and ≤14 days if high‑risk (insurance dependent).

If you or a loved one has been diagnosed with skin cancer, ADS offers comprehensive care—from precise removal to advanced reconstruction—under one roof. Schedule a consult to discuss options tailored to your case.

5 Tips for Choosing the Right Mohs Surgeon for Your Skin Cancer Treatment

Mon, 11 Aug 2025 20:01:03 GMT

Being diagnosed with skin cancer can be scary, and selecting the right surgeon is the most critical step you can take toward a successful outcome. For many types of skin cancer, Mohs micrographic surgery offers the highest cure rate. However, not all physicians who perform Mohs surgery have the same level of training.

Here are five essential tips to help you choose the best Mohs surgeon to ensure you receive the highest quality of care.

1. Verify that your Mohs surgeon has the highest degree of Mohs Fellowship-Training (ACMS)

It is important to confirm that your Mohs surgeon has completed a Fellowship through the American College of Mohs Surgery (ACMS) . Any dermatologist is legally allowed to perform Mohs surgery, but only ACMS fellowship-trained Mohs surgeons have completed an intensive 1- to 2-year training program after their dermatology residency. This specialized training, certified by the American College of Mohs Surgery (ACMS), involves:

At least 500 Mohs surgery cases under the supervision of an experienced ACMS-approved surgeon.
Extensive training in frozen section skin pathology , specifically in interpreting the microscopic slides of the cancerous tissue.
Mastery of advanced reconstructive plastic surgery techniques to achieve the best possible cosmetic outcome after the cancer is removed.
Action Tip : Look for a surgeon who has completed a fellowship through the American College of Mohs Surgery (ACMS). You can verify a surgeon's credentials on the ACMS website

2. Know the Mohs Advantage: Complete Margin Analysis

The primary reason Mohs surgery has a cure rate of up to 99% for skin cancer is its unique method of examining 100% of the surgical margins.

Mohs Surgery: The surgeon removes the visible tumor and a thin layer of surrounding tissue. This tissue is immediately processed in an on-site lab, and the surgeon examines it under a microscope. If any cancer cells are found at the edges, the surgeon knows exactly where they are and removes another thin layer only from that specific area. This process is repeated until no cancer remains.

Standard Excision (often performed by plastic surgeons or ENT surgeons): With a standard excision, the surgeon removes the visible tumor along with a wider margin of what is hoped to be healthy tissue. This is then sent to an off-site lab for analysis, which can take a week. Crucially, only a very small fraction of the surgical margin (less than 1%) is examined, and the rest of the margin is ignored! If no tumor is seen in the 1% of the margin that is analyzed, then it is blindly assumed that the other 99% also does not have tumor hiding out. This is like having a murderer break into your house, and then when you call the cops, they come and only search in a tiny corner of your basement closet. If they don't find the murderer in that one spot of your closet, how safe would you feel if they told you "the coast is probably clear" and left you home alone?

This difference is critical. The inability of non-Mohs surgeons to check the entire margin in real-time results in a lower cure rate and an increased risk of needing more extensive corrective surgeries in the future.

3. Ask About Their Experience

A surgeon's skill is directly related to the quality of their Fellowship training and the sheer number of surgeries they have performed. It is simple: surgeons who have done more surgery cases are better at surgery. Studies have shown that new surgeons make more mistakes than experienced ones.

Please search for a Mohs surgeon who has done at least 15,000 cases in their career . With an experienced surgeon, skin cancer cure rates with Mohs are > 99%. Similar cure rates are not guaranteed if your surgeon is inexperienced or not fellowship-trained. Always ask your Mohs surgeon about their experience in treating your specific type of skin cancer.

4. Review Before-and-After Photos of Reconstructions

Many Fellowship-trained Mohs surgeons are also experts in aesthetic reconstructive surgery. They are skilled in various techniques, from simple closures to more complex flaps and grafts, to minimize scarring and achieve the best aesthetic result. Don't hesitate to ask to see a portfolio of their work, particularly for cases like yours.

5. Prioritize Clear Communication and Comfort

Your surgeon should take the time to explain the procedure, answer all your questions, and discuss what you can expect during and after the surgery. Feeling comfortable and confident in your surgeon and their team is a vital part of the treatment process.

Contact us today to learn more about Advanced Dermatologic Surgery's services!

KSHB 41 Interview: Protect Your Skin During Harsh Winter Weather

Tue, 30 Jan 2024 17:42:21 GMT

Dr Hocker shares winter skin tips on KSHB 41 News

KSHB 41 News asked Dr. Thomas Hocker with Advanced Dermatologic Surgery in Overland Park what can be done to keep your skin safe and protect it from the bitter cold temperatures.

Read the full article and watch the video HERE

Unmasking Warts: Causes, Treatment, & Prevention

Tue, 12 Dec 2023 13:17:06 GMT

Unmasking Warts: Causes, Treatment, & Prevention

Warts are a common dermatological condition that affects people of all ages. While generally harmless, these small, rough growths on the skin can be bothersome and aesthetically displeasing.

Causes of Warts

Warts are caused by the human papillomavirus (HPV), a highly contagious virus that enters the body through small cuts, breaks, or other vulnerable areas of the skin. Once infected, the virus prompts the rapid growth of cells on the outer layer of the skin, resulting in the development of warts.

Types of Warts

There are several types of warts:

Common Warts (Verruca vulgaris): These warts are often found on the hands and fingers and have a rough, grainy appearance. Common warts may have black dots (tiny blood vessels) that give them a speckled appearance.
Plantar Warts: Found on the soles of the feet, plantar warts can be uncomfortable due to the pressure exerted on them while walking. They may appear as hard, grainy growths with tiny black dots.
Flat Warts (Verruca plana): These warts are typically smoother and smaller than other types and often appear in clusters on the face, neck, or hands.
Filiform Warts: These long, narrow warts often develop on the face, especially near the eyes and lips. Filiform warts have a distinctive appearance, resembling thread-like projections.
Genital Warts: As the name suggests, genital warts appear on the genital and anal areas. They are a sexually transmitted infection caused by specific strains of HPV. Genital warts can vary in size and shape and may be raised or flat.

Treatment Options

While some warts may resolve on their own over time, others may persist and require treatment. Common treatment options include:

Topical Medications: Over-the-counter creams, gels, or patches containing salicylic acid can help remove warts by gradually breaking down the infected skin cells.
Cryotherapy: This involves freezing the wart using liquid nitrogen, causing it to blister and eventually fall off. Cryotherapy is a common and effective in-office treatment.
Electrosurgery: Warts can be removed using an electric current, which burns the affected tissue. This method is often performed in a medical setting.
Laser Therapy: Laser treatment targets the blood vessels feeding the wart, leading to its destruction. It is a precise and effective option, especially for resistant warts.
Immunotherapy: Some cases may benefit from immunotherapy, which stimulates the body's immune system to attack and eliminate the virus causing the wart.

Wart Prevention

Preventing the spread of warts involves adopting good hygiene practices and avoiding direct contact with infected skin. Additionally, individuals can reduce their risk of developing warts by keeping the skin clean, avoiding touching warts on themselves or others, and wearing protective footwear in communal areas like swimming pools and locker rooms.

If you have concerns about warts or other skin conditions, consulting with a dermatologist is recommended for personalized advice and treatment.

Skin Cysts: Causes, Types, and Treatment Insights

Wed, 15 Nov 2023 13:12:49 GMT

Skin Cysts: Causes, Types, and Treatment Insights

Skin cysts are common skin conditions that can manifest as fluid-filled sacs beneath the skin's surface. While often benign, these cysts can be bothersome, causing discomfort or cosmetic concerns.

Causes of Skin Cysts

Skin cysts can arise from different factors, and understanding their causes is essential for proper diagnosis and management. Some common causes include:

Hair Follicle Blockages: Cysts can form when hair follicles become blocked, preventing the natural shedding of dead skin cells and hair. This blockage leads to the accumulation of keratin, a protein found in skin, resulting in the formation of a cyst.
Sebaceous Gland Issues: Sebaceous glands produce oil (sebum) to keep the skin lubricated. When these glands become blocked or overproduce sebum, sebaceous cysts can develop.
Inflammation and Infection: Inflammatory skin conditions or bacterial infections can contribute to the formation of cysts. The body's response to infection or irritation may involve the creation of a cystic structure.
Genetic Predisposition: Some individuals may have a genetic predisposition to developing certain types of cysts. Understanding family medical history can provide insights into an individual's risk.

Types of Dermatologic Cysts

Several types of skin cysts can occur, each with its own distinct characteristics. Common types include:

Epidermoid Cysts: Also known as epidermal inclusion cysts, these cysts form when surface skin cells are trapped beneath the skin's surface, leading to the accumulation of keratin. They are typically slow-growing and may be movable beneath the skin.
Pilar Cysts: Similar to epidermoid cysts, pilar cysts are filled with keratin but are often found on the scalp. They are usually round, smooth, and may be hereditary.
Milium Cysts: These small, white or yellowish cysts form when keratin is trapped beneath the surface of the skin. They are commonly seen on the face and are often referred to as "milia."

Treatment Options for Cysts

The approach to treating skin cysts depends on factors such as the type of cyst, size, location, and symptoms. Treatment options include:

Watchful Waiting: Asymptomatic cysts that are small and not causing discomfort may be monitored without immediate intervention.
Incision and Drainage: A healthcare professional may opt to drain the cyst by making a small incision and expressing the fluid. This is commonly done for inflamed or infected cysts.
Corticosteroid Injections: In certain cases, injecting corticosteroids into a cyst can help reduce inflammation and promote shrinkage.
Surgical Excision: Larger or persistent cysts may require surgical removal. This involves excising the entire cyst, including its capsule, to prevent recurrence.
Laser Therapy: Laser treatment can be used to reduce the size of some cysts or improve their appearance, particularly for certain types affecting the skin.

If you notice the development of a skin cyst or experience symptoms, seeking advice from a dermatologist is recommended. With the right knowledge and guidance, individuals can make informed decisions about the best course of action for their skin cysts, promoting skin health and overall well-being.

Board-Certified Mohs Surgeon vs. Mohs Certificate: A Big Difference

Fri, 15 Sep 2023 00:55:25 GMT

Board-Certified Mohs Surgeon vs. Mohs Certificate: A Big Difference

Choosing a Mohs surgeon for skin cancer treatment is important in ensuring you receive the best care and treatment outcome. Mohs surgery can be confusing, with terms like "Board Certified Mohs Surgeon" and "Mohs Certificate" being used. So, what’s the difference between the two and does it matter?

What is Mohs Surgery?

Mohs micrographic surgery is a specialized technique used for the precise removal of skin cancer, particularly for cases involving the face, head, and neck or those with a high risk of recurrence. This surgery involves the precise removal of cancerous tissue layers while preserving as much healthy tissue as possible. It is one of the most effective treatments for skin cancer.

Why a Board-Certified Mohs Surgeon? A Board-Certified Mohs Surgeon requires:

Rigorous Training and Education: A Board-Certified Mohs Surgeon is a dermatologist who has completed additional fellowship training specifically in Mohs surgery. This training typically lasts one to two years and focuses on mastering the intricacies of Mohs micrographic surgery, dermatopathology (the study of skin pathology), and surgical reconstruction techniques.
Board Certification: After completing the fellowship, Mohs surgeons can become board-certified by the American College of Mohs Surgery (ACMS). To achieve this certification, surgeons must pass a comprehensive examination that tests their knowledge and skills in Mohs surgery, dermatopathology, and surgical reconstruction.
Ongoing Commitment to Excellence: Maintaining board certification requires ongoing education, skill assessment, and participation in activities that ensure the surgeon remains up-to-date with the latest advancements in Mohs surgery.

What is a Mohs Certificate? Mohs certificates are different than Board-Certified Mohs Surgery through the following:

Minimal Training Requirement: A Mohs Certificate, is obtained after a shorter training program that may last only a few weeks or months. While this training covers the basics of Mohs surgery, it does not offer the same depth and breadth of education and experience as a Mohs fellowship.
Limited Credentialing: Individuals with a Mohs Certificate may not necessarily be board-certified dermatologists, and their expertise in skin cancer treatment may be less comprehensive compared to a Board-Certified Mohs Surgeon.
Variable Quality: The quality and rigor of Mohs Certificate programs can vary widely, and there may not be standardized criteria for assessing the competence of certificate holders.

Why Choose a Board-Certified Mohs Surgeon

Expertise: Board Certified Mohs Surgeons have completed extensive training and education, making them experts in Mohs surgery and related disciplines. They possess the knowledge and skills to provide the highest level of care.
Safety: Patients can have confidence in the safety and effectiveness of Mohs surgery performed by board-certified professionals who adhere to strict standards of practice.
Superior Outcomes: Studies have shown that Mohs surgery performed by board-certified surgeons results in lower recurrence rates and better cosmetic outcomes compared to procedures performed by non-specialists.

When considering skin cancer treatment, make sure your doctor is a Board-Certified Mohs Surgeon, to ensure the highest quality care and the best possible results. Your skin's health is too important to leave to chance.

Dr. Hocker -Author of #1 Best-Selling Dermatology Book on Amazon

Wed, 26 Jul 2023 18:17:34 GMT

Review of Dermatology

Dr. Thomas Hocker is the author of the number one best-selling dermatology textbook on Amazon. The textbook, Review of Dermatology, 2nd Edition is considered the highly effective tool for dermatology physicians studying for their Board exams. Dr. Hocker along with Dr. Ali Alikhan cover all sub-specialty dermatology areas, including general dermatology, dermatopathology, pediatrics, pharmacology, basic science, and dermatologic surgery. This comprehensive review makes the textbook the most sought-after and purchased book by dermatology physicians on Amazon.

All royalties from the textbook are donated to dermatology-related charities.

What You Should Know About Squamous Cell Carcinoma

Wed, 05 Oct 2022 12:58:09 GMT

What is Squamous Cell Carcinoma?

Squamous cell carcinoma is the second most common form of skin cancer in the United States with approximately 700,000 to one million cases diagnosed annually. It usually appears as a small, scaly, and red sore or bump that is sometimes painful. However, it can mimic other conditions, and look similar to a scaly rash or bug bite. If left untreated, it has the potential to become aggressive.

Most squamous cell carcinomas are the result of prolonged exposure to ultraviolet radiation (UV light). The most common sources for UV light include natural sunlight and tanning beds. While these cancers can form anywhere on our body, they are mostly found in areas that have chronic sun exposure over the years.

"Most squamous cell carcinomas are the result of prolonged exposure to ultraviolet radiation (UV light)"

Treating squamous cell carcinoma early is important. Without treatment, squamous cell carcinomas continue to grow. Most of the time, they grow relatively slowly. However, some may grow rapidly or insidiously, which then becomes an urgent issue for patients. Sometimes, squamous cell carcinomas can even break through the bottom layer of skin and spread to fat, muscle or other parts of the body.

If you are concerned that you may have a squamous cell carcinoma on your skin, the best thing to do is to visit a board-certified Dermatologist . They have special training to recognize if the lesion of concern is a squamous cell carcinoma or another type of skin cancer. The biopsy can often be performed on the same day as your visit. From there, a personalized care plan will be discussed for you or your loved one.

Some board-certified Dermatologists also completed an additional year of fellowship-training in Mohs Micrographic Surgery and Dermatologic Oncology. These specialized dermatologic surgeons who have spent an additional year of training provide the best possible care, with the highest cure rate for skin cancer. At Advanced Dermatologic Surgery, we provide high-quality care to our patients.

If you or a loved one would like to be evaluated for potential skin cancer or would like a full-body skin examination to look for skin cancers, we would love to participate in your care .

What is a Basal Cell Carcinoma?

Mon, 12 Sep 2022 12:30:00 GMT

What is a basal cell carcinoma?

Basal cell carcinoma is the most common form of skin cancer. It is estimated that over 3.6 million cases are diagnosed each year in the U.S. alone. Some reports estimate that basal cell carcinomas account for up to 32% of all cancers globally.

What does a basal cell carcinoma look like?

Basal cell carcinomas are usually raised areas of skin that are red, pink or even skin-colored with a shiny or pearly quality. They can often ulcerate and look like a chronic sore. Many patients state that they will spontaneously bleed after taking a shower or that their pillowcase has blood on it in the morning. Chronic sores that bleed are never normal and almost always need evaluation from a board-certified Dermatologist.

When treated early, especially with Mohs micrographic surgery, the cure rate can reach up to 99%.

Where are basal cell carcinomas usually located?

Basal cell carcinomas can be located anywhere there is skin. However, the most common location is usually somewhere on the head, neck, face, ears, lips or forearms – all of the areas that get the most sun-exposure throughout our lifetimes.

Why is it important to treat basal cell carcinomas early?

Without treatment, basal cell carcinomas continue to grow past the skin down to fat, muscle or even bone. This can significantly impact the quality of your life. When they are allowed to grow for months or even years, it becomes increasingly more difficult to treat without extensive surgery. When treated early, especially with Mohs micrographic surgery, the cure rate can reach up to 99%.

Taking action.

If you are concerned that you may have a basal cell carcinoma on your skin, the best thing to do is to visit a board-certified Dermatologist. They have special training to identify quickly and accurately if the lesion of concern is a basal cell carcinoma or another type of skin cancer. Many times, the biopsy can be done on the same day as your visit. From there, a personalized plan of care will be discussed for you or your loved one.

Some board-certified Dermatologists also completed an additional year of fellowship-training in Mohs Micrographic Surgery and Dermatologic Oncology. These specialized dermatologic surgeons that spent an additional year of training provide the best care possible, with the highest cure rate for skin cancer. At Trinity Dermatology, we provide this high quality of care for our patients.

If you or a loved one want to get evaluated for a potential skin cancer, or would like a full body skin examination to look for skin cancers, we are scheduling appointments within 1-2 business days. Please call 816-643-4501 or contact us today to book an appointment.

The Basics of Mohs Micrographic Surgery

Mon, 22 Aug 2022 13:25:23 GMT

What is Mohs Surgery?

A common question that arises after a patient is diagnosed with skin cancer is “What is Mohs surgery?” and “Why is this procedure being recommended for me?” This blog aims to simplify the rather complex process and answer the question as to why this procedure is considered the gold standard of skin cancer surgery.

Anytime a lesion or sore on the skin is concerning for a skin cancer, it can be removed by a procedure called a biopsy. This is usually done under local anesthesia (simple numbing) with minimal discomfort in the doctor’s office. This piece of tissue is then sent to a board-certified dermatopathologist who assesses the tissue and provides an accurate diagnosis. If the diagnosis is harmless, then no further treatment is needed. If the diagnosis is a type of skin cancer, treatment options are discussed based upon details of the pathology report, and a personalized plan of care is developed for each patient.

Mohs surgery, initially developed by Dr. Frederic E. Mohs in 1938, is a specialized type of surgery used to treat skin cancer. It is regarded as the gold standard to treat skin cancer that is found on the head and neck, or skin cancer that is aggressive on the chest, back, arms or legs.

The process can be broken down into the following four steps:

Is Mohs Surgery right for me?

The main advantages to Mohs surgery are the complete evaluation of 100% of the surgical margins (the sides and base of the skin) while also obtaining the highest cure rates (up to 99% for primary tumors, 94% for recurrent tumors). This is in contrast to standard surgical excision, which only evaluates approximately 1% of the tissue’s margin surrounding a skin cancer and has a lower overall cure rate. Mohs is also considered cost-effective since the surgeon is also the pathologist and repairs the wound with the smallest possible defect.

Patients will then return several weeks after the procedure is completed to ensure appropriate healing and removal of stitches. Once someone is diagnosed with skin cancer, their likelihood to develop another skin cancer is increased, and it is important to obtain routine skin examinations to catch any possible new skin cancers very early. The earlier a skin cancer is detected, the easier it is to remove.

Seeking out treatment by a Mohs surgeon who did an additional fellowship after dermatology residency that was accredited by ACGME and approved the American College of Mohs Surgery (ACMS) provides patients an assurance that they are receiving the best care we can offer in skin cancer surgery.

If you think that you or a loved one may have a skin cancer, call 816-643-4501 today for an appointment.

Thread lifts: the Good, Bad and Ugly

Sun, 17 Jul 2022 07:19:08 GMT

What are Thread Lifts?

Thread lifts are an increasingly popular product to achieve facial and neck lifts and volume addition. Threads are made out of a dissolvable suture material, most commonly polydioxanone (PDS), and takes about 6 months to totally dissolve.

The goal is to temporarily lift cheeks, jowls, brows and neck while adding volume to certain areas due to creation of scar tissue and fluid retention in those areas.

Do I need a Thread Lift?

The GOOD:
Thread lifts offer a minimally invasive method to achieve lift and suspension of facial features that are a common complaint of patients. Also, they can add volume without the use of more traditional facial fillers like hyaluronic acid, calcium hydroxyapatite or fat. They are widely available at med spas, aesthetic centers and dermatology and plastic surgery offices and they carry a relatively low risk profile.

The BAD:

Noticeable, positive results…initially. Look at any before and after picture set of a patient that has undergone thread lifting. What do you notice? The after pictures are always immediately following the procedure. These offer basically no longevity at all. Threads are placed in the fat and dermis of the skin above the level of the face and neck that must be addressed to achieve predictable and long-lasting results. If a patient is content with a short lasting, temporary result then this is reasonable, but for the price paid it generally leaves one wanting. The price to get threads can be steep and ultimately be thousands of dollars per session representing a seemingly poor return.

The Ugly:

Thread related complications, while thankfully not common, can be devastating. Ultimately, this is a foreign body being placed within a patient’s body. When done incorrectly with poor sterilization protocols, or just bad luck, the skin and surrounding tissues can become badly infected, inflamed and sometimes even had tissue death. But uglier than the physical risks is the advertising to an unknowing client base promising powerful results and not being truthful with the client about what the limitations and expectations of these thread lifts should be. There is a reason the vast majority of board-certified facial plastic surgeons, myself included, do not offer threads and generally are opposed to their use.

Simply, they don’t work as advertised.

I want my patients to be as informed as possible about the products and services they pursue to achieve their aesthetic goals. I will always have detailed and thoughtful discussions about their motivations and expectations and help guide them to a product, service or surgery that will serve them the best.

Face Lift Neck lift: Lifted Face = Lifted Spirits!

Mon, 06 Jun 2022 07:19:08 GMT

What is a "Face Lift" and a "Neck Lift"?

Face lifts and neck lifts have been around for many years. Originally, surgeons would stretch and remove skin only to accomplish these lifts. While this was a very safe procedure as it did not significantly endanger any nerves or blood vessels, it had very poor longevity. Since the skin has considerable elasticity, these types of lifts do not provide good long-term results. This left patients with recurrent signs of facial aging in a short amount of time. Sadly, this technique was used by some surgeons up until just a few decades ago.

In more recent years, face lift surgeons have adapted updated techniques that achieve much better long-lasting results. Focusing on release of what are termed “facial ligaments”, securely lifting a layer of the face called the SMAS and specifically contouring the deep layers of the neck. more natural and long-lasting results are possible. Although these techniques carry slightly elevated risk to critical structures and increased downtime, the ultimate outcome is more than worth it. A well-trained face lift surgeon will know these benefits and risks of these techniques and can guide the patient with thoughtful and informative consultation sessions.

The Face Lift, AKA: deep plane, high SMAS and lateral SMAS

Terminology of facelifts is dizzying. Many surgeons have coined their own names for the facelift they perform, but ultimately the name doesn’t always explain the technique. The type of facelift used for each patient should be determined by their particular anatomy, previous facial surgeries and expected outcomes. Commonly used techniques in modern times include deep plane, high SMAS and lateral SMAS. This procedure is not one size fits all and a detailed preoperative examination and consultation are necessary to determine the type necessary to achieve the surgical goals.

So, why does lifting the face lead to lifted spirits? In my view, the goal of facial rejuvenation is not to look different. It is to restore a person’s view of normal through their mind’s eye. Rejuvenation is intended to match an outward appearance to the internal ideal. A face lift certainly achieves a more youthful appearance, but what I gather from my patients is that afterward they now have the outward appearance of their more youthful feeling self. That, friends, is normal and it lifts one’s spirits.

Advanced Dermatologic Surgery Blog & Resources

Understanding Surgical Dermatology: Your Complete Guide to Skin Procedures

Common Surgical Dermatology Procedures

1. Mohs Micrographic Surgery

2. Skin Excision

3. Skin Biopsy

4. Reconstruction and Repair

5. Electrosurgery and Curettage

6. Cryosurgery

Who Should Consider Surgical Dermatology?

What to Expect During Your Visit

Consultation

Procedure

Recovery

Why Choose Advanced Dermatologic Surgery?

Frequently Asked Questions

Take the Next Step

About the Author

7 Sun Protection Mistakes That Increase Your Skin Cancer Risk

Most people believe they are protecting their skin.

About the Author

The Best Sun Protection Strategy According to a High-Volume Skin Cancer Surgeon

Most people think sunscreen is enough. It’s not.

The Four Layers of Effective Sun Protection

Why Layering Matters

Real-World Insight from Surgical Experience

The Bottom Line

About the Author

How Many Melanoma Mohs Cases Does Your Surgeon Perform Each Year? Why Volume Matters

Why Does Surgical Volume Matter for Melanoma Mohs Surgery?

How Does Dr. Hocker's Volume Compare to the Leading Academic Centers?

About the Author

Mohs vs Plastic Surgery

Do Mohs Surgeons or Plastic Surgeons Perform Better Facial Reconstruction After Skin Cancer Removal?

Who This Article Is For

Key Takeaways

Who Performs the Majority of Facial Reconstruction in the United States?

Why Surgical Volume Matters

Safety: Outpatient Mohs Surgery vs. Hospital-Based Reconstruction

Cosmetic Outcomes: Mohs Surgeons vs. Plastic Surgeons

Advantages of Same-Surgeon Reconstruction

When Referral Is Appropriate ﻿

Skin Cancer After Organ Transplant | Advanced Dermatologic Surgery

Skin Cancer After Organ Transplant: What Every Recipient Should Know

About the Author

Squamous Cell Carcinoma After Transplant

Why Squamous Cell Carcinoma Is the Greatest Skin Cancer Threat After Transplant

About the Author

Skin Cancer After Organ Transplant: What Your Transplant Team May Not Have Told You

The Short Answer

Key Takeaways

What You'll Learn in This Article

You're a Transplant Recipient Reading This...

What I See in My Practice

What the Evidence Says

How Much Does Your Risk Increase?

Why Squamous Cell Becomes the Dominant Threat

Risk by Organ Type

The "Tumor Burden" Problem

Why Your Medications Drive Risk

Guidelines and Real-World Practice

How We Approach This at Advanced Dermatologic Surgery

Comprehensive Baseline Examination

Risk Stratification and Surveillance Schedule

Mohs Surgery for High-Risk Tumors

Same-Day Reconstruction

Field Therapy for Precancerous Damage

Coordination With Your Transplant Team

What About Prevention?

Strategies That Have Demonstrated Benefit

Strategies That Have Not Shown Benefit in Transplant Patients

What You Should Do Next

Frequently Asked Questions

About the Author

What Is Surgical Dermatology?

Understanding Surgical Dermatology

Common Surgical Dermatology Procedures

Why Expertise Matters

What to Expect From Surgical Dermatology Care

Why Patients Choose Advanced Dermatologic Surgery

When Referral Is Appropriate

Celebrating Excellence in Skin Cancer Care in Kansas City