Mohs surgery represents a significant advancement in the treatment of skin cancer. This highly precise surgical technique allows for the removal of cancerous tissue while preserving as much healthy skin as possible. Developed by Dr. Frederic Mohs in the 1930s, the procedure has evolved to become the gold standard for treating certain types of skin cancer, particularly basal cell carcinoma and squamous cell carcinoma.
The fundamental principle behind Mohs surgery is the layer-by-layer removal and examination of cancerous tissue. This meticulous approach ensures complete eradication of cancer cells while minimizing damage to surrounding healthy tissue. The procedure’s success lies in its ability to map out the entire tumor, allowing surgeons to target and remove cancer cells with unprecedented accuracy.
Mohs surgery is particularly beneficial for treating skin cancers in cosmetically sensitive areas such as the face, hands, and feet. Its precision allows for smaller incisions and less scarring compared to traditional excision methods. Additionally, the technique boasts impressively high cure rates, making it a preferred choice for both patients and dermatologists.
The Science Behind Mohs Surgery
Mohs surgery is grounded in a scientific approach that combines surgical precision with real-time pathological examination. This unique methodology sets it apart from other skin cancer treatments and contributes to its high success rates.
Microscopic Mapping
The cornerstone of Mohs surgery is the creation of a microscopic map of the tumor and surrounding tissue. This map allows the surgeon to pinpoint the exact location of cancer cells, ensuring targeted removal. The process begins with the surgeon outlining the visible tumor and a small margin of surrounding tissue with ink. This mapped area serves as a guide throughout the procedure.
Layer-by-Layer Removal
Once the tumor is mapped, the surgeon removes the cancerous tissue in thin layers. Each layer is carefully coded to correspond with its location on the microscopic map. This systematic approach ensures that every part of the tumor is accounted for and examined.
Immediate Pathological Examination
A key differentiator of Mohs surgery is the immediate examination of removed tissue. The surgeon, who is also trained in pathology, processes and examines each layer of tissue under a microscope. This on-the-spot analysis allows for real-time decision-making about whether additional tissue removal is necessary.
Precision Targeting
If cancer cells are found in the examined tissue, the surgeon can precisely identify their location using the microscopic map. This allows for targeted removal of additional tissue only from areas where cancer cells remain, preserving as much healthy tissue as possible.
Complete Margin Control
Mohs surgery provides complete margin control, meaning that 100% of the tumor’s edges are examined. This comprehensive examination significantly reduces the chance of leaving behind any cancer cells, contributing to the procedure’s high cure rates.
Understanding the scientific principles behind Mohs surgery helps appreciate its effectiveness in treating skin cancer. The combination of surgical skill, pathological expertise, and meticulous mapping makes Mohs surgery a powerful tool in the fight against skin cancer.
Types of Skin Cancer Treated with Mohs Surgery
Mohs surgery is primarily used to treat certain types of skin cancer. While it’s not suitable for all skin cancers, it has proven highly effective for specific types and in certain situations. Let’s explore the various skin cancers that can be treated with Mohs surgery and understand why this technique is particularly beneficial for them.
Basal Cell Carcinoma (BCC)
Basal cell carcinoma is the most common type of skin cancer and is frequently treated with Mohs surgery. BCC typically develops on sun-exposed areas of the skin and can be aggressive if left untreated. Mohs surgery is particularly effective for BCC because:
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- It often has irregular borders that are difficult to define visually
- BCC can extend beyond visible margins, making complete removal challenging with traditional methods
- Mohs surgery’s layer-by-layer approach ensures complete removal of these hard-to-define tumors
Squamous Cell Carcinoma (SCC)
Squamous cell carcinoma is the second most common type of skin cancer. Like BCC, it often develops on sun-exposed areas. Mohs surgery is frequently used to treat SCC because:
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- SCC can be aggressive and has a higher risk of spreading compared to BCC
- The technique’s high cure rate is crucial for preventing recurrence and metastasis
- Mohs surgery allows for complete removal while preserving maximum healthy tissue in cosmetically sensitive areas
Melanoma
Mohs surgery is also used to treat in situ and early (<1mm) invasive melanoma. In many cases, melanomas can be removed with smaller margins than those recommended for routine excision, with the same or higher cure rates and smaller scars. Using special stains to identify melanoma cells, Mohs surgery is especially useful for:
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- Melanomas on the head, neck, hands, and feet
- Large melanomas where tissue conservation is crucial
- Situations where the borders of the melanoma are poorly defined”
Other Less Common Skin Cancers
Mohs surgery can also be used to treat some rarer forms of skin cancer, including:
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- Atypical fibroxanthoma (AFX)
- Dermatofibrosarcoma protuberans (DFSP)
- Microcystic adnexal carcinoma
- Sebaceous carcinoma
- Extramammary Paget’s disease
These less common skin cancers often have irregular growth patterns that make them ideal candidates for the precision of Mohs surgery.
It’s important to note that while Mohs surgery is highly effective for many types of skin cancer, it’s not always the best choice. Factors such as the type of cancer, its location, size, and the patient’s overall health all play a role in determining whether Mohs surgery is the most appropriate treatment option. A thorough consultation with a dermatologic surgeon is essential to determine the best approach for each individual case.
Preparing for Mohs Surgery
Proper preparation is key to ensuring a smooth and successful Mohs surgery experience. While the procedure itself is relatively straightforward, there are several steps patients can take to prepare themselves both physically and mentally. Here’s a comprehensive guide to help you get ready for your Mohs surgery.
Before UNDERTAKING Mohs surgery…
Before scheduling Mohs surgery, your dermatologist will conduct a thorough medical evaluation. This typically includes:
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- Reviewing your medical history
- Discussing any medications or supplements you’re currently taking
- Evaluating the site of the skin cancer and surrounding areas
- Explaining the procedure and answering any questions you may have
It’s crucial to disclose all medical conditions, especially if you have a history of heart problems, artificial joints, or are prone to infections.
Medication Adjustments
Your doctor may recommend adjusting certain medications before the surgery:
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- Blood thinners: PATIENTS WHO HAVE NEVER HAD A HISTORY OF HEART DISEASE, STROKE, OR BLOOD CLOTS SHOULD DISCONTINUE ASPIRIN, IBUPROFEN, OR OTHER BLOOD THINNING MEDICATIONS ONE WEEK BEFORE SURGERY TO REDUCE THE RISK OF BLEEDING. PATIENTS WHO HAVE HAD A HISTORY OF HEART DISEASE, STROKE, OR BLOOD CLOTS SHOULD CONTINUE ASPIRIN AND PRESCRIPTION BLOOD THINNERS AS DIRECTED BY THEIR DOCTOR.
- Supplements: SUPPLEMENTS SUCH AS FISH OIL, VITAMIN E, GINSENG, GINGKO, AND GARLIC INCREASE BLEEDING RISK AND SHOULD BE DISCONTINUED ONE WEEK BEFORE SURGERY.
- Prescription medications: Continue taking your regular prescription medications unless otherwise instructed by your doctor.
Lifestyle Preparations
In the days leading up to your Mohs surgery, consider the following lifestyle adjustments:
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- Avoid alcohol for at least 48 hours before the procedure
- Get a good night’s sleep before the surgery day
- Eat a normal breakfast on the day of the surgery (fasting is not necessary)
- Arrange for someone to drive you home after the procedure, especially if the surgery site is near your eye or if you’ll be taking anti-anxiety medication
What to Bring
On the day of your Mohs surgery, remember to bring:
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- A list of all medications and supplements you’re currently taking
- Your insurance card and any necessary paperwork
- Comfortable, loose fitting, layered clothing in case procedure rooms are cool.
- A book, tablet, or other entertainment for waiting periods
- A snack and water, as the procedure can take several hours
Mental Preparation
Preparing mentally for Mohs surgery can help reduce anxiety and ensure a more positive experience:
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- Educate yourself about the procedure by reading reliable sources or asking your doctor questions
- Practice relaxation techniques like deep breathing or meditation
- Discuss any concerns or fears with your healthcare provider
- Remember that Mohs surgery has a high success rate and is designed to minimize scarring
By following these preparation guidelines, you can help ensure that your Mohs surgery goes as smoothly as possible. Remember, your healthcare team is there to support you throughout the process, so don’t hesitate to reach out with any questions or concerns.
Advantages of Mohs Surgery
Mohs surgery offers several significant advantages over traditional skin cancer treatments, making it the preferred choice for many dermatologists and patients alike. Let’s explore these benefits in detail.
High Cure Rates
One of the most compelling advantages of Mohs surgery is its remarkably high cure rate:
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- For primary basal cell carcinoma, the cure rate is up to 99%
- For recurrent basal cell carcinoma, the cure rate is around 94%
- For primary squamous cell carcinoma, the cure rate is about 97%
- For recurrent squamous cell carcinoma, the cure rate is approximately 90%
These cure rates are significantly higher than those achieved with standard excision or other treatment methods.
Tissue Conservation
Mohs surgery excels at preserving healthy tissue:
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- The layer-by-layer approach allows surgeons to remove only cancerous tissue
- This precision is particularly valuable for cancers on the face, hands, feet, and genitals where conserving tissue is crucial for both function and appearance
- Minimizing the removal of healthy tissue often results in smaller scars and better cosmetic outcomes
Complete Margin Control
Unlike standard excision, Mohs surgery provides complete margin control:
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- 100% of the tumor’s edges are examined microscopically
- This comprehensive examination significantly reduces the chance of leaving behind any cancer cells
- The technique is especially useful for cancers with irregular or poorly defined borders
Same-Day Results
Mohs surgery offers the advantage of same-day results:
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- Patients know they’re cancer-free before leaving the surgical center
- This immediacy eliminates the anxiety of waiting days for pathology results
- If additional removal is needed, it can be done immediately, avoiding the need for a second surgery
Cost-Effectiveness
While the initial cost of Mohs surgery may be higher than some other treatments, it can be more cost-effective in the long run:
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- The high cure rate reduces the likelihood of recurrence and the need for additional treatments
- The precision of the technique often results in simpler reconstructions, reducing overall costs
- Fewer follow-up visits may be needed compared to other treatment methods
Versatility
Mohs surgery is versatile and can be used to treat:
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- Cancers in difficult-to-treat areas like eyelids, nose, ears, and lips
- Large tumors
- Tumors with indistinct borders
- Recurrent cancers
- Cancers in areas with limited tissue for reconstruction
Outpatient Procedure
Mohs surgery is typically performed as an outpatient procedure:
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- Patients go home the same day
- Local anesthesia is used, avoiding the risks associated with general anesthesia
- Recovery time may be shorter compared to more extensive procedures
These advantages make Mohs surgery an excellent choice for many skin cancer patients, particularly those with high-risk or recurrent cancers, or cancers in cosmetically sensitive areas. However, it’s important to note that while Mohs surgery offers many benefits, it may not be the best choice for every patient or every skin cancer. A thorough consultation with a dermatologic surgeon is essential to determine the most appropriate treatment approach for each individual case.
Potential Risks and Complications
While Mohs surgery is generally safe and effective, like any medical procedure, it does carry some potential risks and complications. It’s important for patients to be aware of these possibilities to make informed decisions about their treatment and to know what to watch for during recovery.
Bleeding
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- Minor bleeding is common during and immediately after the procedure
- In rare cases, excessive bleeding may occur, particularly in patients taking blood-thinning medications
- Hematoma (a collection of blood under the skin) can sometimes develop
Infection
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- While uncommon, there’s always a risk of infection following any surgical procedure
- Signs of infection include increased redness, warmth, swelling, or discharge from the wound
- Patients with weakened immune systems may be at higher risk for infection
Pain and Discomfort
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- Most patients experience mild to moderate pain or discomfort following Mohs surgery
- Pain typically subsides within a few days and can be managed with over-the-counter pain relievers
- Persistent or severe pain may indicate a complication and should be reported to the surgeon
Scarring
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- While Mohs surgery aims to minimize scarring, some degree of scarring is inevitable with any surgical procedure
- The extent of scarring depends on factors like the size and location of the tumor, and individual healing characteristics
- In some cases, additional procedures may be needed to improve the appearance of scars
Nerve Damage
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- Temporary or permanent numbness, tingling, or altered sensation in the surgical area can occur if nerves are affected
- This is more common when treating larger or deeper tumors, or those in areas with many nerve endings
Incomplete Tumor Removal
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- While rare due to the precise nature of Mohs surgery, there’s a small chance that not all cancer cells will be removed
- This risk is significantly lower with Mohs surgery compared to other treatment methods
Recurrence
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- Although Mohs surgery has high cure rates, there’s always a small risk of cancer recurrence
- Regular follow-up appointments and self-examinations are important to detect any recurrence early
Wound Healing Issues
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- Some patients may experience delayed wound healing, particularly those with certain medical conditions like diabetes
- In rare cases, wound dehiscence (separation of the wound edges) can occur
Allergic Reactions
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- Some patients may have allergic reactions to the local anesthetic, adhesives in bandages, or other materials used during the procedure
- It’s important to inform your surgeon of any known allergies before the procedure
Cosmetic Concerns
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- While Mohs surgery aims to preserve as much healthy tissue as possible, some patients may be dissatisfied with the cosmetic outcome
- This is more likely when treating large tumors or those in prominent locations
It’s crucial to discuss these potential risks and complications with your surgeon before the procedure. They can provide more detailed information based on your specific case and medical history. Remember, while these risks exist, they are generally rare, and most patients experience successful outcomes with Mohs surgery. Proper preparation, following post-operative care instructions, and maintaining open communication with your healthcare team can help minimize these risks and ensure the best possible outcome.
Recovery and Aftercare
Proper recovery and aftercare are crucial for optimal healing following Mohs surgery. While the procedure itself is typically straightforward, the healing process requires attention and care. Here’s a comprehensive guide to help you navigate the recovery period and ensure the best possible outcome.
Immediate Post-Surgery Care
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- Keep the surgical site elevated for the first 48-72 hours to reduce swelling
- Take over-the-counter pain relievers as directed
- If needed, apply ice packs intermittently to minimize discomfort and bruising
- Avoid strenuous activities for at least 48 hours.
Wound Care
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- Staff will provide specific wound care instructions on the day of your surgery based on the location of the wound and type of repair
- Follow the written instructions provided at discharge and call the number provided in the event of questions
Managing Discomfort
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- Mild to moderate pain is normal and can usually be managed with over-the-counter pain relievers
- If pain becomes severe or persistent, contact your healthcare provider
- Some swelling and bruising are normal and should subside within a week or two
Activity Restrictions
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- Avoid bending, lifting heavy objects, or engaging in strenuous exercise for at least a week
- If the surgery was on your face, avoid wearing makeup until the wound has healed
- Refrain from swimming or soaking the wound until it’s fully healed
Scar Management
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- After one month, massage with a moisturizer can be used if desired to speed softening
- All wounds mature over six months and will continue to mature until that time
- Once the wound has healed, gently massage the scar with a moisturizer to promote softening
- Once the surface has completely healed, begin use of sunscreen to protect the wound from sun damage
- Your surgeon may recommend silicone-based scar treatments or other scar management techniques
Follow-up Appointments
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- Attend all scheduled follow-up appointments for wound checks and suture removal
- These appointments allow your surgeon to monitor healing and address any concerns
Long-term Care
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- Perform regular self-examinations to check for any signs of recurrence
- Protect your skin from sun damage to reduce the risk of developing new skin cancers
- Schedule regular skin check-ups with your dermatologist
When to Seek Medical Attention
Contact your healthcare provider immediately if you experience:
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- Excessive bleeding that doesn’t stop after 20 minutes of continuous pressure
- Signs of infection such as increased redness, warmth, swelling, or discharge
- Fever over 100.4°F (38°C)
- Severe or worsening pain not relieved by prescribed medications
- Allergic reactions to medications or dressings
Remember, everyone heals differently, and the recovery process can vary depending on the size and location of the surgical site. It’s crucial to follow your surgeon’s specific instructions, as they may differ based on your individual case. Don’t hesitate to reach out to your healthcare team with any questions or concerns during your recovery period. With proper care and attention, most patients heal well from Mohs surgery and achieve excellent outcomes.
Long-Term Follow-Up and Skin Cancer Prevention
After successful Mohs surgery, long-term follow-up and skin cancer prevention become crucial aspects of your healthcare routine. While Mohs surgery has high cure rates, patients who have had skin cancer are at an increased risk of developing new skin cancers in the future. Here’s a comprehensive guide to help you maintain your skin health and prevent future occurrences of skin cancer.
Regular Dermatological Check-ups
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- Schedule regular follow-up appointments with your dermatologist
- Initially, these may be every 3-6 months
- As time passes without recurrence, visits may be reduced to once or twice a year
- During these visits, your dermatologist will:
- Examine the surgical site for any signs of recurrence
- Perform a full-body skin examination to check for new skin cancers
- Address any concerns you may have about your skin health
- Schedule regular follow-up appointments with your dermatologist
Self-Examinations
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- Perform monthly self-examinations of your skin
- Look for any new or changing moles, growths, or lesions
- Pay special attention to the area where you had Mohs surgery
- Use the ABCDE method to evaluate moles:
- Asymmetry
- Border irregularity
- Color variations
- Diameter larger than 6mm
- Evolving size, shape, or color
- Perform monthly self-examinations of your skin
Sun Protection
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- Use broad-spectrum sunscreen with an SPF of 30 or higher daily
- Apply sunscreen to all exposed skin, including the surgical site
- Reapply every 2 hours, or more frequently if swimming or sweating
- Wear protective clothing when outdoors
- Wide-brimmed hats
- Long-sleeved shirts
- Sunglasses with UV protection
- Seek shade, especially during peak sun hours (10 am to 4 pm)
- Use broad-spectrum sunscreen with an SPF of 30 or higher daily
Lifestyle Modifications
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- Avoid tanning beds and sun lamps
- These devices emit harmful UV radiation that can increase skin cancer risk
- Maintain a healthy diet rich in antioxidants
- Foods high in vitamins C and E, beta-carotene, and selenium may help protect your skin
- Stay hydrated to maintain healthy skin
- Consider taking vitamin D supplements if you’re limiting sun exposure
- Avoid tanning beds and sun lamps
Genetic Counseling
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- If you have a family history of skin cancer or have had multiple skin cancers, consider genetic counseling
- This can help identify any genetic predispositions to skin cancer and guide prevention strategies
Education and Awareness
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- Stay informed about the latest developments in skin cancer prevention and treatment
- Educate family members about the importance of skin cancer prevention and early detection
- Consider participating in skin cancer awareness events or support groups
Environmental Considerations
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- Be aware of your environment and take extra precautions in high-UV situations
- At high altitudes
- Near reflective surfaces like water, sand, or snow
- In areas with depleted ozone layers
- Check the UV index in your area and plan outdoor activities accordingly
- Be aware of your environment and take extra precautions in high-UV situations
Occupational Precautions
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- If your job involves outdoor work or exposure to harmful substances:
- Use appropriate protective equipment
- Take regular breaks in shaded areas
- Advocate for workplace policies that prioritize skin cancer prevention
- If your job involves outdoor work or exposure to harmful substances:
Remember, while these preventive measures are crucial, they don’t guarantee that you won’t develop skin cancer again. However, they significantly reduce your risk and increase the likelihood of early detection if skin cancer does occur. Early detection is key to successful treatment, so don’t hesitate to contact your dermatologist if you notice any suspicious changes in your skin.
By incorporating these long-term follow-up and prevention strategies into your lifestyle, you’re taking proactive steps to maintain your skin health and overall well-being. Your healthcare team is there to support you in this journey, so don’t hesitate to reach out with any questions or concerns about your ongoing skin care and cancer prevention.
Mohs Surgery Center Providers and Staff
We Have a Mohs Surgery Center With Experienced Providers and Staff
Mohs micrographic surgery is a specialized technique for the removal of skin cancer. Developed by Dr. Frederic E. Mohs in the 1930s. It is usually used for cancers at high risk for recurrence, including those on the nose, lips, eyelids or ears; those that are large, poorly-defined or recurrent after prior treatment; and those with aggressive microscopic features. Here at Dermatology Associates, Dr. Mark Zalla and Dr. Elliott Campbell perform Mohs Surgery. The Mohs Procedure allows them to microscopically examine the entire margin around and beneath the skin cancer. This precise examination ensures complete removal of the cancer while avoiding removal of excess normal skin, leaving a smaller wound and less scar.
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Mohs surgery stands as a testament to the power of medical innovation and precision in treating skin cancer. From its inception in the 1930s to its current status as the gold standard for treating many types of skin cancer, Mohs surgery has continually evolved to offer patients the best possible outcomes.
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About Dermatology Associates of Northern Kentucky
Dermatology Associates of Northern Kentucky offers a range of services for all age groups, including general and pediatric dermatology, dermatologic surgery, Mohs Micrographic surgery, laser and cosmetic procedures, and Dermatopathology.
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