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Adult & Pediatric Dermatology

The Dermatology Clinic at Blue Mountain Hospital District provides full spectrum skincare for both adult and pediatric patients. Dr. Oliver Wisco and his team from Dermatology Health Specialists in Bend see patients in Grant County 2 days each month. Dr. Wisco founded Dermatology Health Specialists to provide dermatology care to Central and Eastern Oregon, and his passion for rural health care brought him to serve our community.

To make an appointment contact your Primary Care Provider for a referral or call 541-575-2060.

Advanced Skin Cancer Care

Types of Skin Cancer

Central and Eastern Oregon have some of the highest rates of skin cancer in the world. Skin cancer is the most common form of cancer, but it is treatable when found early. Skin cancer is also one of the most preventable cancers, through sun protection with protective clothing, sunhats and daily sunscreen use.

There are several types of skin cancer, with the most common ones being basal cell carcinomas (BCC), squamous cell carcinomas (SCC) and melanoma. For more information on types of cancer, please see derm-health.com. Early detection is key to treatability and full recovery.

Excision

During a standard excision, an area around the skin cancer is marked, the area is numbed, then the tissue is removed with a scalpel. Bleeding is stopped with electrocautery, a low voltage electrical current applied to areas of bleeding. Surrounding skin is sometimes loosened, so that it stretches for easier for the skin to be sewn back together, typically, with two layers of stitches.

Electrodesicciation and Curettage (EDC)

An EDC is a procedure typically used to destroy low-risk small cancers. The lesion is numbed, scraped with a curette (circular sharp tool), then cauterized with an electrocautery device (a low voltage electrical current applied to the bleeding area).

Mohs Surgery

Mohs micrographic surgery is the most advanced and precise treatment for removing most types of skin cancer. Mohs Surgery is a procedure that removes both the visible tumor and microscopic cancer cells beneath the skin surface. If Mohs Surgery is recommended, BMH patients can be treated by Derm Health Mohs Surgeons at Harney District Hospital or in Bend.

Dr. Oliver Wisco and Dr. Matthew Clark are Mohs surgeons with advanced experience in Mohs surgery. During this outpatient procedure, Dr. Wisco or Dr. Clark remove and microscopically examine thin layers of skin until only cancer-free tissue remains. The immediate microscopic examination of tissue is what differentiates Mohs surgery from other skin cancer removal procedures. The cancerous tissue is removed with reduced normal tissue loss, reducing wound size and chances of recurrence. For more information on Mohs Surgery, see Derm-Health.

Adult & Pediatric Dermatology

At Dermatology Health Specialists, all our clinicians care for both pediatric and adult patients. Life long skin health starts early. Proper skincare and treatments for acne and other skin disorders through youthful years can have life long benefits. Derm Health is here to support you through all ages. From surprise issues that arrive overnight, to developing healthy skin protection behaviors, we are passionate about providing comprehensive care to everyone in your family.

Each Derm Health clinician takes a comprehensive approach to their patients. Every patient is offered a full skin exam, regardless of the reason for the appointment. We do this for several reasons. First, even though your skin concern may seem to be localized to a certain area, there can be subtle findings in other areas on the body that help make a diagnosis. Second, we commonly find skin cancer when you did not know it was there. Of course, we always respect the patient’s request, but to truly take a comprehensive approach to your skin, we always recommend a complete skin exam.

There are several ways to treat skin conditions and we personalize our therapeutic and preventative approaches for you and what the most current data shows is effective. We constantly strive to understand the most advanced, data-driven treatments and prevention methods that are cost-effective to help care for your skin and promote overall health.

Mohs Surgery

Mohs micrographic surgery is the most advanced, precise and effective treatment for removing most types of skin cancer. Mohs Surgery is a surgical technique that removes not only the visible tumor but also any microscopic cancer cells that may have extended beneath the skin surface.

Dr. Oliver Wisco is a Mohs surgeon with over a decade of advanced experience in removing skin cancers. During Mohs surgery, Dr. Wisco progressively removes and microscopically examines thin layers of cancer-containing skin until only cancer-free tissue remains. The immediate microscopic examination of removed tissue is what differentiates Mohs surgery from other skin cancer removal procedures. The cancerous tissue is removed with minimal normal tissue sacrifice, minimizing both post-operative wound size and chances of recurrence. Mohs surgery is typically completed in an outpatient setting with a local anesthetic.

Mohs surgery is ideal for the elimination of skin cancers in cosmetically and functionally critical areas, such as head, neck, hands, shins, and feet. It is also used for tumors that have recurred or tumors that have indistinct borders where it is difficult to see the tumor edges. In patients that have a decreased immune system, Mohs surgery should be considered for all skin cancers, regardless of location. Mohs surgery is also indicated for aggressive types of skin cancer.

Mohs surgery is unique and effective because of the way the removed tissue is microscopically examined, evaluating 100% of the tissue edges. The tissue is reviewed microscopically in the clinic by Dr. Wisco, the Mohs surgeon, who is specially trained in the reading of these slides and is best qualified to correlate microscopic findings with the surgical site on the patient.

Advantages of Mohs Surgery

  • Ensuring complete cancer removal during surgery, minimizing the chance of cancer growing back.

  • Minimizing the amount of healthy tissue loss.

  • Maximizing the functional and cosmetic outcome after surgery.

  • Repairing the site of cancer the same day the cancer is removed, in most cases.

  • Curing skin cancer when other methods have failed.

What to expect during Mohs Surgery

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The visible tumor and a small segment of surrounding skin are removed.
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The tissue is examined under a microscope to see if any cancer cells remain at any of the edges.
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If any cancer remains, additional skin continues to be removed and examined under the microscope.
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This process continues until no more canter cells are found.

Mohs Fellowship Training

Upon completion of a one-year internship followed by a three-year dermatology residency, a dermatologist can apply to for a Micrographic Surgery & Dermatologic Oncology (Mohs) fellowship training program. Qualified applicants undergo an extremely competitive selection process to obtain a one-year fellowship position with a program accredited by the Accreditation Council for Graduate Medical Education. Once selected, fellows are trained through a structured curriculum that includes operative and non-operative treatments for skin cancer patients, and exposure to long-term results, recurrences, and complications. Ultimately, fellowship-trained Mohs surgeons are the most comprehensively trained physicians to care for patients with skin cancer or patients that are at risk for skin cancer. Dr. Oliver Wisco completed a dual fellowship in Mohs Surgery and Melanoma in the Boston, MA area.

Standard Skin Surgery

Many benign skin growths and non-aggressive skin cancers or early evolving skin cancers can be removed with a standard excision or destroyed by several different methods. The choice of treatment is typically based on four factors: the condition, size, location, and the patient’s overall health. For potentially malignant lesions, the first step is to biopsy the lesion. This is typically done in one of three ways: a shave biopsy which entails a razor slicing off a portion of the lesion, a punch biopsy where a circular knife is used to remove a portion or all of the lesion, or an excisional biopsy where a scalpel is used to remove the entire lesion, if possible, with a very narrow margin. Once a diagnosis of a cancerous lesion is made, the two most common surgical treatments used are standard excisions and electrodesiccation and curettage.

Excision

As standard excision involves marking a margin around the skin cancer and then drawing a fusiform shape (football shaped) design around it. This shape is used so that once the lesion is removed and the skin is sewn back together, the scar will be minimized. After numbing the lesion, the tissue is removed with a scalpel, and bleeding is stopped with electrocautery (a low voltage electrical current applied to the bleeding vessels/tissue). Undermining, a process of loosening the surrounding skin so that it stretches easier is performed and then the skin is sewn back together. Typically, two layers of stitches are placed. The deep layer is stitched with absorbable sutures that take 2-6 months to dissolve. The top layer is then closed with either absorbable sutures or sutures that need to be removed. The choice of the suture is dependent on the amount of tension on the wound and the risk for scarring in the surgical area. Sutures that need to be removed are usually removed in 7-14 days. Standard excisions are also used for the removal of benign lesions. The removed tissue is sent to a pathologist to evaluate whether the lesion has been completely removed or if additional concerning features are present.

Electrodesiccation and Curettage (EDC)

An EDC is a procedure typically used to destroy low-risk small cancers or benign lesions. The lesion is numbed, scraped with a curette (a circular sharp scraping tool), then cauterized with an electrocautery device (a low voltage electrical current applied to the bleeding vessels/tissue).