A little clinic with a lifesaving procedure
According to the Centers for Disease Control and Prevention, in Oregon an average of people out of 100,000 developed the most serious variety of skin cancer, melanoma, in 2014.
If not surgically removed, the incidents are lethal. Luckily for Wilsonville, Dermatology Clinic P.C. has just arrived on Town Center Loop W and is bringing Mohs surgery to the community.
Named after Dr. Frederic Mohs, Mohs surgery is the combination of surgery and pathology done at the same time, in the same office, by the same doctor. Since its creation in 1930, technology has improved along with cure rates.
"We look at 100 percent of the margin (of the tissue) which is unusual in pathology," Bremmer said. "Usually they'll only look at 5 percent of the margin (for non-Mohs) slides."
Mohs surgery can be used to safely remove early stages of melanoma, but but Bremmer also said Mohs technique for treating the two most common types of skin cancer: basal cell and squamous cell carcinomas. Both types are less dangerous than melanomas, but are still damaging and can spread. The procedure is done in stages, beginning with the surgeon removing the cancerous cells along with any cells that may be infected.
Since these types of cancerous cells are contiguous, there's always some part of the infected cells touching healthy tissue. Through Mohs, unlike in a traditional skin cancer biopsy and removal, only a very small margin is removed because doctors and technicians can check if more tissue is needing to be removed before stitching the surgical site closed. This results in the highest cure rates and least scarring due to doctors not having to reopen previous incisions if more cancerous tissue needs to removed, according to Bremmer.
"Since we can do it all in one day, we can do more complicated repairs that end up looking better," Bremmer said. "Because once you get to the sewing, you already know that the cancer is out."
Even as one of fewer than 20 20 Mohs surgeons in Oregon, Bremmer wasn't always interested in dermatology.
"Back when I was in junior high, somebody made a comment about how something 'wasn't brain surgery,' and right then and there I thought that I would be a brain surgeon, just because it would be something to do," Bremmer said. "But as I got going in training in college and then in medical school I got drawn into dermatology."
Once in the field, Bremmer was attracted to the variety, from doing surgery and pathology to prescribing medicine.
"It reminds me of the way that medicine used to be where you were the one person that did every part of medicine," he said.
Practicing in Oregon, Bremmer said that he'll have no shortage of patients in the state. Oregonians, despite living in one of the more overcast and wet states, boast some of the highest levels of skin cancer in the country.
"Oregon is one of the top states in the country for skin cancers. It truly is an epidemic here," Wilsonville resident and Dermatology P.C. Dr. Preston Chadwick said. "Often when I diagnose a skin cancer, the patient has come in for something else. So routine exams to help find, diagnose and educate patients on what to look for (are) critically important here in Oregon."
Bremmer cautions that it's not just elderly patients who need to worry about skin cancer.
"It's less about age and more if something seems not quite right to somebody then they should come to get it checked out," Bremmer said. "In younger women, around 20s to 40s, melanoma is the cancer most likely to cause their death.
So it's reasonable to get looked at even when you're younger."
Although it is generally known that laying out in the sun or recreating without sun protection increases a person's chance of getting skin cancer, Bremmer said those who like to partake in tanning beds to get a summer-time glow are more likely to get skin cancer than their sun-loving counterparts.
"Tanning beds certainly cause a problem," he said. "I did some back-of-the-envelope calculations on it and about 1 in 1,000 people who tan, ever, will die from melanoma as a result of tanning; and more like 1 in 200 will get a melanoma from tanning (beds).
"You're hurting your DNA even to get a little bit tan. That's why dermatologists are very pale people."
But the good news is that, if caught early, skin cancer is treatable, and through Mohs surgery, patients have a very high rate of recovery. Which is what Bremmer says it's all about.
"I think that the clinic is really dedicated to doing quality work and it's a little unusual," Bremmer said. "Sometimes the business aspect of medicine takes over, and that's not the case here. People really want to do a really good job at every level of the organization.
My goal is to work here until 2050 and then call it good and retire."