Skin Cancer Treatment
Treating Skin Cancer
The prevention, diagnosis, treatment and follow up of skin cancer is one of the major focuses of our practice.
Skin cancer is the most common type of cancer in the United States. One in five Americans will develop skin cancer in their lifetime according to the American Academy of Dermatology. Factors that increase the risk of skin cancer include indoor tanning, sunburns, skin type, red hair, unprotected exposure to UVA/UVB rays, genetics, atypical moles, and having had an organ transplant. Measures to decrease the risk of skin cancer include daily use of a broad spectrum sunscreen with an SPF of 30+, use of sun protective clothing, sunglasses and wide-brimmed hats, seeking shade when possible, annual skin exams with your dermatologist, and periodic self-exams.
Fortunately, skin cancer is one of the most preventable cancers, and highly treatable when found early.
Precancerous Changes (Actinic Keratoses)
Actinic keratoses are sun-induced precancerous lesions. They can feel like a rough patch of skin in an area of sun damaged skin. Sometimes, they will look or feel more like bumps, pimples, age spots, discoloration, or even take on the appearance of an animal’s horn. If left untreated, some will turn into a type of skin cancer called squamous cell carcinoma.
Numerous treatments are available including cryotherapy (liquid nitrogen application) and prescription topical medications such as 5-fluorouracil cream, imiquimod cream and others.
Basal cell carcinoma
The most common type of skin cancer. They usually appear as a pink, pearly bump or pink patch of skin that grows slowly and may bleed easily. If left untreated, basal cell carcinoma will continue to grow and can be locally destructive. Basal cell carcinoma is most common on the head, neck and arms, but they can form anywhere on the body, usually after years of frequent sun exposure.
Squamous cell carcinoma
The second most common type of skin cancer. They can look like a firm, pink bump, a scaly patch, or a sore. Squamous cell carcinomas tend to appear on areas of the skin that get frequent sun exposure. They can grow deep into the skin causing damage and disfigurement as well as spread to other areas of the body. Early diagnosis and treatment can prevent these changes.
This is the most serious form of skin cancer because it has a tendency to spread. It can develop within a mole or appear as a new spot on the skin that looks different from other spots (asymmetric, irregular border, color variation, large diameter). If detected early, melanoma is highly treatable.
Skin cancers can vary in shape, color, size and texture. Any new, changing or suspicious growth should be examined immediately by a dermatologist. Early intervention is essential in the successful treatment of skin cancer. Depending on the type and location of the skin cancer, treatment options may include surgical removal, curettage and electrodessication, prescription topical medications or Mohs surgery.
Mohs Surgery Overview
The diagnosis of skin cancer may be frightening, however, Mohs micrographic surgery offers the most effective and precise technique for treating the most common types of skin cancers (basal cell and squamous cell carcinoma).
Frederic Mohs, MD developed this technique in the late 1930s. The procedure is typically a single-visit outpatient surgery performed under local anesthesia. The Mohs surgeon removes the cancerous tissue in stages while sparing healthy tissue, analyzes 100% of the tissue margin under the microscope to ensure the complete removal of the cancer, and then reconstructs the wound leaving the smallest possible scar.
Mohs Surgery Procedure
The procedure begins with the Mohs surgeon localizing and confirming the correct site of the cancer. The area is then numbed using local anesthesia. The Mohs surgeon then removes a layer of cancerous tissue using a scalpel. Oftentimes, the visible portion of the skin cancer represents the “tip of the iceberg” with roots extending deeper and beyond what the eyes can see. The tissue is then processed and placed on microscope slides, a process that may take up to an hour (during this time, the wound will be temporarily bandaged).
The margins of the tissue are then examined by the Mohs surgeon under the microscope to determine if there are remaining cancerous cells or if the cancer has been cleared. If cancerous cells are still present, then a second layer is removed and this process is repeated until the cancer has been cleared. Once the cancer has been cleared, the Mohs surgeon will determine the best method of reconstruction to obtain the best cosmetic outcome. The reconstruction is often determined by the size and location of the cancer. Some wounds are left open to heal on their own while others are closed with sutures.
The Mohs surgeon most commonly reconstructs the wound immediately after obtaining clear margins, however, there are certain instances where the Mohs surgeon will coordinate care with another specialist for wound repair.
For more detailed information, please visit: https://www.skincancer.org/treatment-resources/mohs-surgery/
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