Skin Cancer

As the earth's ozone layer continues to be depleted, ultraviolet radiation poses an ever-increasing risk to humans. Each year, more than a million new cases of skin cancer are diagnosed, making it the fastest growing form of cancer in the United States. Although a potentially fatal condition, even the most dangerous form of skin cancer, if detected early enough, can be treated and cured.

TYPES OF SKIN CANCER
Skin cancer appears in one of three forms. The first and least dangerous is basal cell carcinoma. This common form of carcinoma does not spread to other parts of the body. If left untreated, basal cell carcinoma can grow beneath the skin and damage sensitive organs.

Another form is Squamous cell carcinoma, usually found on the face, lips, or ears. This type of skin cancer can spread to other parts of the body (lymph nodes and internal organs) and, if left untreated, is potentially fatal. Both basal cell and Squamous cell carcinoma can take on any number of appearances: a small white or pink bump; a rough, dry red spot (keratoses); a crusted group of bumps; a firm, red lump; a sore that will not stop bleeding; or a white patch similar to scar tissue.

The final and most dangerous form of skin cancer is malignant melanoma. Once this cancer spreads throughout the body, is an often deadly. Malignant melonoma is detected either by unusual changes in size, color, or shape of a mole (clusters of heavily pigmented skin cells), or by an unusual growth on the skin.

Knowing your body and monitoring any unusual changes in your skin, moles, and keratoses, are the safest and smartest ways to avoid the damaging effects of skin cancer. It’s a good idea to get your skin checked by a Dermatologist twice a year.

TREATMENTS

Skin cancer poses the greatest risk to people who are genetically predisposed to this type of cancer, have a large number of moles, or display light or fair features (eyes, skin, hair). In the case of a potentially dangerous skin growth, physicians take a skin sample and examine it under the microscope for signs of cancer. Depending on the type of cancer, as well as the location and stage of growth, a surgeon uses any number of treatments. In the case of minor cancer growth, surgical procedures are generally very simple; the growths are removed using either an excision, or by curettage and dessication (where the cancer is scraped out and a small electric current kills the remaining cancer cells). Other treatments include cryosurgery (freezing the cancer cells), radiation therapy, topical chemotherapy (anticancer drugs applied to the skin), and Mohs surgery (slicing off the cancer layer by layer). If the cancer has spread through the body, major surgery is required.

MOHS SURGERY FOR THE TREATMENT OF SKIN CANCER

In the late 1930s, Dr. Frederic E. Mohs developed a new concept in the treatment of skin cancer. This method of skin cancer removal has certain advantages:

1. Mohs surgery produces the highest cure rate for cancer.

2. Mohs surgery can achieve preservation of the maximum amount of healthy skin.

What Is Mohs Surgery?

The concept behind this microscopically controlled surgical excision is that the surgeon also acts as the pathologist. The surgery is done in an outpatient setting under local anesthesia (local numbing medicine). The surgeon often uses an instrument called a curette (a circular knife) in order to debulk the tumor. A scalpel is then used to excise the tumor with a minimal amount of skin being removed. The bleeding is stopped and the specimen is taken to a Mohs laboratory station, where it is prepared for microscopic examination within 45 minutes.

The technician preparing the specimen must be specially trained. Unlike the standard method, where the tumor tissue is cut vertically, the Mohs specimen is prepared in a horizontal fashion, providing multiple bird's-eye views of the cancerous tissue.

When the microscopic slides are ready, the Mohs surgeon acts as a pathologist and reads them. If the slides show complete removal of the tumor, then the patient is ready for closure.

If, however, the microscopic examination shows that cancerous tissue is still present in the skin (i.e., its borders have not been removed), the exact location of the remaining tumor on the skin can be precisely mapped out for removal. This is possible because, just following tumor removal, the Mohs surgeon uses dyes on various surfaces of the tissue in order to locate the exact position.

By using this method, the cancerous tissue can be completely excised in one procedure, achieving not only the best chance of cure but also removal of the least amount of normal skin. Mohs surgery is often performed for basal cell carcinoma and for the second most common type of skin cancer, squamous cell carcinoma. Mohs surgery has a 99% cure rate for basal cell carcinomas that have not previously been treated.

Closing the Wound

When Mohs surgery has been performed and all the cancer has been removed, a wound or defect results. The defect can be repaired in different ways. Sometimes, the Mohs surgeon will allow the wound to heal on its own. This is known as secondary intention. In other cases, the Mohs surgeon will suture, or stitch, the area closed, either sewing one side to the other or, if needed, doing a skin flap. A skin flap involves making an extra incision or incisions into the skin in order to help move adjacent skin to close the defect.

In some cases, the Mohs surgeon will use a skin graft to repair the wound. A skin graft essentially is a patch of skin that is taken from another location, such as the back of the ear or front of the ear, and then placed where it is needed, such as the tip of the nose.

The average case lasts two to four hours. Most of the time is spent waiting in the waiting room while we prepare and examine the tissue. Eat a good breakfast; bring reading material or something to occupy your time.