Skin Cancer Diagnosis and Treatment

  • You’ve Been Diagnosed with Skin Cancer – What Now?

    If you have been diagnosed with skin cancer, you may be frightened – wondering how this might have happened, what you can do about it, and above all – whether you’re in serious danger.

    You’re not alone. More than 1.2 million people in the United States are diagnosed with skin cancer each year, and most have probably felt the same way you do.

    The good news is that while a diagnosis of skin cancer is cause for concern, (if left untreated, the disease can continue to progress), it needn’t be cause for panic. The fact that you were screened or otherwise had your skin cancer diagnosed, is an important first step.

    There are several different kinds of skin cancers, distinguished by the types of cells affected. The three most common forms are:

    • Basal Cell Carcinoma: Basal cell carcinomas (BCC) usually appear as shiny, pink to pearly, fragile, raised translucent lumps that can bleed easily. Basal cell carcinomas are the most common cancer, with more than 2.5 million occurring annually in the United States. Although basal cell carcinomas do not usually spread to other parts of the body through the blood stream, it may cause considerable damage by direct growth and invasion.
    • Squamous Cell Carcinoma: Squamous cell carcinoma (SCC) is usually distinguished by raised, scaly, firm reddish lumps or growths that are sometimes tender or painful. More than 500,000 squamous cell carcinomas occur annually in the United States. Squamous cell carcinoma has the ability to metastasize, or spread through the bloodstream or lymphatics, to other parts of the body. The risk of metastasis increases with tumor size, duration, and specific locations such as the ear or the lip. Approximately 2,000 deaths occur each year from this form of cancer.
    • Malignant Melanoma: Malignant melanoma typically first appears as a pigmented light brown to black irregularly shaped blemish. These lesions frequently stand out from the rest of a person’s pigmented lesions as the ‘Ugly-Duckling’ lesion. Improved outcomes are achieved with early diagnosis and treatment. Melanoma is unfortunately the most-deadly form of skin cancer, with its lethality coming as a result of melanoma’s ability to metastasize to other parts of the body through the bloodstream and the lymphatic drainage system. High-intensity ultraviolet exposure is associated with increased risk of developing melanoma. Recent studies have linked tanning beds to the dramatically increasing incidence of melanoma, finding that “those who tanned indoors had a 74% greater risk of developing melanoma than those who never used the machines.”

    Treatment will vary, depending on several factors.

  • Not all treatments for skin cancer are equal.

    Skin cancer is not necessarily life threatening nor does its therapy have to be disfiguring. Advanced treatment is available that offers the highest potential for cure while minimizing the cosmetic impact – even if previous treatments have failed.

    Options range from common treatments to Mohs micrographic surgery, an advanced surgical technique performed by a highly trained specialist. You should be aware of the benefits and drawbacks of various options and choose a treatment that will remove all the cancer, minimize the risk of recurrence, and leave as little scarring as possible.

    Treating Skin Cancer: The dermatologic surgeon will select the most appropriate treatment for a particular skin cancer or precancerous condition from among the following procedures and techniques:

    Cryosurgery: Liquid nitrogen is applied directly to the skin to freeze cancerous tissue, in a more aggressive fashion than treating pre-cancerous growths. This results in a crusted wound which then heals on its own.

    Curettage: Malignant tissue is scraped away with a sharp instrument. This method is most effective for small, superficial cancers that have not been treated previously. It is often followed by destruction of the cancerous tissue with an electric needle. The wound then heals on its own.

    Surgical Excision: Surgical excision involves excising around and under the skin cancer with a safety-zone of normal-appearing skin, fully removing the tumor for pathologic evaluation. The wound is then reconstructed with sutures.

    Mohs Micrographic Surgery (Mohs): Mohs Micrographic Surgery is an outpatient procedure performed under local anesthesia with two goals: 1) to remove skin cancers with exceptional accuracy and the highest possible cure rate available from any technique, and 2) to keep the surgical defect (wound) as small as possible by minimizing the removal of normal healthy skin.

    When considering options, or to understand why previous treatments have failed, it is important to recognize that the tumor that is visible to you – even to your physician – may be just the “tip of the iceberg.” Not all cancer cells are apparent to the naked eye. Many “invisible” cells may form roots or “fingers” of diseased tissue that can extend beyond the boundaries of the visible cancer. If these cancer cells are not removed, they can lead to regrowth and recurrence of the tumor.

    Types of cancer most likely to form these complicated root systems are those that:
    • Are located in cosmetically sensitive or functionally critical areas around the eyes, nose, lips or scalp
    • Grow rapidly and/or uncontrollably
    • Have been previously treated

    For these cancers, common treatment methods are often not successful because they rely on the human eye to determine the extent of the cancer. These methods can remove too little cancer, which could cause it to recur and require additional surgery, or too much healthy tissue, which could cause unnecessary scarring.

    Once a cancer has been treated by one of these common methods and it recurs, the chances of it being cured when treated again by one of these methods becomes less likely. The scar tissue surrounding a recurrent cancer makes it extremely challenging to differentiate between healthy skin and cancerous tissue and further complicates the determination of how much tissue to remove.

  • Mohs Micrographic Surgery is Advanced Treatment that Gets the Job Done

    Mohs micrographic surgery is an advanced, precise treatment for skin cancer in which the physician serves as surgeon, pathologist and reconstructive surgeon. It is the most effective method available for curing non-melanoma skin cancers, and relies on the precision and accuracy of a microscope to trace and ensure removal of the cancer – down to its roots.

    During Mohs surgery, layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains. It allows surgeons to verify that all cancer cells have been removed at the time of surgery. This increases the chance of a cure and reduces the need for additional treatments or additional surgery.

    Mohs surgery is especially useful for skin cancers that:
    • Have a high risk of recurrence or that have recurred after previous treatment
    • Are located in areas where you want to preserve as much healthy tissue as possible, such as the eyes, ears, nose, mouth, hairline, hands, feet and genitals
    • Have borders that are hard to define
    • Are large or aggressive – forming roots in the skin, along blood vessels, nerves, cartilage or along scars.
    Of all treatments for skin cancer, Mohs micrographic surgery;
    • Offers the highest cure rate (up to 99%)
    • Has the lowest chance of regrowth
    • Minimizes the potential for scarring or disfigurement
    • Is the most exact and precise means of removal

    It also provides the foundation for the best reconstructions and limits scarring and disfigurement.

    Mohs surgery is done on an outpatient basis in a procedure room that has a nearby laboratory that allows our surgeon to examine the tissue after it’s removed.

    Once the obvious tumor is removed, our Mohs surgeons:
    • Remove an additional, thin layer of tissue from the tumor site
    • Create a “map” or drawing of the removed tissue to be used as a guide to the precise location of any remaining cancer cells
    If any of the sections contain cancer cells, our surgeons:
    • Return to the specific area of the tumor site as indicated by the map
    • Remove another thin layer of tissue only from the specific area within each section where cancer cells were detected
    • Microscopically examine the newly removed tissue for additional cancer cells

    If microscopic analysis still shows evidence of disease, the process continues layer-by-layer until the cancer is completely gone.

    Once the removed tissue shows no signs of disease, the removal process stops – preserving or “saving” healthy, normal tissue. This technique ensures that all the diseased tissue – and only the diseased tissue – is removed, thereby minimizing the cosmetic impact.

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