Advances in Skin Cancer Treatment

Skin cancer is the leading form of cancer in the US and the world. According to the American Academy of Dermatology, in the United States alone, between 40 and 50% of people will be diagnosed with basal or squamous cell skin cancers by the age of 65. Anyone can get skin cancer, but your risks increase if you have one or more of the following:

• Fair skin, light eyes, and blond or red hair
• A family history of skin cancer
• A previous skin cancer
• A large number of moles
• Skin that burns, freckles, or reddens easily
• Are over the age of 50
• Are immunosuppressed due to medical conditions or medications

The most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and melanoma.

• Basal cell carcinoma (BCC), the most common skin cancer, looks like a flesh-colored, bead-like bump or pinkish patch of skin. BCCs can form anywhere on the body but develop most often on the head, neck, and arms.

• Squamous cell carcinoma (SCC), the second most common type of skin cancer, presents like a red firm bump, scaly patch, or persistent sore and tends to form on parts of the body that get frequent sun exposure, such as the face, neck, arms, chest, back, and rim of the ear.

• Melanoma, the deadliest form of skin cancer, may start out in an existing mole or suddenly appear as a new dark spot on the skin. Melanoma is fast-growing and tends to spread, making early diagnosis and treatment critical.

Mohs Surgery for Skin Cancer

As long as a skin malignancy has not spread, the most common treatment is surgical removal by a dermatologist or, in certain cases, another type of skin surgeon. Most of the time, skin cancers are removed using traditional excisional surgical techniques. In some cases, a doctor will recommend Mohs micrographic surgery. Named after Frederick Mohs, the surgeon who developed the technique in the late 1930s, Mohs surgery is an extremely precise, tissue-sparing skin cancer removal technique.

Mohs surgery is most frequently use to remove basal cell and squamous cell carcinomas, as well as:

• Skin cancers that have come back after previous treatments or have a high probability of coming back.
• Lesions in areas where you want to avoid scarring and maintain as much healthy tissue as possible, such as the face, hands, feet, and genitals.
• Skin cancers with blurred margins that are hard to define.
• Large, fast-growing skin cancers.

How the Mohs Procedure Is Performed

Performed under local anesthesia, Mohs surgery is a complex procedure that combines surgery with a microscopic examination. The tumor is removed layer by layer. As each layer, or “level” of tissue is removed, it is flash-frozen and cut into thin, translucent slices. Each slice is stained and placed on a glass slide and examined by the Mohs surgeon while the patient waits. If the microscopic examination reveals cancer cells at the tissue margins, more tissue is removed. The procedure is repeated until the margins of the tumor are deemed “clear.” Because Mohs surgery removes a malignancy in thin horizontal slices, a surgeon can examine a tumor’s entire margin. This reduces the chance of any cancer cells getting left behind. As a result, Mohs surgery has the highest reported cure rate of any skin cancer treatment.

Mohs surgery reduces scarring by preserving as much healthy skin as possible. Once the cancer has been fully removed, the surgeon will determine what type of repair will yield the best functional and cosmetic result. The doctor may close the wound immediately, let it close on its own, or refer a patient to another skin surgeon if repair in an operating room is indicated.

The Mohs procedure can take anywhere from 90 minutes to several hours, depending on how many layers of tissue need to be removed, the size of the tumor, and the complexity of the repair.

Save your Skin!

About 90% of nonmelanoma skin cancers are associated with exposure to ultraviolet (UV) rays from the sun and/or indoor tanning booths. Here are a few easy ways to protect yourself from damaging UV rays:

• Limit sun exposure. Stay indoors between 10 am and 3 pm, wear protective clothing, and seek shade.
• Apply sunscreen often, as much as once an hour if you are swimming or perspiring heavily.
• Don’t burn! Cumulative sun damage can lead to basal and squamous cell cancers and premature aging of the skin. Melanoma, the deadliest form of skin cancer, does not require UV damage, but melanoma risk is increases with more sun exposure and intermittent sunburns.
• Avoid tanning beds. Melanoma in younger people is often linked to tanning bed use.
• Learn to perform skin self-exams.
• Get routine skin screenings from a dermatologist.

Learn more about skin cancer and ways to keep your skin healthy by listening to this short podcast with Dr. Wells!