Skin Cancer

Overview

Skin cancer is the most common form of cancer in the United States and involves abnormal growths of skin cells that can form anywhere on the body, but most frequently appear on skin that is exposed to the sun. There are more than a million new cases of skin cancer in the US each year. Although most cases of skin cancer can be successfully treated, it is still important to keep skin safe and healthy and try to prevent this disease.

There are three major types of skin cancer that affect associated layers of the skin. These major types are:

Basal Cell Carcinoma (BCC)

Basal cell carcinoma is the most common type of skin cancer and accounts for over 75 percent of all skin cancer cases in the United States. This type of cancer rarely spreads and can usually be removed easily, but is still a serious condition that requires prompt treatment. Most cases are caused by long-term exposure to ultraviolet rays but people with fair skin and a personal or family history of skin cancer may be at a greater risk.

Basal cell carcinoma affects the top layer of the skin known as the epidermis. It may appear on the skin as a new growth that bleeds easily or does not heal quickly and may be white, pink, flesh-colored or brown. Removal treatment depends on the size, depth and location of the cancer, but may include excision, cryosurgery, Mohs surgery, laser surgery or electrodesiccation and curettage. Basal cell carcinomas are often a recurring condition, so preventive measures and regular body screenings should be taken advantage of.

Squamous Cell Carcinoma (SCC)

Squamous cell carcinoma is a common form of skin cancer that affects over 250,000 people in the United States each year. It is usually caused by excessive, long-term exposure to ultraviolet rays from the sun and most frequently affects people over the age of 50 and with pale skin. Squamous cell carcinoma does not cause pain or any other symptoms, but develops as a growth on the skin, usually in sun-exposed areas. These growths can vary in appearance and may be new or a change to a pre-existing scar.

Squamous cell carcinoma affects the area just below the outer surface of the skin. Most cases can be completely removed through minimally invasive procedures that may include freezing, excision, laser therapy, Mohs surgery or radiation therapy. Skin cancer can usually be treated successfully if detected and removed quickly. It is important to take precautionary measures such as avoiding sun exposure and performing regular skin checks to prevent new cases of squamous cell carcinoma.

Melanoma

Melanoma is a skin cancer of the melanocytes, the cells that make melanin (brown pigments). Accounting for more than 80 percent of all skin cancer deaths, melanoma is the deadliest form of skin cancer. Early detection and treatment greatly increase the likelihood of total freedom from melanoma. Since 1950, melanoma incidence has increased more than 20-fold in older men, and the rate of associated mortality in men has tripled (Geller, et al).

The earliest, most common symptoms of melanoma are abnormal growths on the skin or changes in existing moles. It is therefore important to seek medical attention upon noticing any abnormal changes in your skin.

Melanoma is usually diagnosed through a full skin exam and a biopsy of the suspicious-looking area. If melanoma is found, a stage will be assigned to it; stage I melanoma is the earliest stage, while stage IV indicates that the cancer has spread elsewhere on the body, making treatment more difficult. Melanoma is typically treated by surgically removing the melanoma; later stages of melanoma may also include chemotherapy or radiation therapy to destroy all cancer cells. Sometime a sentinal lymph node biopsy is needed for staging by a general surgeon.

Treatments

Mohs Surgery

Developed by Frederic E. Mohs, M.D. in the 1930s, Mohs Micrographic Surgery for the removal of skin cancer is a highly precise, highly effective method that excises not only the visible tumor but also any “roots” that may have extended beneath the skin surface. Five-year cure rates have been demonstrated up to 99 percent for first-treatment cancers and 95 percent for recurring cancers.

Mohs surgery involves the systematic removal and microscopic analysis of thin layers of tissue at the tumor site until the last traces of the cancer have been eliminated. The immediate and complete microscopic examination and evaluation of excised tissue is what differentiates Mohs surgery from other cancer removal procedures. Only cancerous tissue is removed, minimizing both post-operative wound size and the chance of recurrence.

Mohs surgery is most commonly used for basal and squamous cell carcinomas, although it can be recommended for the eradication of other cancers such as melanoma. Cancers that are likely to recur or have already recurred are often treated using this technique because it is so thorough. High precision makes Mohs surgery ideal for the elimination of cancers in cosmetically and functionally critical areas such as the face (nose, eyelids, lips, hairline), hands, feet and genitals.

Mohs physicians are highly trained to function as surgeon, pathologist and reconstructive surgeon during the cancer removal process. They work in offices equipped with appropriate surgical and laboratory facilities, and are supported by Mohs-trained nursing and technical staff.

As with any surgery, there are risks. There may be temporary or permanent numbness or muscle weakness in the area. Other possible complications include tenderness, itching, shooting pains, and need for further surgery if skin flaps or grafts fail.

For more information, visit the American Society for Mohs Surgery

Secondary Intention Healing – Gelfoam®

Gelfoam® sterile compressed sponge is a Pfizer product that is applied to an open wound to help bleeding subside more rapidly. This is particularly important in those cases when a wound needs to be left open rather than sutured closed. The Gelfoam material is inserted into the base of the wound, where it effectively promotes the formation of a blood clot. A sterile dressing will be placed over the wound to maintain the positioning of the Gelfoam sponge.

The majority of the Gelfoam material is safely absorbed in the wound. If there is any residual Gelfoam material found at the wound site, the doctor will remove it at an office visit.