Melanoma is the most serious form of skin cancer. If detected early, this cancer can be “cured” with surgical excision. Unfortunately, many cases are detected beyond this stage.
Prognosis depends on the thickness of the cancer, which is measured in fractions of a millimeter or roughly 1/10th the thickness of a dime. Depending on the thickness of the cancer, additional procedures such as sentinel lymph node biopsy may be warranted. Prompt diagnosis and treatment are essential. Often an interdisciplinary approach involving a dermatologist, plastic surgeon, and oncologist is used.
Basal Cell Carcinoma
The most common cancer of man. This is a low-grade cancer arising in the “basal” or bottom layer of the epidermis. Growth is typically slow and it may take several years before a lesion is even noticed. This is essentially a skin problem only. Untreated lesions may grow and destroy surrounding tissues, however metastasis or “spread” to lymph nodes and internal organs almost never occurs.
Squamous Cell Carcinoma
The second most common type of skin cancer. This is an intermediate grade cancer which most often arises in sun-damaged skin. Many patients have a history of actinic keratosis or “precancers.” In some instances, the cancer may actually arise in a pre-existing actinic keratosis. Although squamous cell carcinoma is predominantly limited to the skin, if left untreated this cancer has the ability to spread to lymph nodes and internal organs. Metastasis has been reported to occur in up to 5 percent of cases. Prompt diagnosis and treatment is essential.
Mohs Micrographic Surgery
Mohs Micrographic Surgery or Mohs Surgery is a procedure named after the late Dr. Frederick E. Mohs, who developed the technique while working at the University of Wisconsin. Mohs Surgery is considered the “Gold Standard” of skin cancer treatment and produces the highest cure rates of any known cancer treatment. In its current form, the technique consists of two phases: cancer removal and microscopic examination.
Surgical excision involves removing the tumor along with a margin of normal skin. The excised tissue is then sent to a pathologist for further examination to ensure that the skin cancer has been completely removed. Generally, the wound is closed with stitches, leaving only a straight-line scar.
Liquid nitrogen (which is minus 321 degrees Fahrenheit) is applied directly to a skin cancer in order to destroy cancerous cells. Typically, a blister and open wound develop at the treatment site. The resultant wound then heals with a flat scar that is generally smoother and lighter colored than the surrounding skin.
Creams containing Efudex® or Aldara® can be used to destroy superficial skin cancers. The creams are generally applied once or twice daily for one to three months, during which time the areas often become irritated or scabbed. In some instances, it may be necessary to perform a biopsy after treatment to confirm tumor destruction.
Commonly called ED&C or electrodesiccation and curettage, this technique involves scraping away the tumor with a sharp instrument, called a curette, followed by destruction with an electrical needle. The resultant wound is allowed to heal on its own, typically leaving a round, shiny and slightly discolored scar.