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Skin
Cancer
Basal Cell Carcinoma
Melanoma
Mohs Surgery
Squamous Cell Carcinoma
Basal
Cell Carcinoma
Basal Cell Carcinoma (BCC) is the most common type of skin cancer
comprising about 80% of all skin cancers in the United States. The exact
cause of BCC is unknown but it is closely related to chronic sun
exposure, fair skin and family history. There is no known precursor
lesion to basal cell carcinoma.
BCC is almost never life threatening nor does it spread or metastasize
to other organs. If untreated, however, the tumor will continue to grow
and can invade or destroy adjacent structures. There are many cases
where patients have lost an eye or part of their nose or ear because the
tumor was neglected or inadequately treated. Delay in treatment will
also usually lead to lower cure rates and a worse cosmetic outcome.
For these reasons treatment of basal cell carcinoma is recommended at
the earliest stages when the tumor is small and may not even be
symptomatic.
Avoidance of sun may help prevent BCC. Treatment options for the tumor
are many and depend on factors including the size and extent of the
tumor, location on the body, cosmetic concerns, cost, and health status
of the patient, etc… Treatment options may include topical creams,
destruction by scraping the tumor off the skin, freezing, surgical
excision, radiation, and Mohs micrographic surgery.
To view photos and learn more about
Basal Cell Carcinoma, please click
here.
Melanoma
Melanoma is the third most common type of skin cancer comprising less
than 5% of skin cancer cases in the United States. The exact cause of
melanoma is unknown. Unlike basal and squamous cell carcinomas it does
not appear to be related to chronic sun exposure but may be related to
childhood or intermittent exposure. You are more likely to develop
melanoma if you have a family history or if you have fair skin, lots of
moles, or had blistering sunburns as a child.
Some melanomas may start as a precursor lesion called a dysplastic nevus
or atypical mole. Patients who have many of these lesions are more
likely do develop melanoma.
Melanoma is rare in children with 98% of all cases occurring after the
age of 20.
Melanoma is often life threatening if not treated adequately. Although
melanoma accounts for less than 5% of all skin cancers it accounts for
over 75% of deaths from skin cancer. On the other hand, melanoma is
almost always curable if diagnosed early and adequately treated. For
this reason it is important that any new or changing moles, or moles
with the ABCD’s, be evaluated by your doctor.
Treatment options for melanoma are much more limited than for other
forms of skin cancer. The most effective treatment for melanoma is
surgical excision which is often curative if done early. In some cases
this may also involve a selective biopsy of local lymph glands called
sentinel lymph node biopsy. Once melanoma has spread off the skin it is
more difficult to cure. Treatment of advanced melanoma with
chemotherapy, radiation, and immunotherapy are much less effective than
surgery adequately performed on an early lesion.
To view photos and learn more about
Melanoma, please click
here.
Mohs Micrographic
Surgery
Mohs Surgery is a specialized
surgical procedure used for the removal of common skin cancers. It was
developed over 50 years ago by Dr. Frederick Mohs, but only became
popular in the late 1970's. It is performed in the office with local
anesthesia on an outpatient basis. Mohs surgery is often performed by
dermatologic surgeons who have additional fellowship training in the
procedure and in surgical reconstruction.
Mohs surgery is unique for three reasons. First, the surgeon also acts
as the pathologist examining each layer microscopically immediately
after it is removed. This eliminates any chance of communication error
between surgeon and pathologist. Second, on each and every layer 100% of
the margins are examined making it harder to miss any residual tumor.
Third, Mohs surgery is an open-ended procedure. Because it is performed
in the office with local anesthesia we can remove as many small layers
as necessary. This ability to take small layers with each cut keeps the
wound defect as small as possible, which is important in cosmetically
sensitive areas. For these unique reasons, Mohs surgery has the highest
cure rate of any treatment for skin cancer, and achieves this by leaving
the smallest wound defect possible.
Mohs surgery is not necessary for all skin cancers. It is more costly
and time consuming than most other forms of skin cancer treatment. It is
often best suited for treatment of recurrent skin cancers or for tumors
in cosmetically sensitive areas such as the face, ears, scalp, lips,
nose, eyelids, etc.
Fellowship training in Mohs surgery is offered by the American College
of Mohs Micrographic Surgery and Cutaneous Oncology. Dr. Richardson has
completed fellowship training, is a member of the Mohs College, and has
performed thousands of cases of Mohs surgery.
To view before
and after photos of Mohs Micrographic Surgery, please click
here.
Squamous Cell Carcinoma
Squamous Cell Carcinoma (SCC) is the second most common type of skin
cancer comprising about 15% of skin cancer cases in the United States.
The exact cause of SCC is unknown but like basal cell carcinoma it is
closely related to chronic sun exposure, fair skin and family history.
Some SCC’s may begin as a precursor lesion called an actinic keratosis
(AK). AK’s are very common on the face and arms of elderly fair skin
individuals. The presence of AK’s significantly increases the risk of
developing SCC.
SCC of the skin is usually not life threatening although if not
adequately treated it may spread or metastasize to lymph glands or other
organs. Death from squamous cell carcinoma of the skin is rare but it
does occur. As with other forms of skin cancer a worse outcome is more
likely if the tumor is large, neglected, recurrent, or if it occurs in
an immunosuppressed or organ transplant patient. Delay in treatment
usually leads to lower cure rates and a worse cosmetic outcome.
For these reasons treatment of SCC is recommended at the earliest stages
when the tumor is small and may not even be symptomatic.
Avoidance of sun may help prevent SCC. Some studies have shown that
routine sunscreen use can prevent SCC and their precursor lesions, AK’s.
Treatment options for the tumor are similar to those for basal cell
carcinoma and depend on factors including the size and extent of the
tumor, location on the body, cosmetic concerns, cost, and health status
of the patient, etc… Treatment options may include topical creams,
destruction by scraping the tumor off the skin, freezing, surgical
excision, radiation, and Mohs micrographic surgery.
To view photos and learn more about
Squamous Cell Carcinoma, please click
here.
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