Types of Skin Cancer
There are several types of skin cancer, the most common being Basal Cell Carcinoma. Basal Cell carcinoma most often occurs on the sun-exposed areas of the skin and may look like an open sore, reddish patch, or waxy growth with an elevated border and central indentation. Treatment of Basal Cell cancer includes excisional surgery, electrosurgery, microscopically controlled surgery, and radiation.
The second most common type of skin cancer is Squamous Cell Carcinoma. Squamous cell carcinoma also occurs most often on sun-exposed skin and may look like a scaly red patch with irregular borders, a wart-like growth, or an open sore. These cancers may bleed easily if bumped or disturbed. Treatments for this type of cancer include excisional surgery, electrosurgery, radiation, and microscopically controlled surgery.
The most dangerous type of skin cancer is Melanoma. Melanoma may occur on any area of the body and may resemble a mole, but there are important differences. If you notice changes in a mole you should contact a physician immediately. A melanoma may present as an asymmetrical lesion with an irregular border. If the color or pigmentation of the area is not uniform, or if the diameter of the area is greater than six millimeters, these are also danger signs.
Types of Lesions
In addition to these three types of skin cancer, there are two types of lesions that have the potential to progress into skin cancer. One type of pre-cancer is Actinic Keratosis, which appears as a scaly or crusty bump and can be treated with curettage and Electrodesiccation, shave removal, dermabrasion, chemical peels, laser surgery, or topical medication. The second type is the Dysplastic Nevi. Dysplastic Nevi are abnormal moles that resemble Melanoma and are often asymmetrical in shape, have an irregular border, vary in color, and are larger than normal moles. They should be watched carefully for changes that may indicate progressions to Melanoma.
It is important to remember that avoiding sun exposure and tanning beds and wearing sunscreen with an SPF of 30 or higher can best prevent these types of skin cancer.
Skin Cancer Treatment
There are five standard methods for the treatment of skin cancers. The two nonsurgical treatments are cryotherapy (deep freezing) and radiation therapy. The three surgical methods include simple excision, physical destruction (curettage with electrodesiccation) and Mohs micrographic surgery. Newer methods under investigation include photodynamic therapy and immunochemotherapy.
The treatment of each skin cancer must be individualized, taking into consideration such factors as patient’s age, the location of cancer, type of cancer and whether or not cancer has been treated previously. In some instances, more than one type of therapy may be appropriate. But in most cases, only one or two are necessary for particular skin cancer.
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After the removal of the visible portion of the tumor by excision or curettage (debulking), there are two basic steps to each Mohs Micrographic Surgery stage. First, a thin layer of tissue is surgically excised from the base of the site. This layer is generally only 1-2 mm larger than the clinical tumor. Next, this tissue is processed in a unique manner and examined underneath the microscope.
On the microscopic slides, the entire bottom surface and outside edges of the tissue is examined. This issue has been marked to orient top to bottom and left to right. If any tumor is seen during the microscopic examination, its location is established, and a thin layer of additional tissue is excised from the involved area. The microscopic examination is then repeated. The entire process is repeated until no tumor is found.
Mohs Micrographic Surgery allows for the selective removal of skin cancer with the preservation of as much of the surrounding normal tissue as is possible. Because of this complete systematic microscopic search for the “roots” of the skin cancer. Mohs Micrographic Surgery offers the highest chance for complete removal of cancer while sparing the normal tissue. The cure rate for new skin cancers exceeds 97%.
As a result, Mohs surgery is very useful and may be recommended for the following types of cancer:
- When the size or extent of the skin cancer cannot be defined easily.
- When the cancer is in a place, such as the nose, eyelids, lips or ears, where it is desirable to spare as much of the normal skin as possible.
- When the cancer returns after being treated.
- When the cancer is large.
About Mohs Surgery in NYC
Mohs surgery has been shown to be a highly effective treatment for certain types of skin cancer, with a cure rate of up to 99% for certain tumors. Due to the fact that the Mohs procedure is micrographically controlled, it provides the most precise method for removal of the cancerous tissue, while sparing the greatest amount of healthy tissue. For this reason, Mohs surgery may result in a significantly smaller surgical defect and less noticeable scarring, as compared to other methods of skin cancer treatment. The Mohs procedure is recommended for skin cancer removal in anatomic areas where maximum preservation of healthy tissue is desirable for cosmetic and functional purposes. It may also be indicated for lesions that have recurred following prior treatment, or for lesions which have the greatest likelihood of recurrence.
Recovering From Mohs Surgery
Your surgical wound will likely require care during the weeks following surgery. Detailed written instructions will be provided upon your Mohs Surgery at Dr. Rokhsar’s NYC office. You should plan on wearing a bandage and avoiding strenuous physical activity for a week. Most of our patients report minimal pain which is helped with Tylenol. You may experience a sensation of tightness across the area of surgery. Skin cancers frequently involve nerves and months may pass before your skin sensation returns to normal. In rare instances, the numbness may be permanent. You may also experience itching after your wound has healed. Complete healing of the surgical scar takes place over 12-18 months. Especially during the first few months, the site may feel “thick,” swollen, or lumpy, and there may be some redness. Gentle massage of the area (starting about 1 month after the surgery) will speed the healing process.
An indefinite follow-up period of observation is necessary after the wound has healed. You will be asked to return in six weeks, six months, and one year following the procedure. Studies have also shown that once you develop skin cancer, there is a strong possibility of developing other skin cancers in the future. Should you notice any suspicious areas, it is best to check with your physician for a complete evaluation. You will be reminded to return to your dermatologist on a frequent basis for continued surveillance of your skin.
Mohs Surgery FAQ
Will Mohs Surgery leave a scar?
Mohs is a common surgical procedure to remove the layers of cancerous skin. It’s also the most precise technique for the removal of skin cancer. Dr. Cameron Rokhsar specializes in the treatment of skin cancer using the Mohs micrographic surgical technique. All surgical procedures have the potential for some degree of scar visibility. Dr. Rokhsar is also a leading expert in laser surgery treatments and can assure scarring will be minimalized. The appearance of a post-Mohs’ surgical scar depends entirely on the size, location and skin type.
If skin cancer is in a noticeable facial area, should the Mohs Surgery be performed by a plastic surgeon?
Mohs surgery is a very delicate treatment that requires precision. It is advised skin cancer removal be performed by a dermatologist with specialized training in Mohs surgery. Dr. Cameron Rokhsar is a fellowship-trained dermatologist with specialized training in Mohs surgery and has performed countless procedures.
How should I prepare for Mohs Surgery?
Be well rested and eat a good breakfast. Take your usual medications, unless directed otherwise. We request that you do not take any aspirin or aspirin-containing products, such as Anacin or Bufferin, for ten days prior to the surgery. In addition, please do not take Ibuprofen (Motrin, Advil, etc.). These medications may “thin” your blood and cause more bleeding. You may substitute acetaminophen (Tylenol) if required. Do not drink any alcoholic beverages for 24 hours before surgery.
If you have been advised in the past to take antibiotics before a surgical procedure, such as dental work, please adhere to the prescription instructions before your Mohs surgery appointment.
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