Skin Cancer Treatment - Mohs Cancer Surgery

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Dr. Street performs Mohs cancer surgery, a skin cancer removal technique which uses microscopy to remove only the cancerous tissue, leaving healthy tissue intact and unharmed. This precise method minimizes the chance of cancer regrowth, and lessens the likelihood of scarring or disfigurement. This specialized surgery has the distinction of providing the highest skin cancer cure rate - up to 99 percent even if other forms of treatment have failed - as well as the most pleasing cosmetic results.

 

• Levulan (Aminolevulinic acid 20%) is a naturally occurring photosensitizing compound which has been approved by the FDA to treat precancerous skin lesions (actinic keratoses). The blue light treatment treats actinic keratoses we can see, as well as actinic keratoses we cannot see.
• Levulan is applied to the skin and subsequently is "activated by specific wavelengths of light."
• During the treatment, Levulan is applied to the skin, and is left on for a period of time determined by the condition being treated (usually 30-60 minutes). Once the allotted time has expired, the blue light is applied for 10-15 minutes. While in front of the light, a patient may experience burning, stinging, and itching similar to a sunburn, or in some cases, it can be slightly more intense than a sunburn.
• Following the Levulan Photodynamic Therapy, the skin will be cleansed and sunblock will be applied.
• Some people may develop redness, swelling, and possible peeling of the skin after the procedure.
• Direct sunlight, as well as bright indoor light, should be avoided for 48 hours following the treatment due to photosensitivity. Exposure may result in stinging and/or burning sensations and may cause increased redness or swelling of lesions.
• A sunblock, such as one containing zinc oxide, and protective clothing should be worn during the first 48 hours following treatment.
• If you do experience redness, swelling, peeling or flaking, or open areas, know that it may last for 7 days and possibly up to 2 weeks.
  

• Cryosurgery - freezing using liquid nitrogen
• Topical Chemotherapy - applying a cream or lotion
• Chemical Peeling
• Dermabrasion
• Other dermatologic surgical procedures

Basal Cell Carcinoma (BCC)

Basal Cell Carcinoma is the most common type of skin cancer. It occurs most frequently on the head and neck, but also on the trunk and lower limbs, and often appears as a fleshy bump, nodule, or red patch. BCCs are frequently found in fair-skinned people and rarely occur in dark-skinned individuals.

BCCs usually grow slowly, but this does not mean treatment should be delayed. While BCCs rarely metastasize (spread) to other organs, if untreated, the cancer often will begin to repeatedly bleed and crust over, and can extend below the skin to the bone and nerves causing considerable local damage.

Squamous Cell Carcinoma (SCC)

Squamous Cell Carcinoma is the second most common skin cancer.  While primarily found in fair-skinned people, SCC can occur in old scars and burns, therefore affecting all skin types. Typically located on the rim of the ear, face, near the mouth or on the trunk, this cancer may appear as a firm bump, or as a red, scaly patch.

SCC can develop into large masses and become invasive, leading to extensive local tissue destruction and possible risk of metastasis. Therefore, it is important to get early treatment. When detected and treated early, the cure rate for both BCC and SCC approaches 95 percent.

Melanoma

• The most deadly form of skin cancer
• Due to uncontrollable growth of pigment-producing tanning cells
• May suddenly appear without warning, but can also develop from or near a mole
• May spread, making treatment of unusual moles essential

• Follow the ABCDE rule when looking for irregular moles & melanoma:
• Asymmetry
• irregular Borders
• Color is not uniform
• Diameter is 6mm or more
• sudden Elevation

Skin Cancer Treatment

A dermatologist will select the most appropriate treatment depending on the location, size, type and severity of the skin cancer, which may include scraping, excision and suturing, freezing with liquid nitrogen or Mohs micrographic surgery, an advanced surgical technique performed by a highly trained specialist.

Mohs Surgery

Mohs Micrographic Surgery is the most advanced and effective treatment procedure for skin cancer available today. The procedure is performed by specially trained surgeons who have completed at least one additional year or fellowship training (in addition to the physician's three-year dermatology residency) under the tutelage of a Mohs College member.

Initially developed by Dr. Frederic E. Mohs, the Mohs procedure is a state-of-the-art treatment that has been continuously refined over 70 years. With the Mohs technique, physicians are able to see beyond the visible disease to precisely identify and remove the entire tumor layer by layer while leaving the surrounding healthy tissue intact and unharmed. As the most exact and precise method of tumor removal, it minimizes the chance of re-growth and lessens the potential for scarring or disfigurement.

Because the physician is specially trained in surgery, pathology, and reconstruction, Mohs sugery has the highest success rate of all treatments for skin cancer - up to 99 percent. The Mohs technique is also the treatment of choice for cancers of the face and other sensitive areas as it relies on the accuracy of a microscopic surgical procedure to trace the edges of the cancer and ensure complete removal of all tumors down to the roots during the initial surgery.

About Mohs Micrographic Surgery Effectiveness

Mohs Micrographic Surgery is an effective and precise method for treating basal cell and squamous cell skin cancers.

Because the Mohs Micrographic Surgery process features a systematic microscopic search that traces skin cancer down to its roots, it offers the highest chance for complete removal of the tumor while sparing the normal tissue surrounding it.

Clinical studies conducted at various national and international medical institutions - including the Mayo Clinic, the University of Miami School of Medicine and Royal Perth Hospital in Australia - demonstrate that Mohs surgery provides five year cure rates that exceed 99 percent for new cancers, and 95 percent for recurrent cancers.

Mohs Micrographic Surgery is primarily used to treat basal and squamous cell carcinomas, but can be used to treat less common tumors including melanoma.

Mohs Surgery is appropriate when:

• The cancer is in an area where it is important to preserve healthy tissue for maximum functional and cosmetic result, such as eyelids, nose, ears, lips, fingers, toes, and genitals;
• The cancer was treated previously and recurred;
• Scar tissue exists in the area of the cancer;
• The cancer is large;
• The edges of the cancer cannot be clearly defined;
• The cancer is growing rapidly or uncontrollably.
  

Skin Cancer Protection

• Generously apply a broad-spectrum, water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 15 to all exposed skin. “Broad-spectrum” provides protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Re-apply approximately every  one and a half to two hours, even on cloudy days, and after swimming or sweating.
• Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible.
• Seek shade when appropriate, remembering that the sun's rays are strongest between 10 a.m. and 4 p.m. If your shadow is shorter than you are, seek shade.
• Protect children from sun exposure by playing in the shade, using protective clothing and applying sunscreen.
• Use extra caution near water, snow and sand as they reflect the damaging rays of the sun, which can increase your chance of sunburn.
• Get vitamin D safely through a healthy diet that may include vitamin supplements. Don't seek the sun.
• Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you've been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it.
• Check your birthday suit on your birthday. If you notice anything changing, growing or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early. Get familiar with your skin, moles, freckles and  “beauty marks.”