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Skin Cancer Surgeries

"Mohs surgery is the single most effective technique for removing Basal Cell Carcinoma and Squamous Cell Carcinoma, the two most common skin cancers. Cure rates are 98% or higher with Mohs, significantly better than the rates for standard excision or any other method." 

There are basically four reasons for performing skin surgery:

  1. To establish a definite diagnosis with a skin biopsy;
  2. To prevent or provide early control of disease;
  3. To improve the skin's appearance by removing growths, discolorations, or damaged skin caused by aging, sunlight, or disease;
  4. Cosmetic skin improvement.

When You Should Consult a Dermatologist About a Mole

A change in a mole can indicate a serious problem. A dermatologist should be seen if a mole or skin lesion becomes larger, changes color, or develops an irregular border. Other warning signs include itching, crusting, pain, and bleeding. Extensive and potentially disfiguring surgery can often be prevented by prompt surgical removal, by specialized freezing, by treatment with chemicals applied to the diseased tissue, or with the aid of a laser.

Types of Skin Cancer

There are two kinds of skin tumors, benign (non-cancerous) and malignant (cancerous). Of the three main types of skin cancer, the most common and least serious is the basal cell cancer.

Basal Cell Cancer typically appears as a shiny, small lump on sun-exposed areas of the skin. It is common for individuals who spend a lot of time outdoors without UVA/UVB protection. Though these types of tumors grow slowly, they can reach a very large size and penetrate deeply if they are not treated. They may often bleed, develop a crust, seem to heal, and then bleed again. Basal cell cancers have a high cure rate and are easily treated with minor out-patient surgery if detected early.

Squamous cell cancer may show up as a lump or red scaly growth. Untreated, squamous cell cancer can spread and even cause death. It is important to see a dermatologist as early as possible if you suspect that a lesion may be squamous cell. The dermatologist can perform a biopsy to diagnose the lesion and provide the appropriate treatment as needed.

Malignant melanoma is the least common but most serious form of skin cancer. It appears as a dark brown or black mole with uneven borders and irregular color, in shades of black/blue, red, or white. Malignant melanoma most commonly occurs on the upper backs of men, and on the lower legs of women, although it can also develop on the face and other areas of the body. It can spread to other organs (brain, bone, liver, lungs) and cause death. There is a rare form of melanoma that occurs in families with atypical moles. These individuals have many unusual moles, some of which may need to be removed.

Treatment for Skin Cancer

Treatment for skin cancer varies according to the location, extent, and aggressiveness of the cancer and the patient's general health. In most cases, the Dr. Abrams will take a small piece of the abnormal tissue called a biopsy. The tissue is sent to a remote laboratory and examined under a microscope by a dermatopathologist to determine whether it is malignant.

Malignant tumors require more treatment such as curettage, surgical excision; cryosurgery; Mohs' microscopically controlled surgery; topical chemotherapy; laser surgery or radiation therapy.

Curettage and electrodesiccation involve scraping away the malignant tissue with a sharp surgical instrument called a curette. An electrosurgical unit may then be used to stop bleeding and remove a zone of normal tissue.

Surgical excision involves cutting into the skin, removing the growth, and then closing the wound with stitches.

Biopsy means to remove a small piece of the skin for examination under the microscope and diagnosis.

Cryosurgery involves the use of a machine that sprays liquid nitrogen directly onto the skin, or contacts the skin with an instrument, which freezes the cancerous tissue. Freezing can destroy cancer cells, and wound healing will occur with minimal scarring.

Mohs surgery is a way of removing a tumor where each bit of tissue is examined under the microscope to determine the site and extent of malignant cells before more tissue is removed. While the procedure is time consuming, it yields a very high cure rate and is indicated for recurrent tumors and tumors located in areas of high risk for recurrence, such as on and around the nose.

Topical chemotherapy involves the application of a chemical, 5-fluorouracil, which destroys precancerous growths and sometimes cancerous tissue.

Radiation therapy can also destroy cancerous tissue and is useful in certain types of skin cancer, as well as in selected individuals for whom surgery is not possible.

At Abrams Dermatology, we specialize in all of the above methods of treating skin cancers (including Mohs) with the exception of chemotherapy and radiation. If those treatments are necessary, we will provide recommendations for treatment at other facilities.

Abrams Dermatology
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