causes more than 75% of skin cancer deaths
Skin Cancer Diagnosis
If you see something suspicious on self exam, contact your health care provider right away for a diagnosis. The best way to definitively diagnose a skin cancer is to biopsy it, and there are three types of biopsies:
Shave biopsy A small layer is shaved off the top of the abnormal growth.
Punch biopsy A circle of tissue is removed from the abnormal area. A punch biopsy is more invasive, but gives the pathologist a cross section of cells to examine.
Excisional biopsy the doctor uses a scalpel to remove the entire growth and some tissue around it. Some cancers are cured through excisional biopsy, however the margins are not checked; if it is cancerous, you won’t know if the entire cancer has been removed.
Biopsies are performed by family practice physicians, internal medicine doctors, dermatologists and surgeons.
Skin Cancer Treatment
Aldara is a topical cream that is FDA-approved for specific types of BCC cancers in non-cosmetically sensitive areas.
Best for small, shallow basal cell cancers on the trunk, arms or legs
Benefits
- Non-surgical
Challenges
- Only approved for a few cancers and locations
- Lowest cure rate, with an 83% clearance
- Treatment course is 6 weeks, as skin slowly sloughs off
- Unclear if cancer is fully treated
This treatment involves burning, then scraping the wound base.
Best for small cancers in non-facial , non-cosmetically sensitive locations
Benefits
- Quick, without stitches
Challenges
- Scarring
- Unclear if cancer is fully treated
Best for small cancers in non-facial, non-cosmetically sensitive locations
Benefits
- Non-surgical
- Quick
Challenges
- Scarring
- Unclear if cancer is fully treated
Multiple daily treatments for 4-6 weeks as the cancer is exposed to radiation.
Best for patients who are not surgical candidates
Benefits
- Non-surgical
Challenges
- Unclear if cancer is fully treated
- Tissue is permanently affected by radiation
Cutting out the cancer with a wide enough margin that, statistically, all the cancer is gone.
Best for small, well-defined cancers in less cosmetically sensitive areas where there is tissue excess.
Benefits
- Can be done by a dermatologist
- Some margin information achieved
Challenges
- Only 4% of margins evaluated
- Leaves a large defect
Thin layers of tissue are systematically excised and examined under a microscope for malignant cells. When all areas of tissue are tumor-free, surgery is complete.
Best for good surgical candidates with BCC or SCC of the face
Benefits
- Highest cure rate
- Best tissue preservation
Challenges
- Not every patient is a good surgical candidate
- Mohs doctors are often not board-certified surgeons and therefore complete treatment can involve more than one physician
- Plastic surgeon who does repair may not pre-op patient and could be left with a defect s/he can’t safely repair
Mohs excision and immediate cosmetic reconstruction performed by one doctor fellowship-trained in Mohs surgery and board-certified in plastic and reconstructive surgery.
Best for surgical candidates with BCC or SCC in cosmetically sensitive areas (facial)
Benefits
- Cure rate same as Mohs
- Pre-operative visit is performed by plastic surgeon prior to removing any tissue
- Excision and reconstruction are done in the same visit
- Most convenient treatment
- Most cost effective treatment
- Gold standard cosmetic results
- Can be combined with cosmetic surgery
Challenges
- Not every patient is a good surgical candidate
- Some reconstructions can have lengthy recovery processes
Click here for more information on Plastic Micrographic Surgery