Over a million people are diagnosed with skin cancer, or melanoma, each year, and many will share the same emotions: Why me? Am I in serious danger? What should I do? There is no need to panic. Skin cancer is not necessarily life threatening, nor does its therapy have to be disfiguring; however, if left untreated, the disease can continue to progress.
Anyone can get skin cancer. Your risk of developing skin cancer is increased if your parent, child, or sibling has had melanoma. Redheads and blondes have a two-fold to four-fold greater risk of developing melanoma. Darker-skinned people have more melanin, or brownish pigment, in their skin which serves as a buffer by absorbing the sun's harmful ultraviolet rays; thereby lowering, but not eliminating, the risk of skin cancer. Even though there is a strong correlation between ultraviolet exposure to the sun and all types of skin cancer, you can still get skin cancer even if you stay out of the sun.
Warning Signs
Most moles develop sometime after birth, but some people are born with moles. "Birth moles" increase a person's risk for melanoma. The development of a new mole or any changes in the size, color, shape or texture of a mole may be a sign of skin cancer, and should be reported to a dermatologist right away. Melanomas can develop anywhere on the body, even in places that are not exposed to the sun, such as the soles of the feet.
Types of Skin Cancer
There are three main types of skin cancer:
- Basal Cell Carcinoma
- Squamous Cell Carcinoma
- Malignant Melanoma
Basal Cell Carcinoma is the most common type of skin cancer and represents about 80% of new skin cancers. This type is rarely life threatening and does not spread. They can be inherited, but usually occur in patients who have had repeated sun exposure. Patients that develop a Basal Cell cancer have a 60% chance of developing another one within 5 years.
Squamous Cell Carcinoma is another common type of skin cancer that is rarely life threatening. It represents about 16% of new skin cancers and is found most often in people with fair complexions. This type may develop from an Actinic (Solar) Keratosis which is a scaly, crusty bump on sun-damaged skin. They can appear as a red bump, or may seem like an ulcer. They may also seem like a sore that just won't heal. They can range in size from a few millimeters to a few centimeters in diameter.
Malignant Melanoma represents only about 4% of newly diagnosed skin cancers. It is the most serious form of skin cancer and can be deadly. However, if treated early while it is still flat and thin, the cure rate is about 95%. If it is allowed to grow and become lumpy, it can be fatal. This cancer usually stems from a mole that has been present for many years. If you have a mole that doubles in size in just a few months, you should have it examined by a specialist immediately.
There are many treatment options available for skin cancer including scraping and burning, freezing, radiation, routine excision and Mohs surgery. It is necessary to consider all the benefits and drawbacks of the various procedures when you choose your treatment. Often the cancer cells visible to the eye may extend beneath the surface of the skin. These cancer cells must be completely removed or they can lead to regrowth and recurrence of the tumor.
Mohs Micrographic Surgery
Mohs micrographic surgery is a specialized, highly effective technique for removing skin cancers. It was developed in the 1930’s by Dr. Frederick Mohs at the University of Wisconsin and is now practiced throughout the world. Mohs surgery differs from other skin cancer treatments in that it permits the immediate and complete microscopic examination of the removed cancer tissue so that all roots and extensions of the cancer can be eliminated. Mohs surgery has the highest reported cure rate of all treatments for skin cancer.
Treating all skin cancers with Mohs surgery is not necessary. Mohs surgery is reserved for skin cancers that grow back after previous treatment, cancers that are at high risk of recurring, or cancers that are located in cosmetic areas where preservation of the maximum amount of normal skin is important.
Physicians who have the training, surgical and laboratory facilities, and the staff to perform this specialized technique practice Mohs surgery.
WHY REMOVE SKIN CANCERS WITH MOHS SURGERY?
Some skin cancers are deceptively large—far bigger under the skin than they appear to be from the surface. These cancers may have “roots” in the skin or along blood vessels, nerves, or cartilage. Also, skin cancers that recur after previous treatments may send out extensions deep under scar tissue that has formed. Mohs surgery is specifically designed to remove these cancers by tracking and removing these cancerous “roots.”
HOW IS MOHS SURGERY DONE
There are 3 steps involved in Mohs surgery:
The skin is made completely numb using local anesthetic. The visible cancer is removed with a thin layer of additional tissue. This takes only a few minutes and the patient may then return to the waiting room. A detailed diagram (a Mohs map) of the removed specimen is drawn.
The specimen is color coded to distinguish top from bottom and left from right. A technician freezes the tissue and removes very thin slices from the entire edge and undersurface. These slices are placed on microscope slides and stained for examination under a microscope. This is the most time consuming part of the procedure, often requiring an hour or more to complete.
Dr. Memar then carefully examines these slides under the microscope. This allows examination of the entire surgical margin of the removed tissue. That is, the entire undersurface and the complete edge of the specimen is examined. All microscopic roots of the cancer can thus be precisely identified and pinpointed on the Mohs map.
If more cancer is found on the microscopic slides, Dr. Memar uses the Mohs map to remove additional tissue only where cancer is present. This allows the Mohs surgery technique to leave the smallest possible surgical defect because no guesswork is involved in deciding where to remove additional tissue. Only tissue around the “roots” and extensions of cancer is removed.
HOW LONG DOES IT TAKE?
Most cases can be completed in three or fewer stages, requiring less than 4 hours. However, one cannot predict how extensive a cancer will be, because the size of a skin cancer’s “roots” cannot be estimated in advance. We therefore ask that you reserve the entire day for surgery, in case additional surgical sessions are required.
WILL IT LEAVE A SCAR?
Yes. Any form of surgery leaves a scar. Mohs surgery, however, will leave one of the smallest possible surgical defects, and therefore a smaller final scar.
WHAT HAPPENS AFTER THE MOHS SURGERY IS COMPLETED?
When the cancer is removed, Dr. Memar will discuss with you your options. These may include: 1) allowing the wound to heal naturally, without additional surgery (often produces the best cosmetic result), 2) wound repair by Dr. Memar, 3) wound repair by the referring physician or making arrangements for wound repair, or 4) referral to another surgeon for wound closure.
WILL I HAVE PAIN, BRUISING, OR SWELLING AFTER SURGERY?
Most patients do not complain of significant pain. If there is discomfort, Tylenol is usually all that is necessary for relief. However, stronger pain medications will be prescribed when needed. You may have some bruising and swelling around the wound, especially if surgery is being done close to the eyes.
WILL MY INSURANCE COVER THE COST?
Most insurance policies cover the costs of Mohs surgery and the surgical reconstruction of the wound. Please check with your insurance carrier for exact information relating to your surgery. Dr. Memar accepts Medicare assignment for cancer surgery.
HOW DO I PREPARE FOR SURGERY?
Get a good night’s rest and eat normally the day of surgery. If you are taking prescription medications, continue to take them unless otherwise directed. However, avoid taking medications that contain aspirin for ten days before surgery. Also, please do not take any aspirin substitutes, such as Advil, Motrin, ibuprofen, Naproxen, etc. within 24 hours of surgery. You may, however, take Tylenol at any time before surgery. You may want to bring a book or magazine with you to occupy your time while waiting for your slides to be processed and examined. Also, Dr. Memar recommends that you arrange for someone to drive you home after surgery is completed.
Mohs does not rely only on what is seen. Mohs surgery combines the surgical removal of the tumor with the immediate microscopic examination of the tumor and underlying diseased tissue. Our doctor performs Mohs surgery for patients in our region to identify, remove and examine the entire tumor and roots layer-by-layer until the cancer is completely gone. Mohs surgery provides the highest cure rate, has the lowest chance of regrowth, minimizes the potential for scarring or disfigurement and is the most exact and precise means of removal.
Mohs surgery is effective for most types of skin cancer and is commonly used to treat Basal and Squamous Cell Carcinomas. It is the treatment of choice for recurring cancers, large cancers, cancers where the edges cannot be clearly defined, or in areas where it is important to preserve healthy tissue for the maximum functional and cosmetic results.
After our doctor performs your Mohs surgery, your risks of skin cancer can be reduced when you protect yourself from the sun, are aware of suspicious growths and visit your doctor for regular check-ups.
