Basal Cell Carcinoma
Basal Cell Carcinoma (BCC) is the most common type of skin cancer comprising about 80% of all skin cancers in the United States. The exact cause of BCC is unknown but it is closely related to chronic sun exposure, fair skin and family history. There is no known precursor lesion to basal cell carcinoma. BCC is almost never life threatening nor does it spread or metastasize to other organs. If untreated, however, the tumor will continue to grow and can invade or destroy adjacent structures. There are many cases where patients have lost an eye or part of their nose or ear because the tumor was neglected or inadequately treated. Delay in treatment will also usually lead to lower cure rates and a worse cosmetic outcome. For these reasons treatment of basal cell carcinoma is recommended at the earliest stages when the tumor is small and may not even be symptomatic. Avoidance of sun may help prevent BCC. Treatment options for the tumor are many and depend on factors including the size and extent of the tumor, location on the body, cosmetic concerns, cost, and health status of the patient, etc… Treatment options may include topical creams, destruction by scraping the tumor off the skin, freezing, surgical excision, radiation, and Mohs micrographic surgery.
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Melanoma is the third most common type of skin cancer comprising less than 5% of skin cancer cases in the United States. The exact cause of melanoma is unknown. Unlike basal and squamous cell carcinomas it does not appear to be related to chronic sun exposure but may be related to childhood or intermittent exposure. You are more likely to develop melanoma if you have a family history or if you have fair skin, lots of moles, or had blistering sunburns as a child. Some melanomas may start as a precursor lesion called a dysplastic nevus or atypical mole. Patients who have many of these lesions are more likely do develop melanoma. Melanoma is rare in children with 98% of all cases occurring after the age of 20. Melanoma is often life threatening if not treated adequately. Although melanoma accounts for less than 5% of all skin cancers it accounts for over 75% of deaths from skin cancer. On the other hand, melanoma is almost always curable if diagnosed early and adequately treated. For this reason it is important that any new or changing moles, or moles with the ABCD’s, be evaluated by your doctor. Treatment options for melanoma are much more limited than for other forms of skin cancer. The most effective treatment for melanoma is surgical excision which is often curative if done early. In some cases this may also involve a selective biopsy of local lymph glands called sentinel lymph node biopsy. Once melanoma has spread off the skin it is more difficult to cure. Treatment of advanced melanoma with chemotherapy, radiation, and immunotherapy are much less effective than surgery adequately performed on an early lesion.
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Mohs Micrographic Surgery
Mohs Surgery is a specialized surgical procedure used for the removal of common skin cancers. It was developed over 50 years ago by Dr. Frederick Mohs, but only became popular in the late 1970's. It is performed in the office with local anesthesia on an outpatient basis. Mohs surgery is often performed by dermatologic surgeons who have additional fellowship training in the procedure and in surgical reconstruction. Mohs surgery is unique for three reasons. First, the surgeon also acts as the pathologist examining each layer microscopically immediately after it is removed. This eliminates any chance of communication error between surgeon and pathologist. Second, on each and every layer 100% of the margins are examined making it harder to miss any residual tumor. Third, Mohs surgery is an open-ended procedure. Because it is performed in the office with local anesthesia we can remove as many small layers as necessary. This ability to take small layers with each cut keeps the wound defect as small as possible, which is important in cosmetically sensitive areas. For these unique reasons, Mohs surgery has the highest cure rate of any treatment for skin cancer, and achieves this by leaving the smallest wound defect possible. Mohs surgery is not necessary for all skin cancers. It is more costly and time consuming than most other forms of skin cancer treatment. It is often best suited for treatment of recurrent skin cancers or for tumors in cosmetically sensitive areas such as the face, ears, scalp, lips, nose, eyelids, etc. Fellowship training in Mohs surgery is offered by the American College of Mohs Micrographic Surgery and Cutaneous Oncology. Dr. Richardson has completed fellowship training, is a member of the Mohs College, and has performed thousands of cases of Mohs surgery.
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Squamous Cell Carcinoma
Squamous Cell Carcinoma (SCC) is the second most common type of skin cancer comprising about 15% of skin cancer cases in the United States. The exact cause of SCC is unknown but like basal cell carcinoma it is closely related to chronic sun exposure, fair skin and family history. Some SCC’s may begin as a precursor lesion called an actinic keratosis (AK). AK’s are very common on the face and arms of elderly fair skin individuals. The presence of AK’s significantly increases the risk of developing SCC. SCC of the skin is usually not life threatening although if not adequately treated it may spread or metastasize to lymph glands or other organs. Death from squamous cell carcinoma of the skin is rare but it does occur. As with other forms of skin cancer a worse outcome is more likely if the tumor is large, neglected, recurrent, or if it occurs in an immunosuppressed or organ transplant patient. Delay in treatment usually leads to lower cure rates and a worse cosmetic outcome. For these reasons treatment of SCC is recommended at the earliest stages when the tumor is small and may not even be symptomatic. Avoidance of sun may help prevent SCC. Some studies have shown that routine sunscreen use can prevent SCC and their precursor lesions, AK’s. Treatment options for the tumor are similar to those for basal cell carcinoma and depend on factors including the size and extent of the tumor, location on the body, cosmetic concerns, cost, and health status of the patient, etc… Treatment options may include topical creams, destruction by scraping the tumor off the skin, freezing, surgical excision, radiation, and Mohs micrographic surgery.
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