About Skin Cancer

The best way to tell if you have skin cancer is to see a dermatologist who is trained to distinguish the features of skin cancer. You should see a dermatologist right away for a skin cancer check if you see anything new on your skin that lasts for 2 weeks or longer and is:

• Growing
• Changing shape
• Painful, itching or bleeding

When you visit the dermatologist, they will carefully examine your skin for any suspicious growths, moles, and rashes to check them for skin cancer.

If a dermatologist finds something that could potentially be skin cancer, the dermatologist will biopsy the spot by taking a small piece of skin to be sent to a lab.  Skin cancer cannot be diagnosed without a biopsy. A biopsy is quick, safe, and easy for a dermatologist to perform. A biopsy should not cause anxiety. The discomfort and risks are minimal.

Treatment Options

If the skin biopsy confirms skin cancer, your dermatologist will inform you of the diagnosis and discuss the possible treatment options.  Your dermatologist will help you select the best treatment option for you after considering:

• Type of skin cancer (Basal Cell, Squamous Cell and Melanoma)
• Where the skin cancer appears on the body
• Size of the skin cancer
• Stage of the cancer (how deep the skin cancer has invaded and whether it has spread)
• Patient’s health and medications

After considering the above, you and your dermatologist will choose 1 or more of the following treatments for the skin cancer.

Surgical Treatment

When treating skin cancer, the goal is to remove all of the cancer. When the cancer has not spread, this is often possible. To remove skin cancer, the following surgical treatments may be used:

Excision: To perform this, the dermatologist numbs the skin and then surgically cuts out the skin cancer and a little extra normal-looking skin around the cancer. This normal-looking skin is called a margin. The more dangerous or aggressive skin cancers are treated with bigger safety margins to make sure all the cancerous cells are removed. Most skin cancer excisions can be performed in a dermatologist’s office with local anesthesia.

Mohs Surgery: Mohs Micrographic Surgery is a surgical procedure used for removal of cancerous skin cells. The procedure was created by Dr. Fredrick Mohs at the University of Wisconsin in the 1930s and has come to be known as the most successful treatment for Basal cell and Squamous cell carcinomas. This surgical technique has become extensively utilized since it has the exceptional ability to remove all the cancerous skin cells while taking the smallest possible margin of healthy skin.  As the Mohs surgeon is able to visualize the extent of the skin cancer and remove it, the procedure has tremendously high cure rates at 98% or higher. Mohs Surgery is recommended for high-risk cancers located on the eyes, lips, genitals, feet, face, neck, nose, hands, lower legs and ears.

Mohs surgery begins with the surgeon removing the visible part of the skin cancer. Because cancer cells are not visible to the naked eye, the surgeon also removes some skin that looks normal but may contain cancer cells. This part of the surgery is performed one layer at a time. After removing a layer of skin, it is prepared so that the surgeon can examine it under a microscope and look for the extent of the cancer cells. If the surgeon sees cancer cells at the edge of the layer, the surgeon removes another layer of skin. This layer-by-layer approach continues until the surgeon no longer finds cancer cells. In most cases, Mohs surgery can be completed within a few hours depending on how many layers are needed.

Learn More About Mohs Surgery

Mohs Surgery Referral form

Curettage and electrodesiccation: This destructive procedure may be used to treat small basal cell and squamous cell skin cancers that have not invaded into the deeper layers of the skin. It involves scraping away the tumor with a curette (a surgical tool shaped like a sharp spoon) and then using electrocautery to control the minimal bleeding.  This scraping and the cauterizing process is typically repeated 3 times. The wound tends to heal without stitches like around “cigar burn.” This treatment method is about 93% effective as it does not provide the dermatologist with confirmation of complete removal of the skin cancer. It is recommended to monitor the site for possible recurrence and see your dermatologist regularly for follow up skin cancer checks

Other Treatments

Surgical treatment is not the correct option for everybody’s skin cancer. Some patients cannot undergo surgery. Sometimes, surgery cannot remove all of the cancer, and more treatment is used to help get rid of cancer. Other treatments for skin cancer are:

Radiation:   External radiation by a radiation oncologist can help treat larger, or deeper lesions that can’t be completely removed with surgery.

Immunotherapy: This treatment uses the patient’s own immune system to fight the cancer. The patient applies a cream (generic name is imiquimod) to the skin as directed by the dermatologist.

Cryosurgery: The dermatologist freezes the skin cancer. Freezing destroys the treated area, causing the skin and cancer cells to die and slough off.

Chemotherapy applied to the skin: The generic name for the medicine used in this treatment is 5-fluorouracil or 5-FU. The patient applies 5-FU to skin cancer. It destroys the damaged skin cells. When the skin heals, new skin appears.

Chemotherapy: If the cancer spreads beyond the skin, chemotherapy may kill the cancer cells. When a patient gets chemotherapy, the patient takes medicine. This medicine may be swallowed, injected (shots), or infused (given with an IV). The medicine travels throughout the body and kills the cancer cells. The medicine also destroys some normal cells. This can cause side effects, such as vomiting and hair loss. When chemotherapy stops, the side effects usually disappear.

Photodynamic therapy: This treatment consists of 2 phases. First, a chemical is applied to skin cancer. This chemical sits on the skin cancer for several hours. During the second phase, the skin cancer is exposed to a special light. This light destroys the cancer cells.

Radiation therapy: Radiation may be used to treat older adults who have a large skin cancer growth, a skin cancer that covers a large area, or skin cancer that is difficult to surgically remove. Radiation therapy gradually destroys the cancer cells through repeated exposure to radiation. A patient may receive 15 to 30 treatments. This treatment is often only recommended for older adults. Many years after a person is exposed to radiation, new skin cancer can develop.