Skin Cancers

Skin cancer screening saves lives. At SMD we always offer a full skin check to new patients and remind patients to get an annual skin check, especially if there is a high risk for skin cancer.

Those with fairer skin who tend to burn easily have the highest risk of skin cancer. However, anyone of any skin color could get a skin cancer.

Some other risk factors include:

  • Use of tanning beds
  • Excessive sun exposure
  • Living in sunny or high altitude climates
  • Prior skin cancer or precancers
  • History of blistering sunburns
  • Extensive number of moles
  • History of atypical moles
  • Family history of skin cancer
  • History of radiation exposure
  • Certain genetic conditions
  • Weakened immune system

Skin cancer screening involves a total body skin exam, including the mouth, scalp, hands, feet, genital and perianal skin.  Even though most skin cancer occurs in sun-exposed areas, this is not always the case, and some of the higher risk skin cancers may develop in areas that patients may not notice or easily see. In addition to looking at and palpating the skin, at SMD we use dermoscopy, a hand-held device that helps us magnify and pick out certain features of various moles and other growths. This helps us identify which skin lesions might need a biopsy or might need to be followed over time versus those that are benign (harmless). We also offer photo-surveillance, where we measure and photograph a mole or lesion to see whether it changes over time.

For more information on skin cancer and skin cancer surveillance, we recommend the following websites as quality resources:

Skin Cancer Treatments

Getting a skin cancer diagnosis can cause a lot of worry and anxiety. Fortunately, most skin cancers that are caught early are readily treatable in the office with little downtime and very low recurrence rates. At SMD we are committed to presenting all safe and effective skin cancer treatment options to our patients. We take the time to review these options for treatment with our patients, as well as start a prevention plan that will help to maintain healthier skin.

Treatment for skin cancers and pre-cancers provided at SMD include:

Skin Cancer Surgery (excision)

This involves cutting the skin cancer out with a “margin” of normal skin to ensure all the cancer cells are removed. The removed portion of skin is sent to the lab so that the pathology can be reviewed to confirm that the edges are free of tumor. Surgeries are performed on-site in our comfortable procedure rooms and are all performed with local anesthesia.  All pre- and post-surgical care will be reviewed with the patient, but most of the time the sutures (stitches), if not-dissolvable, will be removed in two weeks’ time or less.  Most surgeries heal with a simple thin-lined scar, but based on the size of the cancer and the location, the size and configuration of the scar can vary over time.

ED+C (electrodessication and curettage)

This technique is best for certain skin cancers that are caught very early or are very thin, such as superficial basal cell carcinoma. ED+C is a quick procedure where the area is numbed and the cancer is scraped with a curette (circular blade) and then the surface is heated with a technique similar to cautery to stop any bleeding and to further destroy any abnormal skin cells.  This process usually heals quickly with a low risk of infection or recurrence, and results in a circular scar.

Prescription Creams and Topical Chemotherapies

Some patients elect to treat less-aggressive skin cancers or precancers topically with a cream. The goal in these cases is often scar minimization or the avoidance of an in-office procedure with its associated healing time. This can be an ideal treatment for some early skin cancers located in a cosmetically-sensitive location or for patients who are unable to tolerate an in-office procedure. These prescription creams are also excellent for treating individual precancer lesions or larger areas of skin affected by severe sun damage, perhaps a scalp or forehead. They can be a great preventative measure, as well as treatment.

Photodynamic Therapy

Photodynamic therapy (PDT) is a rapidly growing treatment modality for a wide variety of conditions. We find it to be an especially useful tool in treating extensive precancers of the face or scalp. PDT involves the placement of a painless topical medication on the area to be treated and allowing that to absorb for a period of time (typically 1-2 hours). This treatment area of skin is then exposed to blue or red light, which activates the topical medication to help target and destroy abnormal skin cells.  Reactions can vary from mild redness and tingling to occasional blistering and crusting. Two days of total sun avoidance is required. Once healing ensues over the next few days to a week, the resulting skin is healthier, smoother, and often times more youthful appearing too.

Freezing (Cryosurgery)

Cryosurgery (freezing) uses the extreme cold temperature of liquid nitrogen to treat precancers or skin cancers. Skin cells become frozen on exposure to the liquid nitrogen and as they thaw cell destruction ensues, causing temporary redness and mild swelling.  Eventually a blister and scab may form and gradually fall off. This is very commonly used for actinic keratoses, for example, which are very common precancers. Cryosurgery (freezing) often requires no anesthesia and involves spraying a precise amount of liquid nitrogen directly on the skin for a specific amount of time. The longer the spray, the deeper and wider the wound created.  Most of the time the treatment does not result in a scar, but in some cases a permanent white spot could form.

Mohs Surgery 

In instances where a skin cancer is considered high-risk, based on location or skin cancer subtype, we will recommend Mohs Surgery with our board-certified Mohs surgeon. Mohs Surgeons are dermatologists trained in the removal and pathological diagnosis of skin cancers, and perform skin cancer removal by taking the cancer out in “stages.” This involves taking the tumor out with a very narrow border of normal skin, then immediately processing the tissue while the patient is bandaged and waits in the office. Once the tissue is processed, the Mohs Surgeon can review the pathology slides and determine if and where skin cancer might still be present, and thus repeat the surgery and pathology process as needed. As a result, Mohs surgery has an extremely high cure rate. Usually the Mohs surgeon will close the skin (put in stitches) that same day once the surgery is completed, but occasionally they may choose to let the wound heal in on its own or very occasionally have a plastic surgeon do the repair. The entire procedure is performed with local anesthesia and in our comfortable out-patient setting.  For more information, please review the ASDS Mohs Surgery site and speak to your SMD dermatologist.

Melanoma Specialist Referral 

In the rare event that it’s needed, we are fortunate to have many wonderful Melanoma specialists to whom we can refer. This type of evaluation may include seeing an oncologic surgeon who specializes in melanoma surgery, a medical oncologist who can determine if chemotherapy is needed, or imaging specialists such as radiologists. Once a patient is treated for melanoma, it is critical for ongoing skin cancer monitoring and the dermatologists at SMD are eager to provide ongoing care for all of our melanoma patients.