Skin Cancer

Skin cancer is the abnormal, uncontrolled growth of skin cells caused by radiation from the sun. According to the American Academy of Dermatology (AAD), one in five people will develop skin cancer in their lifetime.

Risk factors include pale skin, family history of skin cancers, being over 40 years old and regular sun exposure. Fortunately, skin cancer is almost always curable if detected and treated early.

The most common skin cancers are basal cell carcinoma, squamous cell carcinoma and melanoma. About 80 to 85% of skin cancers are basal cells, affecting the uppermost layer of the epidermis. Squamous cell carcinoma accounts for 10% of all skin cancers and affects cells in the middle layer of the epidermis. The most serious, and most rare, of skin cancers are melanomas. Melanomas are dangerous since they can metastasize quickly. Melanomas are the leading cause of skin cancer deaths.

Skin cancers vary in shape, color, size and texture, so any new, changed or otherwise suspicious growths or rashes should be examined by a physician. Early intervention is essential to preventing cancer from spreading.

Depending on your skin cancer, various treatment recommendations will be discussed along with cure rates and cosmetic outcomes. Many of these treatments have high cure rates, but Mohs micrographic surgery uniformly produces the highest success rate, especially for the most difficult tumors.

Work with Dr. Patel and the team at True Dermatology to determine the best treatment option for you.

Traditionally, skin cancers have been treated by surgically removing large areas of skin. This leaves the patient with a sizable wound and possibly a long, wide scar. Additionally, a small percentage of these patients will still have cancer remaining in their bodies, requiring additional surgery.

Now patients diagnosed with skin cancer can have a procedure called Mohs Micrographic Surgery, which offers a greater than 99% clearance rate! This state-of-the-art surgery is a delicate and precise procedure that spares as much skin as possible, providing the most optimal cosmetic outcome. Most importantly, when patients leave the office, they know all the cancer has been removed!

Mohs surgery has the highest cure rate — up to 99% for nonmelanoma skin cancers, such as basal cell carcinoma and squamous cell carcinoma.

It is appropriate for most skin cancers and is especially suitable for skin cancer that:

• Is in an area where it’s important to preserve healthy tissue for best functional and cosmetic results
• Has been treated previously and has come back
• Is located near scar tissue
• Is large, greater than 1 cm in diameter
• Does not have clearly defined edges
• Is growing rapidly or uncontrollably
• Is an aggressive subtype (i.e., sclerosing or infiltrating basal cell carcinoma)
• Develops in immunocompromised patients

Dr. Patel is fellowship-trained in Mohs surgery by the American College of Mohs Surgery (ACMS).

The opportunity to participate in Mohs training is extremely competitive.

After completing a residency in dermatology or a related field, a physician can apply to participate in an ACMS-approved fellowship training program. Qualified applicants who have passed a competitive review and selection process undergo a one- to two-year training program.

The training programs are designed to impart experience and judgment. They are comprehensive and rigorous by design because skin cancer occurs in a diversity of forms, degrees and areas of the body.

To complete an ACMS-approved fellowship, a physician must:

• Participate in a minimum of 500 Mohs surgeries.
• Learn to accurately interpret slides of tissue samples that have been removed during Mohs surgery.
• Perform a wide range of reconstructions, ranging from simple closures to complicated multi-step repairs.

Because doctors undergo training over months, they gain a breadth of exposure under the guidance of a qualified Mohs surgeon. This training includes rare tumor pathology, difficult tumor locations and complex wound reconstruction. The fellowship structure provides a depth of experience unmatched by other Mohs programs.

The doctor performing Mohs surgery typically assumes the following roles:

• Anesthesiologist
• Surgical oncologist
• Pathologist
• Plastic surgeon

The ACMS-trained surgeon combines the work of four separate doctors into one. Additionally, these procedures are done in our offices at True Dermatology, so there is no hospital or facility charges.

Once the cancer has been removed, reconstruction for optimizing the final functional and cosmetic result becomes the highest priority.

Dr. Patel will explain your options for repair of the wound, including natural healing, linear closure or using a skin flap or graft. This step will be completed in our office, typically during the same visit as your surgery.

Generally, post-surgical scars improve with time. The team at True Dermatology are experts in reconstruction and aesthetics and are available for you throughout the healing process to discuss any concerns.