Skin Cancer Removal: How it Works and What Are Your Options?
May is Skin Cancer Awareness Month. During the entire month, we’re going to be shedding light on different aspects of skin cancer, including prevention and detection. This week, we’re speaking to Dr. Scott Dunbar on the various methods of skin cancer removal.
How do you decide which method is best for removing skin cancer lesions?
Dr. Dunbar: Each skin cancer is unique, and I take many factors into account when deciding how to best remove the cancer. The most important factor is the severity of the skin cancer. This ranges from the merely ‘annoying’ types like basal cell carcinoma and some types of squamous cell carcinoma to the more concerning forms like melanoma. Another critical factor is where the tumor is located on the patient’s body. A less aggressive tumor located on an arm or leg is much more easily treated than a cancer located on the tip of the nose or near the eyes.
Another factor to consider is what is in the patient’s best interest. Sometimes we can simply scrape out the cancer cells and let the wound heal in on its own, and sometimes it’s best to do a more advanced surgical procedure and high level repair of the wound. In short, I take each cancer and patient into account before I make a treatment decision, and have a conversation to make sure I choose the best possible option for the patient.
Do different types of skin cancers require different removal methods?
Dr. Dunbar: Definitely. More dangerous cancers like melanoma can require large ‘safety margins’ to make sure we get the best cure rate. Others like basal cell carcinoma can be treated more conservatively with Mohs Surgery, which leaves as much healthy skin intact as possible.
How does Mohs surgery work?
Dr. Dunbar: Mohs Surgery was invented by Dr. Frederick Mohs in the 1930s as a way to treat skin cancers. It is the most precise and elegant method to remove many forms of skin cancer. I start by numbing the area and taking out a small layer of tissue around a diagnosed skin cancer. This is completely painless for the patient. The tissue undergoes specialized processing right in the office where I will examine 100% of the edges.
The reason this works so well is that often, skin cancers have ‘roots’ that extend much farther than what meets the eye. With the Mohs technique, I am able to precisely identify and map these roots and continue to remove them in layers until all the skin cancer is gone. This leads to the absolute highest cure rate, well over 99% in most cases.
What are some common misconceptions about skin cancer removal procedures?
Dr. Dunbar: I often have patients ask me if their surgery will leave a scar. Unfortunately, there is no way to remove a skin cancer that doesn’t leave some type of scar behind. Like all fellowship trained Mohs Surgeons, I have been extensively trained in skin surgery and have numerous tricks to minimize the appearance of the surgery. I find that patients are usually very happy to trade their dangerous skin cancer for a barely visible scar.
The other thing that I think surprises people is that a Mohs procedure takes a long time. Processing the tissue in the office requires a lot of time for each layer, and sometimes it takes several layers to get out all the cancer’s roots. This can result in a long day for the patient, but we encourage patients to bring a tablet or book for entertainment and lots of snacks to stay comfortable throughout the day.
Do some areas on the skin leave worse scars than others?
Dr. Dunbar: Like lots of things in skin cancer, it depends. Typically, the bigger the cancer is, the bigger the scar will be, so I always encourage my patients to come in and get checked out anytime they are concerned about a growth on their skin. Early detection and treatment are the best ways to keep your skin healthy and happy.
At what point do you recommend Mohs vs other removal methods?
Dr. Dunbar: Mohs is usually reserved for more challenging basal and squamous cell carcinomas. These are cancers that are either in very delicate areas like the face, scalp, and hands, or relatively large lesions on the body. Small growths that are not on sensitive areas are typically easy to remove with simple scraping or a simple excision which takes much less time.
How does someone who has had a skin cancer prevent getting another skin cancer in the future?
Dr. Dunbar: Unfortunately, a lot of the sun damage that causes skin cancer occurs in the teenage years – so much of the damage is done. But there is still a lot we can do to keep our patients healthy. If you have gotten one skin cancer, the odds of getting another are increased. We recommend getting regular skin screenings, because treating a smaller cancer is much easier than waiting until it grows larger.
Also, it’s never too late to protect your skin from the sun’s harmful rays. Lots of sunscreen–SPF of 50 or higher–reapplied every two hours is best, as well as wearing protective clothing and staying in the shade when possible. There are also some treatments we can do in the office to actually reverse some of the sun damage patient’s have from their early years, such as photodynamic therapy (PDT). I really love using these options to reduce the risk of skin cancers.
For more information on skin cancer, visit The Skin Cancer Foundation.
Scott Dunbar, M.D. is a board-certified dermatologist specializing in Mohs skin cancer surgery and advanced cosmetic dermatology. Dr. Dunbar sees patients in Schweiger Dermatology Group’s Murray Hill, Deer Park and Mattituck and Hoboken, New Jersey dermatology offices.