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Posts Tagged ‘squamous cell cancer los angeles’


Squamous cell carcinoma. What is it?

Saturday, October 13th, 2012

My beautiful girl

A lot of patients ask me what is squamous cell carcinoma (and how do you spell it)? SCC is the second most common type of skin cancer. Basal cell cancer is first. SCC is potentially more problematic because a small percentage of them metastasize (can travel to other parts of the body) and cause serious problems or death. SCC’s can spread, break apart and travel more easily. I wrote a review paper on metastatic SCC in Dermatologic Surgery, our main journal, and the cases I’ve seen can be absolutely devastating. Luckily with proper treatment and an eagle eye, many lives can be saved. We think SCC’s come from cumulative sun damage, while BCC’s may be due to long intense exposures, but it is not clear. It has been proven that sunscreen use prevents SCC’s and their precursors, actinic keratoses, better known as “precancers.”

Luckily, most SCC’s are caught early enough to not be a long term problem. SCC in-situ (those on the surface of the skin which have not invaded the middle layers microscopically) have an excellent long-term prognosis, provided they are properly treated. If on the head, neck, genitals (men and women get them usually from a past history of genital warts) or other critical places, Mohs surgery is the best choice. Let’s just hope the Affordable Care Act lets us continue with this option. Otherwise, most cases are treated with burning and scraping (electrodessication and curettage) or “ED&C” or an excision. Other non-FDA approved options include imiquimod cream and photodynamic therapy. Cryotherapy in my opinion, is not reliable.

For invasive SCC’s, if the lesion is very small (less than 5 mm) then ED&C or excision may be acceptable if the lesion is off the head and neck. I personally believe that no matter the size of the lesion, if the SCC is on the head and neck regardless if in-situ or invasive, or if the lesion is recurrent, Mohs surgery is the superior choice. Recurrent SCC’s can spell trouble, and I strongly recommend Mohs surgery in those cases.

To read more about the differences between Mohs surgery and excision with frozen sections (“fake Mohs”) please refer to this section on my website

On a lighter note, loved taking my girls to the pumpkin patch last week.

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Skin cancer, the gift that keeps on giving

Saturday, February 4th, 2012

…well at least it’s not genital warts (see previous post). Once you get a skin cancer, unfortunately, you often will get more. The younger you are when you get one, the more likely you will have more in your lifetime. Almost everyone we treat with Mohs surgery has had a previous skin cancer elsewhere. It is important to prevent skin cancer in the first place by avoiding prolonged sun exposure and practicing common sense sun protection. Does that mean you have to be a recluse? No, but purposefully sunbathing is not very smart.

An experienced dermatologist can often recognize a skin cancer in its earliest stages, though every dermatologist has missed something at some point in their careers. (And if they claim they have not, they are big fat liars!). Therefore, we rely on patients to do their own self exam and observe any suspicious lesions for changes in color, shape, size and border, and to come in for periodic exams. Don’t let anyone freeze any lesions more than once without discussing the possibility of a biopsy for any persistent or recurrent lesion. The person that set the record in my office for the longest time spent in Mohs surgery in one day was a celebrity in his 40’s who had had a lesion frozen twice with two different dermatologists. He pulled through wonderfully and took it very well considering, but we were both dumbfounded at the extent that this tumor had grown.

I love what I do and I get the most satisfaction from educating my patients on their skin lesions and skin cancer, but I would rather not be cutting off parts of your nose, eyelids, lips, etc for your sake. Preventative care is really important.

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