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Mohs Surgery & Skin Cancer

Learn more about Mohs Surgery and Skin Cancer and view frequently asked questions.

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Skin Cancer

Skin cancer is mostly caused by sun exposure, however, melanoma has a genetic component in some patients. Some unusual skin cancers have no relation to sun exposure.

Actinic Keratoses ("Precancers")

Actinic keratoses or "precancers" are often the first signs of excessive sun exposure. They look like flesh-colored to pink scaly flat areas or raised hard growths when advanced, and feel like sandpaper or a pointy area. They tend to scale and regrow if picked.

If left untreated, actinic keratoses can develop into squamous cell carcinomas; therefore they are usually treated with cryotherapy (liquid nitrogen freezing) or chemotherapeutic creams such as Efudex (5-fluorouracil). Prevention involves good sun protection and topicals such as Retin-A or glycolic acid.

Basal Cell Carcinoma

Basal cell carcinoma is the most common tyep of skin cancer. Basal cell carcinomas can look like anything from a pink scaly patch to a flesh colored waxy growth to a scar. They are often mistaken for moles, pimples, cysts or rashes. Basal cell carcinoma can even occur on the eyelids. Darker skinned patients can present with a pigmented variant of this cancer.

Though they are often slower growing and highly curable, without treatment they can cause significant disfigurement. Depending on the site, size and subtype of basal cell carcinoma, treatment options include Mohs surgery, electrodessication and curettage (ED&C), excision, Aldara cream or radiation. Mohs surgery provides the highest cure rate.

Squamous Cell Carcinoma (SCC)

Squamous cell carcinoma is the second most common type of skin cancer. It is usually sun related, but can also be due to trauma, scars or warts. Like basal cell carcinoma, their appearance varies widely and can occur anywhere, but most often on sun-exposed areas. There are various subtypes of SCC, including Bowen's disease, SCC in-situ and keratoacanthoma.

Squamous cell carcinomas are very curable in most cases. However, they do have greater potential to metastasize. They also can travel down a nerve which can cause significant morbidity and sometimes mortality.

Treatment options are the same as with basal cell carcinoma. The first signs of a SCC can be an actinic keratosis (precancer) as mentioned earlier. Therefore, sun protection and routine skin exams are key to prevention and early diagnosis.

Melanoma

Melanoma is the 3rd most common type of skin cancer, but its behavior is the most aggressive. Melanomas may be sun-related, genetic or both.

Melanomas are usually brown to black, flat areas or raised bumps. There are rare variants that can be red or white in color. In older patients, they tend to occur on the face as irregular dark splotches, known as lentigo maligna. There are rare cases of melanomas of the palms, soles and nails.

The prognosis of melanoma relates to the thickness of the melanoma at the time of diagnosis and whether it has spread to the lymph nodes. Melanoma in-situ, (confined to the top layer of the skin) has an excellent cure rate.

Melanomas mostly arise spontaneously, and not necessarily from a mole that changed into a melanoma. Therefore, regular examinations, including self-exams, are important.

Dysplastic Nevus (Atypical mole)

Dysplastic nevi are "funny moles" that are more irregular in color, border or size and have specific pathologic features. Some patients have many (dysplastic nevus syndrome) which has a strong genetic component.

All patients with dysplastic nevus are at higher risk for melanoma, so it becomes imperative for regular exams, including self-exams, to occur. Total body photography is a way to document the changes in these moles, which can be done in our office. Most do not need removal, but some may require an excision if severe atypia is found (sometimes called atypical melanocytic hyperplasia).

More Uncommon Skin Cancers

The following are more rare skin cancers. Mohs surgery is often used to treat these cancers.

Dermatofibrosarcoma protuberans (DFSP) often present in younger patients as irregular firm lumps or patches. Microscopically, they grow extensively in many directions with small roots. They can grow to a large size and can metastasize, but cure rates are excellent with Mohs surgery.

Merkel cell carcinoma, atypical fibroxanthoma (AFX) or malignant fibrous histiocytoma (MFH) usually occur in sun-exposed areas as flesh colored or pink bumps. They tend to occur in older patients with a history of other skin cancers. These tumors can be aggressive and metastasize. Mohs surgery is often used for treatment, but with Merkel cell carcinoma radiation is used in addition.

Microcystic adnexal carcinoma or eccrine carcinomas are rare tumors which arise from the sweat ducts. They have small roots so Mohs surgery is often used for treatment.

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