Dermatology

Several effective methods are used to treat skin cancer depending on the location of the cancer, its size and previous therapies.

Treatment methods include: surgical removal, or excision, with suturing (stitching); curettage and electrodesiccation (scraping and burning with an electric needle); radiotherapy (X-ray treatments); cryosurgery (freezing); and Mohs micrographic surgery.

Most skin cancers can be removed with an easy, in-office skin surgery. Excision of the skin cancer involves removing an oval shaped piece of tissue that surrounds the skin cancerous lesions. Once the tissue is removed, the wound is closed with dissolving sutures and a linear top layer of nylon sutures. The excised tissue is sent to a Pathologist to confirm all skin cancerous cells have been removed.

The procedure is performed using a local anesthetic (lidocaine) and typically takes 30 minutes to 1 hour to complete.

Special circumstances may require a Mohs surgeon to perform the excision. To learn about Mohs surgery and Heritage Medical Associates’ Mohs Surgeon, Dr. Brent Moody, please click here.

Shortly after your arrival, you will be taken to one of the treatment rooms, where the tumor area will be numbed with a needle.

The doctor will remove a thin layer of skin surrounding the cancer. After this has been done, any bleeding will be stopped with an electric cautery machine. You may return to the waiting room or stay in the treatment room while we examine the removed tissue in our laboratory.

If examination of the tissue reveals that your tissue still contains tumor cells, the procedure will be repeated. Further tissue is removed only from the areas where tumor cells were found.

The goal is the remove all of the skin cancer while preserving the greatest amount of healthy tissue. Since skin cancers can grow deeply and develop roots extending beyond the area that you actually see, the final size of the surgical incision will be determined by the extent of the tumor.

The average number of surgical sessions required is one to three. However, you may require more before your skin cancer is completely removed. Fortunately, this can usually be done in the course of a single day. When surgery is completed, a decision will be made as to the way to manage your wound.

Discomfort. Most patients do not have severe pain, but may experience slight discomfort. If this occurs, we suggest you take two tablets of Tylenol every four hours.

Bleeding. Occasionally, bleeding follows surgery. If this happens, do not become alarmed. Lie down and place steady, firm pressure over the wound as close as possible to the bleeding area. Apply the pressure continuously for 20 minutes (timed). Do not lift the bandage to check on the bleeding. If bleeding persists after 20 minutes of steady pressure, apply pressure for an additional 20 minutes. If bleeding still continues, call our office, or go to the nearest hospital emergency room.

Swelling. Swelling is very common following surgery, particularly when it is performed near the eye. All wounds swell a little. Usually this is not a problem, and the swelling diminishes as the wound heals. Ice packs may help to reduce the swelling.

Drainage. All wounds will drain to some extent during the first week or two. This is why frequent dressing changes are necessary.

Infection. Infection of the wound is unusual. However, if you see think, foul-smelling fluid coming for the wound, call our office immediately. An antibiotic may be necessary.

Redness. All wounds will develop a halo of redness, which disappears gradually. If the area becomes extremely red and itchy you may be allergic to either the ointment or tape. Call our office if this condition develops.

Scarring. All surgeries leave a scar. However, your scar will improve and become less noticeable as time passes.

Stitches and skin grafts. If we close the wound with sutures (stitches) or place a skin graft, you should keep the area clean and dry until the next visit.

You may experience some tightness, or drawing, as the wound heals. This is normal and usually lessens with time. Patients also commonly experience some itching after their wounds have healed. Rubbing a small amount of plain petroleum jelly on the scar often relieves this. Frequently, tumors involve nerves, and it may take up to a year, or even two years, before normal feeling returns to an area. Sometimes the area remains numb permanently. Only time will tell.

The scar tissue that grows over the wound contains many more blood vessels than the skin that was removed. This results in a red scar that may be sensitive to temperature changes. This sensitivity improves with time and the redness gradually fades.

Sometimes, the scar is unacceptable to the patient and the patient’s family. If this is the case, surgical scar revision may be considered. However, we usually advise patients to wait 12 months before having the scar revision performed. This is because the scar continues to improve in appearance and becomes less conspicuous up to one year after surgery.

Cancer of the skin, like other cancers, is a disease of cells, which are tiny structures that make up all parts of the body. Although they differ in shape and function in various organs, all cells reproduce themselves by dividing. Normal growth and repair of tissue takes place in this orderly fashion.

When cell division is not orderly and controlled, abnormal growth occurs. Masses of tissue called tumors build up. Tumors can be benign or malignant. A malignant tumor is a cancer.

Benign tumors do not spread. But cancerous or malignant tumors invade and destroy surrounding normal tissue as they grow. Occasionally, cancer cells may break away from the tumor and spread (metastasize) through either the blood or lymphatic vessels to distant parts of the body, where they form additional tumors.

There are three primary forms of skin cancer: basal cell carcinoma, squamous cell carcinoma and malignant melanoma.

Most skin cancer cases are either basal cell carcinoma or squamous cell carcinoma. Of the two, basal cell carcinoma occurs more frequently and grows more slowly. It rarely spreads through the blood or lymphatic systems to distant parts of the body.

Squamous cell carcinoma is the second most common skin cancer. It is more serious, since it has a greater ability to spread internally to nearby lymph nodes and to other parts of the body.

Malignant melanoma may be life threatening if not treated early. It usually appears as a brownish-black spot or bump in the skin that enlarges and sometimes bleeds. Sometimes melanomas arise in moles that have been present for many years.

Although most skin growths are benign, any new growth on the skin or a sore that does not heal should be brought to your dermatologist’s attention.

Skin cancer has many different appearances including a small, waxy lump that eventually bleeds and crests or as a dry, scaly, red patch. Although it may begin very small, skin cancer can grow to become very large.

Skin cancer sometimes forms from a precancerous skin condition called actinic keratosis. These are red, rough patches of skin that develop as a result of sun damage and are commonly found on the face, neck or hands.

If the doctor thinks that a skin growth may be cancerous, a biopsy is performed. The whole area or a sample of the area is removed surgically and sent for examination under the microscope. The biopsy is used to confirm or rule out a diagnosis of cancer and to determine the type of any cancer found.