Dakota Beacon

Cancer – a powerful word that raises concern and alarm. The emotional power of this single word conjures thoughts of deadly malignancies, interminable suffering, and death. “Skin cancer,” however, sounds more benign because of its visibility and by not being hidden within the body.

I speak from experience on this topic, so let me offer words of encouragement to the would-be skin cancer patient. I have had over two dozen basal and squamous cancers removed including one pre-melanoma cancer. Additionally, I have had pre-cancerous skin treatments too numerous to count to remove damaged skin before it becomes cancerous. These include chemical eradication as well as photodynamic therapy, freezing, and electrodessication.

In 1977 at the tender age of 34 I had a “reality check.” A weeping sore on my left temple proved to be an obvious clue. The sore would scab over, revert to a scaly patch, and soon break open again. Lab results from a biopsy confirmed the tissue to be basal cell carcinoma, the most common but least dangerous skin cancer.

A week later I went under the surgeon’s knife. In an hour-long procedure he excised the basal cell and covered the half-dollar-size wound with a skin graft taken from my collar bone area. Scarring resulted. That was my first encounter with skin cancer. I wish the physicians treating me in the 1970s knew then what they know now. In retrospect, I wish I knew then what I know now.

The slow transformation of sun-damaged skin into basal cell carcinoma or other skin cancers occurs often. Damaged skin may be pre-cancerous. However, if allowed to continue untreated, the damage may transition to full cancer.

There are three types of skin cancers typically resulting from over exposure to the sun. Basal cell carcinoma is the most common type and is easily treated. Treatments may include excision as in my case, electrodessication, radiation treatment, laser surgery, or micrographic surgery. More about this last type in a moment.

Squamous cell carcinoma is the second most common form of skin cancer. Although squamous skin cancer most often arises in sun damaged skin, it can also occur from burns, scars, X-rays, and chemicals. Treatments are like the treatment for basal cells. Squamous cells seldom spread through the body.

Melanoma, the deadliest form of skin cancer, is the least common type. It may look like a mole initially then change in size and color. If these signs appear, or if otherwise in doubt, a dermatologist should be consulted at once. If not detected early, colonies of melanoma cells may spread to internal organs.

At this writing I am preparing for another surgery to remove a squamous carcinoma. As mentioned above, I have had well over two dozen skin cancers removed, mostly by state-of-the-art Mohs surgery. Mohs surgery is a specific type of micrographic skin cancer removal developed by Dr. Fredrick Mohs in the 1930s. Using this technique, a trained dermatologist removes skin cancers one layer at a time. This ensures all cancer has been completely removed. It also ensures that the least amount of good tissue is removed and with minimum scarring.

So, why Mohs surgery? Mohs surgery removes skin cancers with a higher risk for extensions or “roots” not seen with the eye and that can typically be bigger than appear on the skin’s surface. Here are other reasons for using the Mohs procedure: 1) recurring skin cancers following a previous unsuccessful treatment, 2) some cancers that show an aggressive pathology as indicated from a biopsy, 3) cancers that are large or rapidly growing, or 4) cancers that cannot be clearly defined. Mohs surgery technique is typically used near the nose, eyelids, lips, ears, scalp, hands, or feet.

During Mohs surgery, after numbing the area, the surgeon removes all visible skin cancer. An added 2–3-millimeter margin of skin around the wound is removed. While the patient waits with an open wound, the tissue is marked, “mapped,” frozen, and processed. Under the microscope the surgeon examines the tissue for evidence of cancer. If found, the procedure is repeated removing the cancerous tissue until all cancer is excised. This may take one to three iterations. Stitches may not be necessary if the wound is small and shallow.

The advantage of Mohs surgery speak for itself. Mohs surgery results in the highest cure rate -- 95% to 99%. Other methods have a cure rate of 50% to 90%.

Experience is a great teacher. In my case, I consent to undergo a full body scan twice a year by my dermatologist.

My advice to anyone would be to ask questions of your primary care physician during your annual physical exam. Note any suspicious spots or blemishes beforehand. Referral to a dermatologist may be in order. As the saying goes, “An ounce of prevention is worth a pound of cure.”

Dennis M. Patrick can be contacted at (JavaScript must be enabled to view this email address).