Dakota Beacon

Cancer! The very word evokes dread. By qualifying the word with an adjective, the seriousness of the disease seems less severe. “Skin cancer” sounds much less threatening. Maybe the fact that skin cancer is visible and not hidden within the body makes it seem less threatening.

I speak with familiarity on this topic, so let me offer words of encouragement to would-be skin cancer casualties by recounting my own experiences. I have had many basal cells, some squamous, and one pre-melanoma cancers removed by excisional and micrographic surgery. Additionally I have had many pre-cancerous skin treatments in an attempt to remove the damaged skin before becoming cancerous. These treatments included chemical eradication as well as photodynamic therapy, freezing, and electrodessication.

In 1977 at the tender age of 34 reality struck. A weeping sore on my left temple provided 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 of many encounters with skin cancer. I wish the physicians treating me in the early 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, or actinic keratosis, into basal cell carcinoma or other skin cancers, is common. Various keratoses may be pre-cancerous. However, if allowed to continue untreated, the keratoses may transition to full cancer.

There are three types of skin cancers resulting from over exposure to the sun. Basal cell carcinoma is the most common type and is easily treated. Treatments may include excisional surgery 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 most often arises in sun damaged skin, it can also occur from burns, scars, X-rays, and chemicals. Treatments are similar to the treatment for basal cells. Squamous cells rarely spread through the body, but if so, it can be fatal.

Melanoma, the most deadly form of skin cancer, is the least common type. It may look like a mole initially and change in size and color. If these signs appear, or if otherwise in doubt, a dermatologist should be consulted immediately. If not detected early, colonies of melanoma cells spread to internal organs. Early melanoma is treated surgically similar to other skin cancers.

At this writing I have had well over a dozen skin cancers removed, six of which were done by Mohs surgery. I am preparing for my seventh Mohs procedure.

Mohs surgery is a specific type of micrographic skin cancer removal developed by Dr. Fredrick Mohs in the 1930s. Using this technique, trained dermatologists remove 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 is used for skin cancers with a higher risk for extensions or “roots” not seen with the eye and can typically be bigger than appear on the surface. Here are some reasons for treating skin cancers with a Mohs procedure: skin cancers that recur after previous treatment; that show an aggressive pathology on the biopsy; that are large; that are rapidly growing; or that cannot be clearly defined. Mohs surgery technique is typically used in close proximity to the nose, eyelids, lips, ears, scalp, hands, or feet.

Advantages of Mohs surgery speaks for itself. Mohs surgery results in the highest cure rate -- 95% to 99%. Other methods have a cure rate of 50% to 90%. The effectiveness of Mohs surgery permits the surgeon to evaluate 100% of the margin as well as detect cancer “roots” that were missed in the initial excision.

During Mohs surgery, after numbing the area, the surgeon removes all visible skin cancer. An additional 2-3 mm margin of skin around the wound is removed. While the patient waits with 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 on the patient removing the cancerous tissue until all cancer is excised. This may take two to three iterations. Stitches may not be necessary if the wound is small and shallow. Otherwise, stitches are required.

Experience is a great teacher. My advice to any young adult or older person 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).