|
The most common forms of skin cancer are basal cell carcinoma,
squamous cell carcinoma, and melanoma. Melanoma is the least
common but most aggressive tumor. Treatment of melanoma depends
mostly on the thickness of the tumor and often requires a
multi-specialty approach. Squamous cell and basal cell carcinoma
can be treated by a variety of methods.
Curettage
Commonly called ED&C for electrodessication and curettage,
this technique involves scraping away the tumor with a sharp
instrument followed by destruction with an electrical needle.
The resultant wound is allowed to heal on its own, typically
leaving a round, shiny and slightly discolored scar.
Surgical Excision
Surgical excision involves removing the tumor with a margin
of normal skin. The tissue is mailed to a lab to ensure
that the tumor is completely removed. The wound is closed
with stitches leaving a linear scar, or the wound can be
left to heal on its own which leaves a round shiny scar.
Cryosurgery
Liquid nitrogen is applied directly to the skin to freeze
the cancerous tissue. An open wound forms at the site of
treatment and heals in four to eight weeks. The resultant
scar is typically smoother and lighter colored than normal
skin.
Topical Chemotherapy
Creams containing 5-fluorouracil or imiquimod can destroy
small superficial tumors. The creams are applied once or
twice daily for one to three months, during which time the
areas often become irritated or scabbed.
Laser Surgery
Carbon dioxide laser treatment involves intense waves of
light that are beamed at cancerous skin to cut away or vaporize
the tissue and a margin of normal skin. The open wound is
left to heal on its own, which usually leaves a shiny round
scar.
Mohs Micrographic Surgery
Mohs micrographic surgery is our most accurate method to
remove basal and squamous cell carcinomas. Under local anesthesia,
the tumors roots are traced out using a very precise method
of tissue analysis that conserves normal skin. We recommend
Mohs surgery for situations where it provides the highest
cure rates (99% for a new basal cell carcinoma and 96% for
a new squamous cell carcinoma):
- Cancers on the scalp, face, neck, eyelids, ears, lips,
nose
- Cancers that recurred after previous treatment
- Cancers beside old scars
- Cancers that are large
- Cancers with poorly defined edges
- Cancers that grow rapidly
Any physician who performs surgical excision of a tumor
and reads the pathology his or herself can legally claim
it as Mohs surgery. High cure rates and good cosmetic outcomes
depend on proper training. To regulate the quality of training
in the United States, The American College of Mohs Micrographic
Surgery and Cutaneous Oncology oversees one or two year
formal training programs called fellowships. Make sure your
physician is a fellowship-trained member of the "Mohs
College" to ensure the highest level of expertise.
Reconstruction
Dr. Warner and Dr. To have extensive training and experience
with wound reconstruction. On average, they reconstruct 15
to 20 wounds a week. The technique for repair depends on the
location, size, and shape of the wound, the type of tumor,
and patient preference. Options include primary closure, secondary
intention, flaps, grafts, and delayed closure.
Primary closure involves suturing the wound edges together.
This usually means closing a circular wound into a single
linear scar. That scar can often be placed in junctions and
wrinkles to minimize visibility. We have our own techniques
to minimize scar stretching and prevent "rail road track"
scars.
Secondary intention involves allowing the wound to heal on
its own. This can take four to six weeks on the nose or ears,
but longer on the trunk and extremities. Healing by secondary
intention can produce excellent cosmetic results in certain
locations such as the ear and creases of the nose.
A skin graft involves removing skin from a different site
and suturing it onto the wound. Skin can be borrowed from
various sites on the face, ears and neck that will heal with
very subtle scars. Skin grafts are especially helpful for
large shallow wounds.
A flap involves making new incisions near the original wound
in order to transfer adjacent tissue. A flap uses the nearby
skin which provides the best color and texture match. The
extra incisions can often be placed in existing creases or
subtle areas. Flaps are very useful to fill deep wounds and
to prevent distortion of mobile structures like the nose,
eyebrows, eyelids, and lips.
Delayed closure (by 2 to 4 weeks) may be necessary to allow
more blood vessels to form in the wound bed prior to a flap
or a graft.
Repair of large deep defects occasionally requires multiple
surgeries.
|
