Skin Cancer Treatment
Skin cancer is a common problem, especially as people grow older. It represents the most common form of cancer and most cases are triggered by a combination of sun exposure and genetic susceptibility. Fortunately, most cases can be treated without significant long-term effects, especially if caught early.
Skin Cancer Treatment Overview
Your First Visit
If you have been diagnosed with or have a lesion suspicious for skin cancer, your primary physician or dermatologist may refer you to our office. If a biopsy has been performed we ask that you bring a copy of this result with you or have a copy forwarded to our office. At this initial consultation, we will evaluate your lesion and discuss how we might best treat this. If surgical removal is required, we will discuss how we plan to do this, how the defect will be closed, and what kind of result you might expect. If you decide to proceed, we will schedule a time for the procedure to be done in our office (most cases) or in the operating room.
We also see patients who are scheduled to have their cancer excised in by another physician using the Mohs’ procedure. This is an excisional technique done by specially trained dermatologists where the tumor is excised and immediately examined microscopically in their office to assure complete removal. If your dermatologist anticipates a large defect or one located in an anatomically complex area, they may refer you to us to close your wound. At your initial consultation in our office (before the planned procedure) we will have an opportunity to meet you, assess what the defect might be after excision, and review our plans for closing this.
If excision is required, most cases can be performed in one our well-equipped procedure rooms in our office. A local anesthetic is used and the procedure generally takes 30 minutes or less. In the simplest cases, we excise the cancer and close the skin directly with sutures. If the defect is larger, we may need to rearrange the local tissues to minimize the distortion and tightness of the skin by performing a skin flap procedure. Occasionally we may utilize a skin graft for the closure of defects, using a piece of skin removed from another area of the body where you may have some excess.
In some cases, based on the cancer size, location, and type, we may recommend utilizing “frozen sections” during the procedure. Similar to the Mohs’ technique, your cancer will be removed and the wound left open until we have microscopic confirmation of complete removal. We have your specimen transported to our pathologists at Lawrence Memorial Hospital 2 blocks away, where it is quickly processed and examined by our pathologists. While awaiting the result (typically about 30 minutes) a dressing will be applied and you can relax, read a magazine or book, etc. If complete removal has been accomplished, we will then close the defect. Otherwise, additional tissue removal may be needed until we can be sure all cancer has been removed. Of course, utilizing this technique will add time to your procedure, making it last 1 hour or more.
Treatment in the Operating Room
Some skin cancers, depending on the size or type, are more appropriately treated in the operating room. This is especially true of cancers that require wide excision (melanoma, merkel call carcinoma, and others) and or are particularly large. Typically, these are outpatient procedures that are performed at Lawrence Memorial Hospital or the Lawrence Surgery Center.
In the case of large or complex cancers, we may work with other specialists (oncologists, radiation oncologists, general surgeons, dermatologists) in a coordinated fashion to provide your care. Some skin cancers, especially early ones, may not require surgical removal and can be treated by cryotherapy (freezing), laser, topical treatments and other methods. If non-surgical treatment seems best for you, we may refer you to your primary doctor or dermatologist.