Over a million people are diagnosed with skin cancer, or melanoma, each year, and many will share the same emotions: Why me? Am I in serious danger? What should I do? There is no need to panic. Skin cancer is not necessarily life threatening, nor does its therapy have to be disfiguring; however, if left untreated, the disease can continue to progress.
Anyone can get skin cancer. Your risk of developing skin cancer is increased if your parent, child, or sibling has had melanoma. Redheads and blondes have a two-fold to four-fold greater risk of developing melanoma. Darker-skinned people have more melanin, or brownish pigment, in their skin which serves as a buffer by absorbing the sun's harmful ultraviolet rays; thereby lowering, but not eliminating, the risk of skin cancer. Even though there is a strong correlation between ultraviolet exposure to the sun and all types of skin cancer, you can still get skin cancer even if you stay out of the sun.
Warning Signs
Most moles develop sometime after birth, but some people are born with moles. "Birth moles" increase a person's risk for melanoma. The development of a new mole or any changes in the size, color, shape or texture of a mole may be a sign of skin cancer, and should be reported to a dermatologist right away. Melanomas can develop anywhere on the body, even in places that are not exposed to the sun, such as the soles of the feet.
Types of Skin Cancer
There are three main types of skin cancer:
- Basal Cell Carcinoma
- Squamous Cell Carcinoma
- Malignant Melanoma
Basal Cell Carcinoma is the most common type of skin cancer. This type is rarely life threatening and does not spread, but it can be aggressive and destructive. They usually occur in patients who have had repeated sun exposure. Patients that develop a Basal Cell cancer have a 60% chance of developing another one within 5 years.
Squamous Cell Carcinoma is another common type of skin cancer that is not usually life threatening when removed early. It represents about 16% of new skin cancers and is found most often in people with fair complexions. This type may develop from an Actinic (Solar) Keratosis which is a scaly, crusty bump on sun-damaged skin. They can appear as a red bump, or may seem like an ulcer. They may also seem like a sore that just won't heal. They can range in size from a few millimeters to a few centimeters in diameter.
Malignant Melanoma represents only about 4% of newly diagnosed skin cancers. It is the most serious form of skin cancer and can be deadly. However, if treated early while it is still flat and thin, the cure rate is about 95%. If it is allowed to grow and become lumpy, it can be fatal. This cancer often stems from a mole that has been present for many years. If you have a mole that doubles in size in just a few months, you should have it examined by a specialist immediately.
There are many treatment options available for skin cancer including scraping and burning, freezing, radiation, routine excision and Mohs surgery. It is necessary to consider all the benefits and drawbacks of the various procedures when you choose your treatment. Often the cancer cells visible to the eye may extend beneath the surface of the skin. These cancer cells must be completely removed or they can lead to regrowth and recurrence of the tumor.
Mohs Micrographic Surgery
Mohs does not rely only on what is seen. Mohs surgery combines the surgical removal of the tumor with the immediate microscopic examination of the tumor and underlying diseased tissue. Dr. Jerry Cooper performs Mohs surgery for patients throughout metro Atlanta, including Buckhead, Dunwoody and Decatur to identify, remove and examine the entire tumor and roots layer-by-layer until the cancer is completely gone. Mohs surgery provides the highest cure rate, has the lowest chance of regrowth, minimizes the potential for scarring or disfigurement and is the most exact and precise means of removal.
Mohs surgery is effective for most types of skin cancer and is commonly used to treat Basal and Squamous Cell Carcinomas. It is the treatment of choice for recurring cancers, large cancers, cancers where the edges cannot be clearly defined, or in areas where it is important to preserve healthy tissue for the maximum functional and cosmetic results.
After Dr. Cooper performs your Mohs surgery, your risks of skin cancer can be reduced when you protect yourself from the sun, are aware of suspicious growths and visit your doctor for regular check-ups.
BEFORE MOHS MICROGRAPHIC SURGERY
- Take your usual medications, unless otherwise directed.
- Please let us know if you take aspirin, Coumadin (warfarin), Plavix (clopidogrel), Ticlid (ticlopidine), Vitamin E, or other prescription or non-prescription blood thinners; however, DO NOT DISCONTINUE THESE MEDICINES UNLESS DIRECTED BY DR. COOPER
- Please do not take any Gingko Biloba, non-steroidal anti-inflammatories (NSAIDs) like Advil, Aleve, ibuprofen, or Motrin, or aspirin-containing products like Alka Seltzer, BC powders, Goody’s, or Excedrin, for 10 days prior to your surgery. These medications may "thin" your blood and cause more bleeding. You may substitute acetaminophen (Tylenol) if required.
- Do not drink any alcoholic beverages for 48 hours before or after surgery.
- If you normally take an antibiotic prior to dental work (in other words, require antibiotic prophylaxis), please bring this to our attention so that there is no delay in your surgery.
- Shower and shampoo your hair before surgery, as your wound and initial dressing will have to remain dry for 24 hours after surgery.
THE DAY OF SURGERY
- Be well rested and eat a light meal before the procedure
- Do not take your fluid pills (Lasix, furosemide, etc) the morning of surgery. You may take them when you arrive home after surgery.
- Wear lose fitting and comfortable clothing that does not pull over your face. If treated area is on your face please remove all make-up before the treatment.
RECONSTRUCTION
After the skin cancer has been completely removed, a decision is made on the best method for treating the wound created by the surgery. These methods include letting the wound heal by itself, closing the wound in a side to side fashion with stitches, closing the wound with a skin graft or a flap. In most cases, the best method is determined on an individual basis after the final defect is known. Most of the wound closures are performed in our office. However, other surgical specialists may be utilized for their unique skills if a tumor turns out to be much larger than initially anticipated or upon your request. We individualize your treatment to achieve the best results.
When the reconstruction is completed by other surgical specialists, your reconstruction will usually take place on a subsequent day. There is no harm in delaying the reconstruction for several days. If the reconstruction is to be extensive, that portion of the operation may require hospitalization. This is the exception rather than the rule as most wounds are repaired immediately in our office while the site is still anesthetized.
AFTER MOHS MICROGRAPHIC SURGERY
Your surgical wound will likely require care during the weeks following surgery. Detailed written instructions will be provided. You should plan on wearing a bandage and avoiding strenuous physical activity for at least a week. We will discuss your activity restrictions at the time of your surgery. Most of our patients report minimal pain which responds readily to Tylenol. You may experience a sensation of tightness across the area of surgery. Skin cancers frequently involve nerves and months may pass before your skin sensation returns to normal. In rare instances, the numbness may be permanent. You may also experience itching after your wound has healed. Complete healing of the surgical scar takes place in 12-18 months. Especially during the first few months, the site may feel "thick," swollen, or lumpy, and there may be some redness. Gentle massage of the area (starting about 1 month after the surgery) may speed the healing process.
You will be asked to return in one to three weeks following the procedure. An indefinite follow-up period of observation is then necessary after the wound has healed. Studies have shown that once you develop a skin cancer, there is a strong possibility of developing other skin cancers in the future. Should you notice any suspicious areas, it is best to check with your dermatologist for a complete evaluation. You will be reminded to return to your dermatologist on a frequent basis for continued surveillance of your skin.
Please Contact Atlanta Dermatology and Laser Surgery by calling (404) 296-8000 to find out more about MOHS surgery.