Skin Cancer / Moles / Warts / Skin Tags

Skin Cancer Treatment

Skin cancer is the most common form of cancer in the United States and is the result of the abnormal growth of skin cells that can form anywhere on the body, but most frequently appear on skin that is exposed to the sun. There are more than a million new cases of skin cancer in the United States each year. Although most cases of skin cancer can be successfully treated, it is important to follow safe skin care recommendations to prevent this disease.

There are three major types of skin cancer that affect different layers of the skin. The types of skin cancer are named for the different types of skin cells that become cancerous.

Basal Cell Carcinoma
Basal cell skin cancer occurs in the basal cell layer of the skin and is the most common type of skin cancer in people with fair skin. It commonly occurs on areas of the skin that have been exposed to the sun, such as the face. It rarely spreads to other parts of the body.
Squamous Cell Carcinoma
Squamous cell carcinoma occurs in the squamous cells and is the most common type of skin cancer in people with dark skin. In dark skinned individuals, it commonly occurs in places that have not been exposed to the sun such as the legs or feet. While individuals with fair skin may have an occurrence of squamous cell carcinoma in sun exposed areas, such as on the face, head, ears and neck. Squamous cell skin cancer may spread to other parts of the body.
Melanoma
Melanoma is the most aggressive type of cancer and is more likely than other skin cancers to spread to other parts of the body. Melanoma occurs in the melanocyte (pigment) cells within the skin and can form on any part of the body, regardless of past sun exposure.

Treatment for skin cancer depends on the type, size and location of the tumor. Most options include the removal of the entire growth and are an effective form of treatment. Removal procedures are usually simple and require only a local anesthetic in an outpatient setting. Some of the treatment options for skin cancer may include:

Freezing
Excision
Mohs surgery

Depending on the stage and severity of the skin cancer, in addition to the removal of the growth, chemotherapy and radiation may be recommended if the cancer has spread to other parts of the body.

What is Mohs surgery?

Mohs surgery is a specialized, highly effective technique for removing skin cancers. It was developed in the 1930s by Dr. Frederick Mohs at the University of Wisconsin and is now practiced throughout the world. Mohs surgery differs from other skin cancer treatments in that it permits the immediate and complete microscopic examination of the removed cancer tissue so that all roots and extensions of the cancer can be eliminated. Mohs surgery has the highest reported cure rate of all treatments for skin cancer.

Treating all skin cancers with Mohs surgery is not necessary. Mohs surgery is reserved for skin cancers that grow back after previous treatment, cancers that are at high risk of recurring, or cancers that are located in cosmetic areas where preservation of the maximum amount of normal skin is important.

Physicians who have the training, surgical and laboratory facilities, and staff to perform this specialized technique practice Mohs surgery. Dr. Wasserman has received extensive training in Mohs surgery and has board certification in both Dermatopathology and Microscopic Dermatologic Surgery.

Why remove skin cancers with Mohs surgery?

Some skin cancers are deceptively large – far bigger under the skin that they appear to be from the surface. These cancers may have “roots” in the skin or along blood vessels, nerves, or cartilage. Also, skin cancers that recur after previous treatments may send out extensions deep under the scar tissue that has formed. Mohs surgery is specifically designed to remove these cancers be tracking and removing these cancerous “roots”.

How is Mohs surgery done?

There are three steps involved in Mohs surgery:

The skin is made completely numb using local anesthetic. The visible cancer is removed with a thin layer of additional tissue. This takes only a few minutes and the patient may then return to the waiting room. A detailed diagram (Mohs map) of the removed specimen is drawn.
The specimen is color coded to distinguish top from bottom and left from right. A technician freezes the tissue and removes very thin slices from the entire edge and undersurface. These sliced are placed on microscope slides and stained for examination under the microscope. This is the most time-consuming part of the procedure, often requiring an hour or more to complete.
The doctor then carefully examines these slides under the microscope. This allows examination of the entire surgical margin of the removed tissue. That is, the entire undersurface and the complete edge of the specimen is examined. All microscopic roots of the cancer can thus be precisely identified and pinpointed on the Mohs map.

If more cancer is found on the microscopic slides, the doctor uses the Mohs map to remove additional tissue only where cancer is present. This allows the Mohs surgery technique to leave the smallest possible surgical defect because no guesswork is involved in deciding where to remove additional tissue. Only tissue around the “roots” and extensions of cancer is removed.

Mole Removal

Many moles and birthmarks on the skin are completely benign, and pose no threat, even if unsightly, to the person on whom they appear. Oftentimes, though, patients will want these moles removed because they find them unattractive. Fortunately, there are a number of effective removal options available today.

Depending on their depth, location and color, as well as the patient’s skin type, age and other factors, treatment for benign but unattractive moles and birthmarks may use the following methods:

Laser or Pulsed-Light Therapy
Surgical Excision
Surgical Shave

Wart Removal

Warts are skin growths caused by viruses. Different warts respond to different treatments; some go away on their own. Salicylic acid products (in the form of drops, gels, pads and bandages) can help self-treatment of many warts by dissolving the keratin protein that makes up the wart and the dead skin above it. Others can be removed via liquid nitrogen freezing or electrical stimulation. Surgery may be recommended for painful or large warts that do not respond to these treatments.

Skin Tag Removal

Skin tags are little pieces of skin that stick out from the surface of the skin. Usually found on the neck, the underarms, under the breasts and in folds of skin in the groin or belly, these common skin growths are often the result of clothing rubbing against the skin. Most skin tags are acquired, although some people are born with them. Skin tags typically occur in people over the age of 40 and those who are overweight or have diabetes. They are also more common in women than men.

While skin tags are not cancerous and don’t cause problems unless they are continuously irritated, many people nevertheless choose to have these painless growths removed for precautionary or cosmetic purposes. Patients are often bothered by them due to itching and sometimes even bleeding, since they can get caught in zippers, clothes, or necklaces and jewelry. Their removal is an easy, common procedure often done daily in our office.

There are several different ways to effectively remove skin tags, including freezing, burning and removing with scissors. Small tags may be removed without the use of anesthesia, while larger ones may require a local anesthetic. These treatments are usually effective in removing the growth, but may cause temporary skin discoloration or bleeding. Your doctor will help you decide which treatment option is best for you.