Tag Archives: Skin Cancer

Skin Cancer

Skin Cancer


Last month I wrote about the importance of Sunscreen.  I can’t tell you how many patients I have seen since with sunburns.  This month I wanted to review some of the more common skin cancers.


The main cause of all these skin cancers is ultraviolet radiation.  That is why sun protection is so important.  Avoiding sunburns goes a long way to preventing skin cancer.


The most common skin cancers I remove are Basal Cell (BCC) and Squamous Cell (SCC) Carcinomas.  Usually, these cancers grow in areas that have suffered sun damage although they can occur anywhere.  Typically, they grow locally and do not metastasize.  Removal of these is curative.  Sometimes I remove these cancers in the office.  Often I excise these in the Operating Room with local anesthesia and IV Sedation.


In the operating room, we have a Pathologist who will take the specimen I remove and perform Frozen Section.  To perform frozen section he orients the specimen by color coding the edges.  He then freezes the tissue to extreme temperatures.  After freezing, he can thinly slice the tissue and look at it under the microscope.  If he determines that I have gotten around the tumor then I will begin to reconstruct.  If he thinks he still sees some cancer, then I will cut out more until he gives me the “All Clear”.


To reconstruct these I follow the time proven reconstructive ladder.  Wounds that are small I will allow to heal on their own.  If they are larger and I can get the tissue together, I will just sew the edges together.  Often I will have to rearrange the tissue to create a flap and minimize any cosmetic deformities.  Sometimes, I will do a skin graft and take skin from somewhere else on the body and transplant it to the area I cut out.  The trick here is to reconstruct and make it look like nothing was ever done.  Of  course, I will not reveal all my tricks for doing that here!


The most dangerous skin cancer that I see often is Malignant Melanoma (MM).  Like the Basal and Squamous cancers I discussed earlier, the main cause for Melanoma is Ultraviolet Radiation.  There are also some people who have a genetic predisposition to getting MM.  Unlike BCC and SCC, Melanoma has a much greater risk of distant spread of cancer.


Excisions of melanoma need a much more aggressive surgery.  Frozen sections are not great for checking the margins, so the Pathologist must rely on more traditional methods.   With MM we take much larger amounts of tissue (think cm instead of mm) to try and get around the cancer.  The Pathologist usually takes several days to tell us if we got completely around the cancer.  In some cases of Melanoma, we must also check the lymph nodes to make sure the cancer has not spread.  In these cases, we will perform a Sentinel Node Biopsy (SNB).


The idea of the SNB is that we get the node cancer would most likely drain to.  If there is cancer in this node, we may have to remove more nodes in the same area.  To do an SNB we have the radiologists inject a small amount of radioactive dye near the tumor and track what lymph node the dye goes to.  We will also inject a small amount of blue dye so that we can see the node as well.


The excision of MM results in a much larger wound to reconstruct.  As you can imagine, this is a much more difficult reconstructive problem.  But, I still follow the same reconstructive ladder that I follow for BCCs and SCCs.  It is hard to make it look like nothing was ever done in these cases.  The key to getting a nicer reconstructive result is to minimize the resection.  The only way to do that is to catch the cancers early.


Regular skin checks are the best way to catch cancers early.  If you see a suspicious or changing mole you want to show it to your Dermatologist early.  For those with a family or personal history of skin cancers, you should see your Dermatologist AT LEAST once a year.  I encourage all my immediate post-op patients to see their Dermatologists every 3 to 4 months.  If you are unsure about how to do a self-exam for skin cancer, this site is a good resource.


But remember, the best way to avoid skin cancer is to avoid UV exposure as much as possible.  That means no tanning booths or sun tanning.  It also means using a Broad Spectrum UV blocker when you are in the sun and reapplying often.


Skin cancer sweepstakes san antonio

What are all those old people doing out there?

This is a common question I hear from our young tanned patients.  You will find people of all ages in our reception room.  There will be kids with traumatic injuries from dog bites or burns to Octogenarians with Skin Cancer.  Since May is Skin Cancer Awareness Month, I thought I would use this month’s blog post to reinforce the importance of sunscreen.


The number one cause of Skin Cancer is Sun Damage.  To prevent skin cancer all you need to do is avoid sun damage.  To do this, you can either come out only after sundown or you can protect your skin with hats, clothing, and sunscreen.  The American Academy of Dermatology has a great website on how to spot skin cancer and prevention tips.


We sell the EltaMD brand of sunscreen in the office.  These products have either Titanium Dioxide or Zinc Oxide and are true broad spectrum UV blockers.  If you click the link, you can enter a sweepstakes drawing to win Prizes during May.  Remember, all it takes is one bad sunburn to lead to skin cancer later in life.  For many of you, the best reason to avoid UV rays is the premature aging caused by sun damage.

Skin cancer sweepstakes san antonio

Tanning booths are even worse than the sun’s rays when it comes to damaging your skin.  The concentrated UV energy from tanning booths may give you a healthy glow now, but it damages the collagen and elastin of your skin.  The World Health Organization has actually declared indoor tanning devices to be cancer-causing agents.  Not only can they cause Melanoma (a 59% increase in incidence), but they also increase the risk of a benign mole becoming a Melanoma.

how to select sunscreen

As far as treatment of skin cancers, I usually perform a procedure called Excision with Frozen Section Margin Control.  In this procedure, I excise the Cancer in the operating room, the Pathologist then freezes the tissue and looks at it under the microscope.  If there is still cancer at the edges,  I will excise more tissue until we are all the way around the Cancer.  After the Cancer has been removed, I then reconstruct the defect created.  Sometimes I can close the area in a straight line, other times I may rotate a flap of tissue, or perform a skin graft.  Either way, it is much better to prevent skin cancer in the first place by practicing Sun Avoidance.


Next time you are in the office, ask Hilda or Linda for samples of the sunscreen and see how you like it.


Sunscreen Innovation Act

The new Sunscreen Innovation Act

In November, the Sunscreen Innovation Act (SIA) was signed into law.  Hopefully, this will bring the U.S. up to par with Canada and Europe for sun protection.  The impetus for the Act was the lack of attention by the FDA to sunscreen products.

Skin cancer is the most common cancer in the United States.  It can be prevented by avoiding Ultraviolet (UV) rays, but the sunscreens we have today often do not cover the full UV spectrum.  You may be surprised to learn that the last sunscreen ingredient approved by the FDA was in 1990.  Almost 25 years since any new products have been approved.  Now, that would be fine if there just weren’t any advances since then, but there have been.  There are several products available in Canada and Europe that we cannot get here and they provide a broader range protection.  In fact, since 2002, the FDA has been sitting on 8 applications.  The FDA has not provided any comments or guidance as to why those 8 products have not been approved.

The SIA forces the FDA to act on new applications for sunscreen products quickly.  Hopefully, this means within 6 months we will have some new products available.  That should be just in time for our summer vacations!

Until then, I continue to recommend using a product with Titanium Dioxide or Zinc Oxide as those are broad spectrum UV blockers.  We carry the EltaMD line of products in the office, next time you are in pick up a sample to try.

You can read more about the SIA at the Congress’ web site.