SKIN CANCER & SURGERY
Basal Cell Carcinoma
Basal Cell Carcinoma is a malignant tumor that occurs secondary to chronic sun exposure. It is the most common type of skin cancer, more common than Squamous Cell Carcinoma and Melanoma . It has various clinical presentations but the most common is a pearly red lesion that tends to bleed and scab over. It is most common in white individuals with a history of exposure to the sun. It tends to be locally aggressive and destructive, but metastasis is rare. When it occurs on the face, especially round the eyes and nose, it can invade deeply and cause extensive destruction. It is clinically treated with surgery. Mohs Micrographic Surgery is used for Basal Cell Carcinomas on the face.
Squamous Cell Carcinoma
Squamous Cell Carcinoma is a malignant tumor that arises from the upper layers of the skin (epidermis) and is mainly due to chronic sun exposure. It is most common in white skin individuals mainly older than 50 years of age. Actinic keratosis, also known as a pre-cancerous lesion, may progress to Squamous Cell Carcinoma. In healthy individuals, the rate of metastasis is low however not impossible. Patients that are immunosuppressed or on immunosuppressing medications may have an increased incidence of Squamous Cell Carcinoma. Common areas include face, including tips of ears, scalp, upper extremities, trunk and shins (particularly in females). They clinically present as thick scaling lesions. They may be eroded or ulcerated and may bleed. A subset of Squamous Cell Carcinoma, known as Keratoacanthoma, may develop very quickly in a matter of 2 to 3 weeks. Squamous Cell Carcinomas must be treated early and appropriately in order to prevent the possible risk of metastasis.
Melanoma
Melanoma is the most lethal type of skin cancer. Melanoma mainly affects middle-aged and young individuals, particularly fair skin types. It is the second most common malignancy in males between the ages of 30 to 49 and the fourth most common malignancy in males between the ages of 50 to 59. About thirty percent of melanomas arise from prior moles while seventy percent of melanomas arise in normal skin and not from pre-existing moles.
Based upon the 2009 American Cancer Society statistics, there were 121,840 new cases of melanomas and 8,650 deaths. This means that 19 Americans die of melanoma every day, which is almost one person per hour. (Cancer Facts & Figures, 2009, page 4,)
Melanoma is increased in patients with a family history of melanoma, history of atypical (dysplastic) moles, numerous moles (greater than 50), red hair individuals, individuals with fair skin types and history of several sunburns.
ABCs of skin cancer is a mnemonic device that has been introduced to make people aware of the danger signs of melanomas. These are listed below. For a rack card with the ABCs of skin cancer, please call our office for more information.
Routine skin examination is important every 6 to 12 months, depending on family and personal history. Dr. Behnam performs a comprehensive thorough skin examination checking every inch of the body using the latest magnifiers and dermoscopic devices that allow for better visualization, identification and detection of abnormal moles.
Mohs Micrographic Surgery
Dr. Behnam is a member of the American Society for Mohs Surgery and was trained under the renowned and prominent Mohs surgeon Dr. Christopher Zachary. Mohs Micrographic Surgery is a tissue sparing procedure designed for removal of skin cancers, such as Basal Cell Carcinomas and Squamous Cell Carcinomas. Mohs Micrographic Surgery allows for complete examination of all surgical margins to ensure that margins are completely clear of tumor. It is typically indicated for skin cancers on the face, where tissue preservation is paramount. It can also be employed for aggressive types of tumors, tumor size greater than 2 cm and recurrent skin cancers. There are four major steps, surgical removal of the skin cancer, preparation of the tissue for pathology reading by a technician using a cryostat, reading the pathology specimen under a microscope, and then surgical reconstruction of the defect. Mohs surgery allows for a cure rate of 97% to 99% for Basal Cell Carcinomas.
