The Skin Cancer Foundation Journal

MAY 2013

The 2012 edition of The Skin Cancer Foundation Journal features medically reviewed, reader-friendly articles such as tanning, the increasing incidence of skin cancer diagnoses among young women, & the prevalence of melanoma among white males over 50.

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CUT to the CHaSE Why Mohs Surgery Is Increasingly The Treatment of Choice LAURA kLINE, MD, AND BRETT COLDIRON, MD F rom topical treatments like chemotherapy and liquid nitrogen to more invasive procedures involving needles and scalpels, skin cancer therapies are almost as varied as the lesions they treat. But in recent years, thanks to technical advances, one treatment method is becoming the gold standard for a widening range of skin cancers. With its low recurrence rates, excellent cosmetic results, and all-in-one-sitting cost-effectiveness, Mohs surgery today is the right treatment to choose for many skin cancer patients. Skin cancer affects more than two million people in the US annually.1 The most common cancer, it is also one of the most curable forms when treated at an early stage. The majority of skin malignancies are the nonmelanoma skin cancers (NMSC) basal cell and squamous cell carcinoma (BCC and SCC), for which there are numerous effective treatments. WHICH TO CHOOSE? Fortunately, with prompt diagnosis and intervention, most NMSC patients can be successfully treated in offce settings under local anesthesia. The treatment method chosen depends on many factors, including the location and size of the skin cancer; whether or not it has been treated previously; whether the tumor is located in an old scar; how deeply it has invaded the tissue; what it looks like under the microscope (i.e., its growth pattern); the age of the patient, and the potential cosmetic outcome. For example, for small, superficial BCCs arising on the back, chest, arms, or legs, treatment can be as simple as topical chemotherapy or curettage and electrodesiccation (scraping off the lesion and then cauterizing the wound site with an electric needle). Other popular therapies include excisional surgery (removing the visible tumor along with a "safety margin" of healthy-looking skin, using a scalpel) and cryosurgery (freezing off the tumor with liquid nitrogen), among others. Patient preferences vary. Some are anxious to avoid surgery, while others want to treat their skin cancer with a single procedure. Nonetheless, everyone is looking for a safe, effcient, cost-effective remedy. An ideal skin cancer treatment would also offer a very high cure rate, and would precisely and accurately remove any skin cancer while sparing uninvolved skin. Such considerations are especially important when treating invasive skin cancers that arise on cosmetically sensitive and functionally important areas such as the face, ears, lips, necks, and hands. Since the head and neck are extremely vulnerable to chronic sun exposure — and in fact the most common sites for skin cancers — these are concerns most skin cancer patients face.2 Removing even a small amount 57

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