The Skin Cancer Foundation Journal

MAY 2014

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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S K I N C A N C E R F O U N D A T I O N J O U R N A L 62 Health cer after treatment. 15-17 Photodynamic therapy (PDT) is another treatment for superfcial BCCs and in situ SCCs. This method involves applying a chemical to the skin that makes cancerous and precancerous cells more susceptible to destruction by specifc wavelengths of light. 17-19 De- structive methods such as cryotherapy 20 as well as electro- desiccation and curettage 21 are also used for superfcial le- sions. All three of the above treatments may be associated with mild to moderate pain both during and immediately following treatment. Healing may produce some degree of hypopigmentation (lighter skin color) in the case of cryotherapy and electrodesiccation and curettage. 20-22 Fol- lowing treatment, your dermatologist will monitor the area for any signs of recurrence. or SCCs and BCCs of an aggressive subtype or located in function- ally important or cosmetically sensitive areas of the face (nose, ears, lips or eyelids), Mohs mi- crographic surgery (MMS) is the treatment of choice. 22-25 M MS permits surgeons to remove tu- mors in a way that yields the highest cure rates while pre- serving as much healthy tissue as possible. Following removal of the visible tumor along with a small margin of normal tis- sue, the tumor is processed in a way that permits examination of the entirety of the periph- eral and deep tumor margins. Using this technique, the sur- geon is able to specifcally target areas of residual tumor if present. Cure rates for primary BCC' s have been reported as high as 99 percent. MMS is also the preferred treatment for recurrent BCC's. 23-25 Mohs surgeons (Fellows of the Amer ican College of Mohs Surger y) have pursued specialized training following der matology residency which allows them to do this skillfully as well as to repair the resulting defect in ways that optimize appearance and function. Conventional surgical excision of an SCC or BCC also provides microscopic verification of a cancer' s removal, but it requires that more tissue be removed initially. Tissue processing takes longer, delaying con- firmation of margin clearance by several days to even a few weeks. Cure rates for primary tumors with standard excision are slightly lower than those of MMS (approxi- mately 90 percent at 5 years). 23-25 hen a BCC is not amenable to surgery due to extensive local spread or metastasis, con- sideration may be given to use of an oral sys- temic medication called vismodegib (Erivedge TM ). Due to its severe side efects, inferior response rates compared with surgical treatment and the need for prolonged treatment, therapy with vismodegib should be reserved for patients meeting strict criteria. Side efects such as muscle aches, hair loss and taste changes are signifcant and often persist be- yond the time when treatment has ended. 11 After Cancer People with a history of basal or squamous cell carcinoma should have at least an annual follow-up with a dermatologist for complete skin examinations. For those with a history of melanoma, closer follow-up is initially indicated. The National Comprehensive Cancer Network (NCCN) out- lines specifc recommendations for follow-up based upon the stage of one's melanoma. 14 It is the opinion of the authors that patients with a history of mela- noma should be seen every six months for life. Early detection and treat- ment of all forms of skin can- cer are vital to minimize any long-term morbidity or, in the case of aggressive skin cancers, mortality. Prevention of skin cancer through behavioral modifcations cannot be overemphasized. Daily use of sunscreen (with reapplication every two hours) and sun-protective clothing are simple ways to mitigate the sun's efects on one's skin. Individu- als should also avoid or at least minimize direct sun expo- sure during peak hours of the day (10 am to 4 pm). Any new, changing (size, shape or coloration) or symptomatic (painful, bleeding) skin lesions should be brought to the at- tention of your dermatologist for further examination and possible biopsy as soon as possible. The longer you wait to treat a skin cancer, the more treatment it may require. Mohs permits surgeons to remove tumors in a way that yields the highest cure rates while preserving as much healthy tissue as possible. References available on p.96

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