George Woodbury MD 2/17/2023
There are basically three types of skin cancer: Melanoma, Squamous Cell Skin Cancer, and Basal Cell Skin Cancer, also called Basal Cell Carcinoma. Memphis Dermatologists like myself spend a lot of time working with patients on Basal Cell Carcinoma because that type of Skin Cancer is the most common nationwide, affecting upwards of two million Americans this year. So let’s take a look at what causes it, how we diagnose it, and what can be done about it.
The main culprit is exposure to Ultraviolet Light (UV Light) from the sun or from tanning salon lamps. Exposure to UV rays in childhood or young adulthood is a big issue, especially in certain high risk people, including redheads and blonds, people with blue eyes or people who freckle or burn easily in the sun, and people who live in or play in the sun. High risk groups include water skiers, golfers, runners, people who like to go to Florida or Texas or really any southern state, and lifeguards, construction workers, and roofers. These groups especially should get a Skin Cancer Screening at least once a year/ But remember that really all people are at risk. In fact, the Afro-Caribbean singer Bob Marley actually died of skin cancer in his 30s.
Dermatologists like myself diagnose Basal Cell Skin Cancer by getting patients undressed and checking their skin: a Skin Cancer Screening. We generally inspect the sun-exposed areas, such as the face, neck, scalp, back, and chest. But in the over thirty years of Dermatology that I’ve been a Memphis Dermatologist, I’ve diagnosed multiple patients with Basal Cell Skin Cancer as well in sun-protected areas, like the groin and buttocks, so we like to get patients into an examination gown so we can do a full check.
If Dermatologic Surgeons like myself see a lesion or lesions that are suspicious, we generally remove the lesion for evaluation by the Dermatopathology laboratory, for biopsy. It generally takes a week or two to get the results back.
And what is the rule of thumb as to which lesion or lesions are suspicious for Basal Cell Skin Cancer?
These lesions tend to be translucent in color, meaning that light can often shine through them, and they tend to scab or bleed, and they tend to enlarge over weeks or months. They’re often shiny and red or pink. Lesions that are scabbed or crusted sometimes are actually the second most common type of skin cancer: Squamous Cell Skin Cancer (Squamous Cell Carcinoma). Lesions that are brown, black, or gray are sometimes the third most common type of Skin Cancer: Melanoma. For more on this topic of what skin cancer looks like, including photographs, check out a short movie that my Memphis Dermatology practice sponsored in 2018 for Youtube: “understanding the Melanoma Crisis: Scarlet’s Story.”
How is Basal Cell Skin Cancer treated?
If we make the diagnosis of Basal Cell Skin Cancer, which can be done either by clinical suspicion on the part of the doctor or by taking a diagnostic biopsy, generally the lesion is treated by cutting it out by Dermatologic Surgery. This means that we cut out that portion of skin under a shot of local anesthetic, generally lidocaine or bupivacaine, the same medicine used by dentists, and suture (i.e. The Dermatopathology report generally takes a week or two turn-around time after the specimen is sent into the lab. The piece of skin that we take out will go to the Dermatopathology Lab, where it will be cut up, similar to a loaf of bread, and the Dermatopathologist will check the borders of the specimen to try to make sure that the margins of that specimen are free of skin cancer. Generally, Dermatologic Surgeons use an eighth of an inch margin on lesions, to try to get a free margin on the skin cancer. Anytime that Dermatologists remove a lesion, there is a risk that the margins of the specimen sent into the lab might be positive for skin cancer, so we might have to do an additional procedure, to “clear the margins.”
What is Mohs Surgery?
Dr. Frederick Mohs developed a special technique of processing tissues right at the time of surgery – called Mohs Surgery – so that the Dermatologic Surgeon could get a report right away. I have been offering Mohs Surgery in my own Cordova Dermatology practice since 2004. Mohs Surgery is generally used for skin cancers of the face, neck, scalp, hands, free or genital area; for recurrent skin cancers of any location (meaning ones that have grown back after a prior removal); or for certain high-risk subtypes of skin cancer, including what are called Morpheaform or scar-like Basal Cell Skin Cancers and Highly Undifferentiated Squamous Cell Carcinomas. Mohs Surgery can also be used for Melanoma, but sometimes Melanoma is easier to read with regular processing of tissue than with Mohs processing, so the most frequent application of Mohs Surgery is with Basal Cell Skin Cancer and Squamous Cell Skin Cancer.
Skin Cancer Surgery is well tolerated by most people, and well over 90% of cases of Skin Cancer Surgery are done in the office, out-patient. The procedure often takes between fifteen and an hour, sometimes two hours, depending on the case. The patients generally go home right afterward. It’s possible to come to the office alone, but sometimes it's a nice option to ask someone else to come to the office the day of surgery because a patient may feel a bit unsteady afterward. Dermatologic Surgeons often write a prescription for pain medication, such as Acetaminophen with codeine or Oxycodone, which contains narcotic, in case the patient is sore once the anesthetic wears off, about four to six hours after the procedure. Soreness and/or itching can last for some days to weeks or months after the procedure, indicating healing within the area. Infection could present as pus at the sight and is possible anytime you cut into the skin, as a possible complication of surgery that can usually be handled with antibiotics.
One aspect of skin surgery to be aware of is that anytime Dermatologic Surgeons cut into the skin there will be a scar. We try to make this scar as small as possible by suturing the site, but there will be some evidence that we've worked in the area. There is also a chance of getting a raised scar – a Keloid – which can generally be managed by monthly injections of the area with a steroid – to help to settle out the scar.
Are there other options for Basal Cell Skin Cancer besides surgery?
There are other approaches to skin cancer, such as radiation therapy and use of 5-fluorouracil cream, but these do not generally give the high percentage cure rate that we achieve with surgical excision. Select cases of skin cancer can be managed with an alternative to excisional surgery that’s call desiccation and curettage, meaning that the Dermatologic Surgeon scrapes off the cancer then cauterizes or burns the base of the the area. There are other approaches being investigated through Dermatologic research.
Be aware that I am also President of Big River Silk™ Skincare, an organic skincare company that distributes a helpful broad-spectrum sunscreen: Vanicream Sunscreen Sport SPF 50. We also manufacture and distribute antiwrinkle cream (GlycoShea™ Cream and GlycoShea Lotion), an acne wash for people with complexion issues (AmberSoy Soap Gel), and best skin cream moisturizer (HypoShea Moisturizer Cream and HypoShea Oil). Check us out at https://www.Bigriversilkskincare.com.
So if you or a family member or friend, has a suspicious lesion, or if you’re high risk, consider seeing a “Dermatologist Near Me.” My own Memphis Dermatology practice since 1993 has been with Rheumatology and Dermatology Associates, 8143 Walnut Grove Road, Cordova TN 38018 (1-901-753-0168). Or you can find a Dermatologist closer to you by going to the American Academy of Dermatology web site, www.AAD.org, then plugging your zip code into the “Find a Dermatologist” tab. Don’t delay. Get examined today!
George Woodbury, Jr., M.D. 2/17/2023
Rheumatology and Dermatology Associates
Big River Silk Skincare Inc.
8143 Walnut Grove Road
Cordova TN 38018