Surgery is a very effect treatment for common skin cancers such as basal cell carcinoma and squamous cell carcinoma. The surgery can consist of a simple removal of the skin cancer or a more involved procedure such a Mohs surgery. If the tumor is small and not aggressive in nature and is in a location where cosmesis is not of concern, then a simple excision should suffice. The tissue should then be sent to an outside pathologist who will review the specimen and report on if the entire tumor was removed with adequate margins.( a margin is the area around the tumor that we want to see no cancer cells just normal skin cells).
This form of treatment is very effective as well as cost saving. What I have noted in recent years is the increased, often unnecessary, usage of Mohs surgery. This is a microsurgery in which the dermatologist looks under a microscope to make sure the margins are adequate. Whereas this is very effective, it is much costlier and is often not needed. For example, if you have a skin cancer on your arm or leg a simple excision is more than adequate for control of this cancer. Mohs surgery may add up to an additional $1,000 in medical costs and the outcome will be the same.
If on the other hand you have a skin cancer in the middle of your face Mohs surgery makes more sense. The margin status can be obtained while you are in the office. This often results in smaller margins and the cosmetic result should be improved. Unfortunately, sometimes large portions of skin will still have to be removed to get adequate margins. We have all seen people with huge scars on their face, nose and ears from these surgeries. Is that the only course of treatment? No.
Radiation therapy is often a good choice for skin cancers. It can spare normal tissue and the cosmesis is often excellent with the outcome similar to surgery. The treatment uses radiation that does not penetrate the skin very deeply. You would go for daily treatments and the side effects are mainly redness and skin irritation over the radiated fields. Whatever area is being treated remains intact such as an ear or a nose. The redness rapidly clears and leaves the skin soft. It often looks smooth, young and wrinkle free. I have had numerous patients ask me (jokingly) for treatment to the other side of their face since the skin looks so good.
If you are diagnosed with a skin cancer and you are concerned about the cosmesis ask for a Radiation Oncology consultation. I can not tell you if you would be a good candidate or not without seeing you but I can tell you after over 25 years of treating skin cancer with radiation therapy, the results are excellent and patient satisfaction very high.
It doesn’t hurt to get a second opinion and it may save a big part of your nose (or ear).
Michelle Haessler M.D.
Board Certified Radiation Oncologist