Squamous cell carcinoma of the skin is the second most common skin cancer in the US. We don’t think of common skin cancers as being lethal but approximately the same number of people die per year from metastatic squamous cell cancer of the skin as die from melanoma.

Unfortunately, there is not a standardized treatment protocol nor a way to predict which cancers will become more aggressive. New biomarkers have been developed which share 6 genes in all squamous cell cancers of the skin and 18 genes which appear to be able to identify the cancers which can become recurrent from non-recurrent cancers.

This is very important from a treatment standpoint. Up until now oncologists could not tell which cancers had potential to become lethal and so all squamous cell carcinomas of the skin where basically treated the same. Being able to identify these more harmful cancers has the potential to save lives by individualizing a screening and treatment protocol to best enable doctors to ensure the best outcome for each patient.

Along the same lines, the New England Journal of Medicine published research on new immunotherapy for squamous cell carcinoma of the skin. PD-1 Antibody therapy appears to be active in skin cancers with a 48% response rate.

Michelle Haessler M.D.

Board Certified Radiation Oncologist



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



It is so hard on all loved ones when a family member becomes ill. It makes you realize how precious life is and how important it is to maintain your health. With all major illnesses the first thing you need to do is take a deep breath and be thankful for all the wonderful people in your life and the professionals who are trying their best to help you and your spouse. Then you need to come up with a plan to maximize the outcomes.

The first thing to do is follow your physician’s orders. Yes, I said orders not recommendations or suggestions. When your husband was in the hospital the physician wrote orders to be followed by the nurses and staff. They weren’t maybes or suggestions but orders. There is no such thing as noncompliance in the hospital but there is such a thing with patients and physician orders. If you want the best outcome follow your physician’s orders. They will want him to follow a diet, exercise, rehabilitation program and medication regime. Noncompliance will decrease the chance for the best outcome. As physicians we want to see our patient’s quality of life to be the best it can be and it is so hard to witness noncompliance and see a worse outcome.

Vitamin D deficiency has been linked to cardiovascular disease for a long time. The studies on supplementation have been somewhat mixed in part due to study design. A study published on January 3 2018 (Med Clin) randomized cardiac patients to vitamin D supplementation and their usual medication or just their usual medication and the results were encouraging.

Among patients who had low levels of Vitamin D3 (<50nmol/L) almost 27% had major adverse cardiac events compared to 0% with vitamin D levels over 50nm0l/L. This was a prospective randomized study so it certainly demonstrates that there may be a huge benefit to Vitamin D3 supplementation for patients with coronary heart disease.

It is well established that vitamin D3 is necessary for bone and teeth health. It is also well established that the majority of Americans do not get enough Vitamin D3. We simply can’t make enough from sun exposure. The farther away from the equator we live, the less likely we are to be able to absorb enough of the suns rays. In winter it is particularly challenging and some studies have shown that it is nearly impossible even if we spent all day in the winter sun. In the summer we put sunscreen on and again it limits our exposure to the sun’s rays.

Supplementation is really the only way to get enough vitamin D3.It is such an important vitamin linked to good cardiovascular health, maintaining a good blood glucose level, supports the immune system and many more important functions.

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My Frienemy The Sun

My Frienemy The Sun

I have been watching a lot of astronomy shows lately and have come to the realization of how wonderful our sun is. Without its perfect rotation and location there would be no life on earth. Its warmth and energy help nourish and foster all life on earth. As humans, it is our primary source of Vitamin D. As with all things great and wonderful, too little or too much can harm us. We need to balance our exposure and a little common sense goes a long way.

It has been beaten into our heads that the sun is bad for us. That is not really true. Sunburn is bad for us but not sun exposure. So we faithfully put on our sunscreen to prevent sunburn, but by doing that we decrease the very vitamin that we can not get enough of from our food-Vitamin D.

Why is vitamin D so important? Without it our bone health is at jeopardy. We can develop brittle bones call osteomalacia in adults or rickets in children. Our immune system needs vitamin D to fight off diseases. Low vitamin D is linked to high cholesterol,obesity,heart disease,erectile dysfunction and cancer. The farther away you live from the equator the lower you Vitamin D level will be.

The National Health and Nutritional Examination Survey 2005-2006 found a large percentage of Americans were deficient in their levels of Vitamin D even at low levels. 41% on average at 20 ng/ml. If you have darker pigmented skin the deficiency rate goes up, African Americans were the most deficient at 82% and Hispanics had a 69% deficiency. Why is this? It is due to the lower level of the suns absorbency in darker skin.

There are a few foods that have vitamin D in them but it would be almost impossible to consume enough to compensate for the lack of sun exposure. How many pounds of mushrooms or quarts of milk a day can you really consume? It has only been the last 100 years or so that we have gone from an agricultural society to an industrial society. We are hard wired to get our vitamin D from the sun. So what do we do?

If we have a light complexion we have to use sunscreen because we may burn. Sun burn can lead to skin damage and skin cancer. But we can’t get enough vitamin D. If we have a darker complexion our skin has a harder time absorbing the sun rays so our vitamin D level in lower.

We pretty much have to take a nutritional supplement.

Nicotinamide (B3) has also been shown to improve skin health. It is a form of niacin that DOES NOT cause flushing or other annoying side effects. It helps form two important coenzymes NAD and NADP. These are of vital importance for energy production, DNA repair and regulation of cell cycle. It may help with Diabetes and high cholesterol and sun damaged skin.

Curcumin is the active ingredient in the spice turmeric. It is poorly absorbed unless pepper is added to it. It helps with general anti-inflammatory health possibly easing the pain of arthritis and it also helps regulate the cell cycle. Regulating the cell cycle is very important with maintaining good general health and fighting off disease.

Covitale-7 is the only product combining all of these ingredients into one easy to take product . You would have to take at least 6 pills a day to equal the effectiveness of Covitale-7. It is meant as a nutritional supplement to compliment a healthy life style.

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Adopt a Dog Month And How It Can Help You Fight Cancer

Adopt a Dog Month And How It Can Help You Fight Cancer

I have always loved dogs and always will. October is National Adopt a Dog Month sponsored by the American Humane Society, so what better time to talk about how dogs can help your health. I grew up with dogDogs give us love. Proven scientifically although I don’t know why they spent the research money, I could have told them that

Its adopt a dog month. Go out and save a life. For every dog you save you save 2or 3 dogs. The one you adopted and if you adopted from a rescue organization you opened up a spot there for them to take in another dog from a shelter- which opens up a spot at the shelter. So 3 dogs saved. Oh, and don’t forget about adopting a cat.s. My first dog as a child was “Candy” a tough little cocker spaniel. She was a sweet, ornery little thing. My most vivid memory of her was coming home to find my Italian grandmother stuck in our recliner unable to get out of the recliner because Candy decided she didn’t want her to. Every time my little grandmother tried to get out of the chair it was a battle of wills- a snippy little cocker spaniel and an equally snippy little Sicilian Grandma. Candy won.  Great memories.

Since that time, I have had many dogs who have lived long and wonderful lives. Most have been rescues. I recently looked at the statistics for euthanasia of shelter dogs over the last few decades and was pleasantly surprised to see that fewer dogs are being euthanized due to the efforts of shelters, rescue groups and heightened public awareness. I currently have two rescue Siberian Huskies. I never expected to own one Husky, let alone two, but what wonderful dogs. They both have interesting stories of abandonment and abuse, as most rescues do, but it never ceases to amaze me how they have adjusted and enhanced my life seemingly forgetting their past.

What can dogs do for you and your health and cancer?

  1. Dogs can smell cancer. This doesn’t surprise me as their sense of smell is so much greater than ours. This has been proven scientifically and is currently being researched as to how to benefit patients
  2. Dogs can give us companionship. This is very important on the dark days that we all have. They can lift depression and give us hope and the will to live.
  3. Dogs have health benefits like lowering our blood pressure
  4. Dogs provide endless entertainment and love.
  5. Dogs give us purpose.
  6. They provide exercise. You need to walk them. Take care of them. Throw a ball for them. All of this uses calories and provides exercise. Exercise is very important to fight cancer.
  7. Dogs give us love. Proven scientifically although I don’t know why they spent the research money, I could have told them that.
  8. Its adopt a dog month. Go out and save a life. For every dog you save you save 2or 3 dogs. The one you adopted and if you adopted from a rescue organization you opened up a spot there for them to take in another dog from a shelter- which opens up a spot at the shelter. So 3 dogs saved. Oh, and don’t forget about adopting a cat.