Part 2 Of The Skin Cancer Series: Treatment And Prevention

 

What is the treatment?

petersen skin cancer pic 7Treatment of skin cancer depends on the type, size, location, and depth of the skin cancer and overall health of the patient. BCCs and SCCs can be treated with outpatient MOHS surgery, outpatient surgical excision, or radiation therapy. MOHS surgery is a specialized “tissue sparing” skin cancer surgery most routinely used on the face, ears, scalp, and NMSC over 2 cm in size. The skin cancer is surgically excised and then immediately examined under the microscope by the MOHS surgeon. The surgery continues until all of the skin cancer has been removed and 100% of the margins have been examined. Some small and very thin NMSCs can be treated with a topical chemotherapy cream that is applied at home for a few months.

If a diagnosis of melanoma is made, the melanoma is given a stage or category, based on certain features seen under the microscope. Guidelines for treatment have been developed based on the stage of the melanoma. The cure rates for very thin melanomas (stage 0-1) are extremely high with surgery alone. If the melanoma is more advanced, deeper, and/or or has spread to lymph nodes, nearby skin, or organs, then immunotherapy, chemotherapy, removal of lymph nodes, and/or radiation therapy may be needed.

What is the surveillance and what are the recommendations once it has been diagnosed?
For a new skin cancer diagnosis, it is recommended that patients have full body skin checks every 3 months for the first 2 years, followed by every 6 months for the next 1-2 years and then yearly. Patients with a history of melanoma are also advised to have yearly eye, dental, and gynecological examinations. We also recommend yearly skin checks for first-degree relatives of a patient with a diagnosis of melanoma. This means a patient’s mother, father, brother(s), sister(s), and children need to have skin checks regularly.

Is a woman over the age of 35 at increased risk for developing skin cancer?
Melanoma is the most common cancer below the age of 30. However, as we age, the risk of skin cancer increases and the incidences of all skin cancers have been increasing in women specifically. Women under 50 who develop BCC, SCC, or melanoma commonly have a history of indoor tanning.

Should a diagnosis of skin cancer change a whether a woman over the age of 35 should become pregnant?
If a woman of childbearing age is diagnosed with a BCC, SCC, or thin/localized melanoma AND receives appropriate treatment, then planning of a future pregnancy is not affected by her diagnosis of skin cancer. Therefore, it is okay for her to continue to try to get pregnant after treatment. If a patient had advanced melanoma, it is recommended that she wait 2-3 years before attempting pregnancy.

What if a woman is pregnant and is diagnosed with skin cancer?

petersen skin cancer pic 8Although rare, if a skin cancer is diagnosed during pregnancy, the treatment should follow the same guidelines as if the patient was not pregnant. For example, surgical removal of the skin cancer should be performed during the pregnancy and not delayed until after delivery. In most cases, the surgical procedure itself has very low risks to the fetus and appropriate medications are chosen for anesthesia, pain control, and antibiotics (if needed) to reduce the risk of harm to the fetus. If chemotherapy and/or radiology studies are needed, such as in advanced melanoma, these can be delayed until after the first trimester, unless benefit of the chemotherapy or radiologic study outweighs the risks to the pregnancy. Although the risk of spread of melanoma to the fetus is very rare, it can affect the placenta and/or fetus in cases of metastatic melanoma.

What can I do to lessen my chance of skin cancer?
The primary goal of dermatologists is skin cancer prevention and early detection. Even without a personal or family history of skin cancer, it is advised to have your skin checked every 1-2 years. Below is a list of skin cancer prevention strategies:

1. Avoid indoor and outdoor tanning. For patients wanting a healthy tan glow to their skin, I recommend either sunless tanner applied at home or applied by a technician at a spa with an airbrush technique.

2. Wear sunscreen daily. Not only does is help reduce your chance of skin cancer, it also limits skin aging by reducing the formation of fine lines, wrinkles, rough skin texture, broken blood vessels, and brown spots.

3. With strong and/or continuous sun exposure, apply sunscreen 30 minutes before sun exposure and then reapply every 2 hours or after water exposure or excessive sweating.

4. With strong sun exposure, wear wide brimmed hats, sunglasses, and sun protective clothing and seek shade (i.e. umbrellas, porches, canopies) in peek hours of the day. There are gorgeous, fashion forward options now, so no excuses. I love “rash guards”, which are long sleeved, breathable, fitted, SPF fabric shirts originally worn by surfers. They are wonderful to wear while swimming, snorkeling, playing in the sand, fishing, and any activity where you may not be able to reapply sunscreen as needed. They are easy to find online and available from many retailers.

5. Remember to protect your family… and yourself. My patients often remember to take care of their children, but forget to reapply sunscreen to their own bodies.

6. Stop smoking. Smoking is a risk factor for skin cancer and premature skin aging.

7. Know the ABCDEs of melanoma and check your skin monthly so you become familiar with your moles. If a spot has changed, is new, and/or does not improve in 1 month, see your dermatologist.

For Part 1 of the skin Cancer Series click here!

References:
1. American Academy of Dermatology: www.aad.org
2. American Society of Dermatologic Surgery: www.asds.net
3. Lee KC, et al. Safety of cosmetic dermatologic procedures during pregnancy. Dermatol Surg. 2013 Nov;39(11):1573-86.