Causes Of Skin Cancer
It is important that our patients have their skin checked for abnormal moles, signs of sun damage or skin cancer.
Sun exposure over a life time, especially sun burn in early childhood, is an important risk factor in the development of skin cancer. A new or changing mole requires urgent referral to a dermatologist and should not be ignored.
Patients with multiple or irregular moles are more at risk of developing melanomas and should monitor their moles on a regular basis. Some skin cancers are easily treatable, however some melanomas and cancerous moles have the potential to spread and cause wide spread disease, so early detection is vital.
Skin Cancer Treatment
Our dermatologists are specifically trained to diagnose lesions by looking at them and if necessary performing a biopsy.
Same day treatment is offered in most cases and, depending on the diagnosis, sometimes creams are used to kill the cancer cells, or scraping the lesion away to the appropriate depth, cutting it out, freezing it with liquid nitrogen, using photodynamic therapy or occasionally radiotherapy. The choice of treatment will depend on the tumour type.
Mohs micrographic surgery (MMS) is a specialist surgery employed to treat non-melanoma skin cancers. It is used when there is a high risk of the cancer spreading or returning or in delicate areas such as around the eyes or nose where minimal skin removal is advisable.
It involves a surgical excision of the tumour and a small area of surrounding skin leaving as much healthy tissue as possible in tact. Skin cancer is caused by the uncontrolled growth of abnormal skin cells which triggers mutations or genetic defects that can cause tumours. The main cause of skin cancer is exposure to the sun’s ultraviolet light but age is a contributory factor with only one in three people diagnosed with melanoma being under 55-years-old.
The advantage of Mohs is that all excised tissue is examined under the microscopic as part of the surgery so the surgeon knows exactly how deep the skin cancer goes rather than having to estimate. The instant feedback allows for the removal of all the cancer cells while sparing as much normal tissue as possible.
The progressive procedure involves removing one thin layer of tissue at a time which is then checked to the margins for cancer cells. If they are present, the procedure is repeated until a final clean tissue sample is examined.
The elimination of guesswork with precision techniques provides the best therapeutic and cosmetic results. Standard surgery involves removing the visible cancer affected skin and margin of healthy skin at the same time. But sometimes the borders are hard to define so a generous margin of healthy skin is removed.
Mohs is particularly effective on the most common skin cancers, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). BCCs, which often look like open sores, red patches or shiny bumps are the most frequently occurring form of skin cancer and can be diagnosed by sight. SCCs is the second most common type of skin cancer in the UK. Both are caused by prolonged exposure to ultraviolet rays.
Dermatologists at St. John’s have Mohs as a specialty and are proficient and experienced in performing the procedure. It is done on an outpatient basis in an operating room close to a laboratory to enable easy and swift examination of tissue layers. The procedure normally takes about four hours.
The areas of skin are outlined with a special pen and are then injected with a local anaesthetic so there is no discomfort for the patient. The first layer is removed with a scalpel and sent for examination and it may take an hour before results are available to indicate if further layers need to be removed.
Depending on the area of skin removed, the wound could require stitches or be left to heal on its own but in some cases a skin graft from another part of the body may be needed. Mohs has a success rate of 98% or higher but follow-up consultations are advised.