William Callaghan. MD (Skin-Cancer-Removal Surgery)
Skin cancers are, overall, the most common forms of cancers. They are most often associated with sun exposure, but can also be exposure to radiation or other environmental factors. They are becoming more common as people inhabit the more sunny areas of the world. This makes their diagnosis a very important part of treatment since incorrect diagnosis may be fatal or deforming.
The most common types of all skin cancers are basal cell carcinoma (BCCA), squamous call carcinoma (SCCA), and melanoma. There are other types, but they are too numerous and beyond the scope of this article.
Basal cell carcinoma (BCCA) is the most common type of all cancers, including skin cancers. They rarely metastasize (spread to organs) but do grow locally and cause deforming tissue destruction.
Squamous cell carcinomas (SCCA) are the second most common type of skin cancer. They can metastasize, but need to be larger in order to do so (usually greater than 3 cm).
Melanomas are skin cancers, which can spread depending on depth of invasion, rather than size. Melanomas are considered invasive when they invade beyond the basement membrane of the skin (the layer which contains the skin cells). They are amongst the most lethal of skin cancers and generally spread to lymph glands prior to metastasizing to major organs such as the lungs, liver, or brain.
The treatment for all skin cancers involves surgical excision. Other modalities are most often secondary or not as effective or are reserved for adjunctive therapy (ies). These treatments include radiation therapy, chemotherapy, or vaccines.
Surgical excision of skin cancers focuses on margins. Generally a “free” margin is required prior to any reconstructive procedure. That is, a margin that is free of tumor. This is usually performed by microscopic analysis.
MOHS micrographic surgery is a type of surgery that involves excision of sections of a tumor, usually in quadrants, and simultaneous microscopic analysis until all of the margins are free of tumor. This type of treatment is most often used for basal cell carcinomas, but also for squamous cell carcinomas. It has been used for melanomas; however, it is not the standard of care.
The types of repair, or reconstruction, cascade is as follows: direct repair, local flaps, skin grafts, regional flaps, or free flaps (tissue transfers). The main goal is to provide the simplest way of skin closure, but if there is not adequate tissue available to close the skin defect, then one of the above methods are used.