Atrium Health Navicent Specialty Center

Skin Cancer Surgery

There are three main types of skin cancers squamous cell carcinoma, basal cell carcinoma and the most deadly type is Melanoma. Dr. Dale specializes in the treatment of each of these cancers and other more unusual skin cancers. The basal cell and squamous cell cancers often are treated with surgical resection, or wide local excision, to completely remove the cancer.

Usually, chemotherapy and/or radiation therapy are not needed since the risk of spread from these cancers is relatively low. Melanoma, however, is a more aggressive type of skin cancer that starts in the melanocytes, cells that make the pigment melanin. Risk factors for developing melanoma are focused around unprotected sunlight exposure or even tanning bed light. In addition to the skin melanoma can also begin in other parts of the body where the "sun doesn't shine" such as in the eye and even internal organs. For skin melanoma the most important prognostic factors are related to the depth of invasion into the skin, or how deep it is.

There are five levels of skin and each level of invasion increases the risk of spread. This can also be measured with a tiny ruler called a micrometer. Those melanomas over 0.75 millimeters deep or greater than a level 3 skin invasion carry a higher risk of spread to the regional lymph nodes or even beyond that to other parts of the body To determine if a deep melanoma has spread the technique of Sentinel Lymph Node Biopsy was developed by Dr Donald Morton at the John Wayne Cancer Center where Dr. Dale was trained by Dr. Morton.

This technique utilizes Lymphoscintigraphy to actually map the route of possible spread through the small lymphatic vessels draining the cancer. this is done by injecting a dye at the site of the melanoma which then spreads to the first draining lymph node, the sentinel node. This dye is often colored or contains a small amount of radioactivity allowing Dr. Dale to identify the Sentinel Lymph node in surgery and then remove it to determine if the cancer has spread. In many cases if the cancer has not spread to the lymph node then it has not spread at all and the chance of cure is very high.

If the cancer has spread then further surgery to remove additional lymph nodes is performed to ensure the cancer is surgically removed. At the same time the Sentinel Lymph Node is removed in surgery a Wide Local Excision is performed at the site of the melanoma on the skin to completely remove the cancer and ensure a good clean margin of tissue is removed to reduce the risk of the cancer coming back or recurrence. If melanoma spreads beyond the lymph nodes to other organs or sites of the body then surgical resection is always considered to help improve life expectancy and survival.

As a trained surgical oncologist Dr. Dale specializes in the surgical treatment of melanoma ensuring the best chance of survival. For those patients with metastatic melanoma there are many new treatment options. These treatments often use the bodies' own defensive mechanisms to fight the cancer. This new emerging field is referred to as immunotherapy.

Our multidisciplinary care team at our comprehensive cancer center insures rapid referral to our medical oncology colleagues who deliver these new and exciting therapies. The cancer center also offers access to the many American Cancer Society programs many other resources are available in the patient learning center. In addition our patients have access to many support groups and therapy classes offered at the cancer center to ensure not only a physically rewarding recovery but also a mental and spiritual one as well. Dr. Dale, his office staff and nursing staff are dedicated to delivering world class care to our patients and their families right here in central Georgia.

Treatments offered: surgery, chemotherapy, and radiation therapy depending on the type and size of the cancer

Skin cancer is on the rise, and those who have it want to get rid of it in the simplest and most effective way possible. Skin cancer surgery is the most commonly chosen option, and there are a number of different surgical options available. Here are some of the most widely selected surgeries and what they entail:

Electrodessication and Curettage

For small, simple skin cancers like basal cell carcinomas, electrodessication and curettage is a good option. The procedure involves taking a dull instrument called a curette to scrape away cancer until the skin is reached. Once this has been accomplished, an electrical tool is employed to burn off the ulcer that was created by the curetting.

This procedure is usually repeated three times to ensure that all cancerous tissue has been eliminated and that a proper margin around the cancer area has been treated. The procedure is simple and generally requires no follow up.

The main benefits of this type of skin cancer surgery are that it can be performed in a doctor's office under local anesthesia and for minimal cost. The main drawback is that there is no follow-up pathology performed to check if cancer has been completely eliminated. Despite this, the cure rate using this surgery for basal cell carcinomas is around 95 %.

Mohs Micrographic Surgery

This skin cancer surgery is most often used for larger cancers or cancers in areas that are cosmetically significant. It involves taking off the cancerous tissue and examining it under a microscope. If the tissue still shows cancer cells at the margins, tissue mapping allows the surgeon to go to the exact area where the cancerous cells were spotted to remove a bit more tissue. This process is continued until the most recent excised skin is cancer-free.

The benefits of this skin cancer surgery are that it destroys the smallest amount of healthy tissue possible, allowing for the best cosmetic result. It also boasts a 99% cure rate for basal cell cancers and certifies pathologically that the cancer is removed. The downside is that it is a more time-consuming and elaborates procedure than electrodessication and curettage. The complexity also results in elevated cost.

Cryosurgery

For patients with bleeding issues or sensitivity to anesthesia, cryosurgery represents a reasonable option. Using a cotton swab or spray gun, liquid nitrogen is applied to the cancer to freeze it to death. This generally requires at least three cycles of freezing, allowing thawing, and then repeating. For non-melanoma skin cancers, this skin cancer surgery has a cure rate of 99 %. Like electrodessication and curettage, there is no pathological follow up check using this kind of surgery.

Laser Surgery

Lasers are sometimes used to treat superficial skin cancers, but this is generally only done when other methods have been unsuccessful. While a laser is more precise than a standard surgical tool, a surgeon trained in its use for this type of skin cancer surgery is required. There is minimal data currently on the effectiveness of this type of surgery.

For most common types of skin cancer, there are highly effective surgeries available. Knowing which the right type to pursue a given cancer is a decision requires consultation with a doctor who knows about the appropriate options.