Skin cancer refers to the growth of abnormal (cancerous or malignant) skin cells. Most skin cancers are one of three types: basal cell carcinoma, squamous cell carcinoma or melanoma. Basal cell and squamous cell carcinoma are often lumped together in a category called, “non-melanoma skin cancer.”
- Basal cell carcinoma is the most common type of skin cancer. It can appear anywhere on the body, but often appears as a pink nodule on the nose, cheek or chin. It is very rare for basal cell carcinoma to spread to another area of the body.
- Squamous carcinoma is often found on the lip or ear. It can appear as a nodule or open sore and rarely spreads to another area of the body.
- Melanoma is the least common, but the most serious type of skin cancer. It often looks like an irregular mole. It is usually more than one shade of black, brown or gray. The best chance for a good outcome is early removal. Once a melanoma has grown into the tissue under the skin, it can spread to other tissues and organs, just like other serious cancers.
A skin biopsy is the removal of part, or all of a suspicious skin lesion. Depending on the size and location, a variety of methods can be used. Most removals are done after injection of a numbing medication into the area (local anesthesia). Biopsies are sent to a pathologist in a lab, who examines it under a microscope.
- Shave biopsy – This is the removal of a thin slice off the top of the lesion, like taking icing off the top of a cake. Any bleeding is stopped with controlled heat (cautery). Shave biopsy is not a good choice for suspected melanomas.
- Punch biopsy - This is like a tiny cookie-cutter that removes small round pieces of skin. Sutures and/or cautery may be needed.
- Excisional biopsy - The entire lesion is removed and sent for testing. Sutures (stitches) are used to close the wound after the tissue is removed. This is the best method for suspected melanomas or for lesions that are irritating and/or bleeding.
- Incisional biopsy – This is done when a lesion is too big to remove. It involves taking a pie-wedge piece of normal and abnormal skin for a pathologist to examine. Sutures and/or cautery may be needed.
Lesions that have been determined to be cancerous can be removed using a complex procedure known as “Mohs technique.”
- Mohs technique is when cancerous skin cells are removed one layer at a time.
- A medication is injected into the lesion to numb the area prior to the procedure.
- After each layer is removed, the tissue is immediately examined under a microscope to see if any cancer cells are present. If cancer cells are seen, another layer of skin is removed and examined. The steps continue until the microscopic examination does not reveal any cancer cells.
- The wound is then either allowed to heal on its own or closed with sutures.
Your healthcare provider may recommend a skin biopsy and/or Mohs surgery if you have changes in your skin or a lesion (such as a mole) that appears suspicious or abnormal.
- Mohs surgery is most often used in the removal of basal cell carcinomas.
- The main advantage to the Mohs technique is that only diseased skin is removed. The skin is removed from a specific area, saving as much normal skin as possible.
- The Mohs technique allows the surgeon to get to the root of the cancer. This decreases the chance of it coming back.
- Mohs surgery is usually performed in a healthcare provider's office. In certain circumstances it may need to be performed in an operating room.
Skin cancers can occur anywhere on the body, no matter what your skin color or ethnicity is. They can even occur where the sun never reaches. Some of the risk factors for skin cancer are:
- Frequent or long term sun exposure - even a single bad sunburn can increase your lifetime risk of melanoma
- Increased age
- Fair complexion, including blue eyes and blond hair
- Family history of melanoma
- Immune system weakness (from disease or certain medications)
- Tanning in a tanning booth
Anyone can get skin cancer, even if they don't have any risk factors.
Some of the signs of skin cancer include lesions on the skin that are:
- Scaly, shiny, or waxy
- Firm, red, or rough
- Different on one side than the other (asymmetrical) or has edges that are irregular
- Oddly colored (can be brown, black, red, white, or blue)
- Large, typically bigger than an eraser on a pencil
- Not healing and tend to bleed
- Changing or look different
Contact your healthcare provider if you have any changes in an existing skin lesion or any of the above symptoms of skin cancer. Your healthcare provider may recommend a skin biopsy or Mohs surgery. Prior to the procedure you should tell him or her about any medications you are taking (including over-the-counter medications and supplements). You should also ask if there are any specific instructions you should follow before and after the procedure. These may include:
- Medications you should not take before the procedure, such as blood thinners
- Regular medications you should continue to take on the day of your procedure
Dermatology surgeons who are members of the American College of Mohs Surgery (ACMS) have had at least one extra year of training after their dermatology residency.
- A Mohs surgeon will usually close the wound right after the primary surgery.
- In some cases, a plastic surgeon needs to close the wound. When this is necessary you will receive a separate bill from the dermatologist and plastic surgeon.
What should I ask my healthcare provider before having a skin biopsy or Mohs surgery?
- What is my diagnosis and reason for the procedure?
- Why are you recommending Mohs surgery in my case? Are there any alternatives that are not as complex?
- What type of skin cancer do I have?
- What other treatment options are available to me?
- Do I need to see a dermatologist or plastic surgeon?
- Will I need to see a medical oncologist (cancer doctor)?
- What are the possible complications?
- How should I care for the wound?
- What are the follow up plans?
After your procedure, you should know what you had done, what medication was given (if any), and what symptoms you should report to your healthcare provider. You should also understand all home care instructions (including medications and side effects) and follow-up plans.