Actinic Keratoses are often considered a precancerous condition. They represent the earliest stage in the development of squamous cell carcinomas in sun damaged skin. They are small scaly spots most commonly found on the face, lower arms and back of the hands in fair-skinned individuals who have had significant sun exposure. They are often more easily felt than seen. If not treated, some actinic keratoses may become squamous cell skin cancers, requiring more extensive treatment. If diagnosed in the early stages, actinic keratoses can be removed by cryotherapy (freezing), by applying various lotions for a period of time, or by other dermatologic surgical procedures. Sunscreens help prevent actinic keratoses.
Dysplastic nevi are moles which are abnormal in size, shape or color but are not yet cancerous. These moles are more likely than ordinary moles to develop into melanoma and are advised to be surgically removed.
Basal cell carcinoma is the most common type of skin cancer in light-skinned people. These tumors are due to long-term sun damage and usually appear as a small pearly bumps or nodules most often on the head or neck. They can also present as red patches or scar-like growths. These tumors do not spread quickly but if ignored they will eventually bleed or crust over. Although this type of cancer rarely metastasizes (spreads to other parts of the body), it tends to infiltrate the surrounding area destroying deep tissues and nerves. Over time basal cell carcinomas can lead to great deformity and disfigurement, so it is important to see a dermatologist promptly if a lesion is suspected. Mohs micrographic surgery is the most efficacious treatment for basal cell carcinoma.
Squamous cell carcinomas are the second most common skin cancer. They are most commonly found in fair-skinned people. They can occur anywhere but typically present on the face. They are also common on the mucosa of the lips. This cancer can be aggressive, grow quickly and develop into large masses. Sun damage is the biggest precursor for squamous cell carcinomas but arsenic and immunosuppressive drugs can also contribute to their occurrence. Squamous cell carcinomas also have the potential for metastasis, so it is imperative to seek early treatment. Mohs micrographic surgery is the must curative treatment for cutaneous squamous cell carcinomas.
Malignant melanoma is one of the most deadly skin cancers, and it is increasing in frequency. Melanoma begins when pigment cells (melanocytes) become abnormal and divide haphazardly. These cells then invade and destroy normal cells as a cancerous growth.
It is estimated that for those born in 2000, United States citizens have a 1:74 lifetime risk of developing melanoma. It is also estimated that more than 4600 Americans will develop melanoma annually and that 7700 will die from melanoma each year, indicating that nearly every hour an American will die from melanoma.
There are many variables that increase the risk of developing melanoma. Excessive sun exposure, and sunburns, are the most preventable causes of melanoma. A person's risk of developing melanoma increases with ≥ 3 blistering sunburns before the age of 20 and with having outdoor summer jobs for ≥ 3 years as an adolescent. Heredity also plays a part since 10% of melanomas are familial. Abnormal moles (dysplastic nevi), which may also run in families, and a large number of normal moles also can serve as markers for people at increased risk of developing melanoma. Tanning beds are also a strong risk factor for melanoma. Anyone can get melanoma but fair-skinned people are more susceptible. Dark-skinned people can also develop melanoma particularly on the hands or feet or under the nails.
Melanoma usually develops in a preexisting atypical mole or on sun damaged skin most commonly on the legs of women and the backs of men. Melanoma usually presents as a brown or black irregular spot. They are usually asymmetric, have irregular borders, a variety of colors or hues and a diameter of > 6mm (ABCD). There may be oozing or bleeding, itchiness or pain.
Melanomas can grow aggressively and metastasize (spread) quickly. They commonly spread to lymph nodes and then to internal organs such as the lung or brain.
Early detection remains the best treatment so a prompt examination by a dermatologist is essential. The dermatologist will excise the suspicious lesion and submit it for pathologic review. Any following surgery will be determined by the depth of the melanoma. Margins of normal skin can vary from 0.5cm (for in situ lesions) to 3cm depending on the depth of the tumor. Sometimes adjunctive therapies such as a sentinel lymph node biopsy, interferon injections, chemotherapy or vaccines may be necessary for deeper lesions that have spread. Dr Dimino has helped direct a melanoma clinic and is an expert at early detection and surgical excision of these cancers.
What can I do to protect myself from skin cancer? It is very important to wear a broad spectrum sunscreen with a SPF of 30 or greater and to reapply that sunscreen every 80 minutes when outdoors. UVA light can penetrate windows so sun protection in the car is also essential. Wearing broad-rimmed hats and sun protective clothing is also advisable. Avoid tanning beds and avoid sun exposure from 10am through 4pm when the sun is strongest.
Mohs micrographic surgery is state of the art skin cancer surgery for basal cell and squamous cell carcinomas and a few others cutaneous malignancies. For over 30 years, the Mohs technique has provided complete cancer removal down to the cellular level with the least potential for scarring and disfigurement. Mohs has the highest cure rate (up to 99%) for primary lesions. In order to ensure these incredible results, Mohs micrographic surgery should only be performed by a dermatologic surgeon who has completed an approved fellowship training program in Mohs and reconstructive surgery and who is a member of the elite American College of Mohs surgery. This training is in addition to board certification in dermatology.
Mohs surgery is the treatment of choice for large, ill-defined or recurrent skin cancers and for tumors in cosmetically demanding areas (eyelids, nose, ears, and lips).
Dr. Dimino performs Mohs surgery in her office surgical suites under local anesthesia. Dr. Dimino and her staff take great pride in their results as well as in making the process as comfortable as possible for their patients.