Skin cancer surgery is becoming more important by the year since more of us are living longer lives, are spending more time in the sun, and are demanding the best results in terms of cures and cosmetic outcomes.  Below you will find some key points that will help to determine what sort of surgery is for you, and what you might expect when you submit to the knife!

Optimal Treatments

• Mohs surgery
• Excision and repair
• Destructive procedures
• Laser surgery
• Radiation
• Topical therapies

Mohs surgery

Named after Frederick  Mohs MD who first conjured up this extraordinarily successful technique in the early 1940s, Mohs surgery has become the standard technique for removal of complex skin tumors in critical anatomic locations. By examining 100% of the borders surrounding the tumor, the cure rate is often quoted to be above 98%. Those tumors that are recurrent, that have an infiltrative aggressive pattern may well have a success rate less than this, say in the 95 % range.  But these are good odds for patients who have only known recurrence after recurrence.  Mohs surgery  is tissue sparing, allows total removal of  the tumor, with subsequent immediate and definitive repair.

 

Excision and repair

Most skin cancers can be adequately treated by non-Mohs methods, particularly those that are not on the face.  Excision and repair are very reasonable methods, resulting in up to 95% success.  Excision means cutting the cancer out with a scalpel, giving enough margin to be relatively confident that the whole tumor is out. However, many of these tumors have 'roots' going deeper into the skin and fat. It is quite possible that the specimen, after having been processed by the pathologist, will demonstrate 'persistence of tumor at the margins of excision.   If your surgeon has already done the repair, then you will have to make a decision about taking the repair down and resecting more tissue, or just leaving the wound alone, and carefully observing the area for a recurrence, which can occur in about 33% of such cases.

 

Destruction

Destruction indicates the the tumor has been removed by scraping, freezing, burning, or lasering, and any other method that physically damages the tumor so that it is unlikely to recur.  This method is not often used for tumors on the face because it tends to leave a flat or depressed white or  pigmented scar.

• Non-Ablative rejuvenation of the skin
• Laser Resurfacing
• Photo-rejuvenation of the skin                             
• Congenital birth marks
• Rosacea and pigmentation
• Scars
• Hair removal
• Tattoo removal
• Acne and psoriasis

Photorejuvenation of the Skin

As we age, and our skin becomes weathered, certain changes can occur that make our skin look older than we might appreciate. Many methods are available to correct this premature aging process. A vast array of traditional and novel methods can take years off our appearance, and leave a natural and rejuvenated look to the skin.  For those that wish to view an extensive PowerPoint lecture on this subject, click the following link : Ablative and Non-ablative Rejuvenation.

 

Congenital Birth Marks

Birth marks come in all shapes and sizes, and may consist of blood vessels, pigmentation, and other abnormal collections of tissue. Selective methods for their removal are critical in the latest techniques for their treatment, to achieve maximal improvement without significant scarring or textural change.

 

Rosacea and pigmentation

Rosacea is one of the most common indications for laser surgery.  Troublesome blood vessels or blushing of  the face can be removed very effectively and without scarring using a number of lasers, particularly the KTP and pulsed dye lasers.  Pigmentation associated with chronic sun exposure can also be removed selectively, and with minimal collateral damage. Some devices like the intense pulsed light can remove both blood vessels and pigmentation, and also 'tone' or rejuvenate the skin at the same time. 

Scars

The appearance of scars can be a cause for concern, particularly if they are located in prominent anatomic areas.  An obvious scar can detract from an initial meeting or presentation. Fortunately, many scars can be helped with the use of intralesional injections of steroids, lasers, and topical dressings.  The best treatment is often benign neglect, as time will generally be associated with a gradual fading of the scar.

 

Hair Removal

The revolution in laser hair removal is an example of an old art being made much more effective and safe with the aid of new technology.  Whereas electrolysis has stood the test of time in slow permanent removal of hair, laser assisted hair removal is much faster, more effective, and frankly less uncomfortable.  having said that, lasers still cannot effectively removal all hair, particularly blond and red hair.  And in some patients, the lasers only thin the hair. Laser hair removal is not permanent in all patients, and in a small number can actually increase hair growth.

 

Tattoos

If you thought it cost a lot to have your tattoo put on, consider the cost of taking it off.  Although laser surgery can be incredibly effective at removing some tattoos, others can take multiple treatments, only partially remove some colors, and in a few cases, cause some scarring in the process. But that will not deter those that find their tattoos impact their lives, either with obtaining employment, a new romance, or just fit it with the new life style.  Seriously, lasers can transform most tattoos that are no longer desired, but it will take multiple treatments, be somewhat painful, both to your senses and the pocket book.

 

Acne and psoriasis

This story is really neat.  For so long, dermatologic surgeons have been at the forefront of developing surgical treatments for 'surgical' skin problems.  Now the latest craze is the development of lasers to treat common medical problems, such as acne, psoriasis, rosacea, and other conditions.  Read on to hear about the latest technology ..