Skin Cancer & MOHS Surgery

Dr. Dubow is a fellow member of the American Society for MOHS Surgery as well as the American Society for Dermatologic Surgery. In addition, as a board certified skin pathologist, he is among a very small group of physicians in the United States who are board certified in both Dermatology and skin pathology. He has performed over 1,000 MOHS surgeries and actively participates in meetings of national MOHS societies.

Of all the cancers, skin cancer is the most common cancer in the United States. Fortunately, most skin cancers are visible, can be diagnosed and successfully removed before they spread to other parts of the body. Also, many lesions can be detected and treated at a pre cancerous stage.

All people, regardless of skin colors and races, can get skin cancer. Those with light skin who sunburn easily have the highest risk. Risk factors include: sunburns, family history of skin cancer, exposure to X-rays and a weakened immune system. Additionally, using indoor tanning beds greatly increases the risk of developing skin cancer. It is important to know the facts about skin cancer and skin cancer stages in order to protect yourself from the disease.

There are 3 main types of skin cancer, and 1 type of pre-cancer:

Actinic Keratosis

Actinic keratosis (AK) is the most common type of precancerous skin lesion. An AK is evidence that sun damage has occurred and that the individual is at greater risk of developing skin cancer. AKs normally occur on the face, lips, ears, scalp, neck, back of the hands, shoulders, forearms and back, as these are the parts of the body that are most often exposed to the sun. When on the lip, they are called Actinic Cheilitis.  AKs usually appear as small crusty, scaly or crumbly bumps or horns ranging in size from 1 mm to 1 inch. They are dry and rough to the touch and can be raw or sensitive. If AKs are treated early, they can almost always be completely removed before turning into skin cancer.

However, if left untreated, AKs may develop into squamous cell carcinoma, a common form of skin cancer in Los Angeles.

Pictures of Actinic Keratosis

 

Courtesy of the Skin Cancer Foundation

Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the most common type of skin cancer. In most cases it appears on skin that gets a lot of sun, such as the face, scalp, neck, hands, and arms. BCC generally is a skin bump or growth that is pearly or waxy and is normally flesh colored or light pink. Basal skin cancer grows slowly and usually does not spread to other parts of the body. But it should still be treated promptly. Treatment of basal cell skin cancer varies depending on the size, depth and location of the lesion.

Pictures of Basal Cell Carcinoma Skin Cancer

Courtesy of the American Academy of Dermatology

Squamous Cell Carcinoma

Squamous cell carcinoma (SCC) is the second most common type of skin cancer. This form of skin cancer arises in the squamous cells that make up most of the skin’s upper layers (epidermis). It tends to form on skin that gets frequent sun exposure including the rim of the ear, face, neck and arms. Anyone who has had a basal cell carcinoma is also more likely to develop squamous skin cancer. This skin cancer looks like a firm bump, scaly patch or an ulcer that heals and then re-opens, and is usually red in color. They often look like warts and sometimes appear as open sores with a raised border and a crusted surface. SCCs detected at an early stage and removed promptly are usually curable and cause minimal damage. However, left untreated, they eventually penetrate the underlying tissues and can become disfiguring. Treatment of SCC varies depending on the size, depth and location of the lesion.

Squamous Cell Carcinoma Photos 

Courtesy of the Skin Cancer Foundation

Melanoma

Melanoma is the most serious form of skin cancer. If it is caught and treated early, it is almost always curable. Seeking the help of an experienced Los Angeles dermatologist is always a great way to ensure you're getting the help that you need. However, if it is not caught early on it becomes hard to treat and can be fatal. Fair-skinned individuals with light hair and eye color have an increased risk of developing melanoma. Additionally, those who have a family history of the disease or have ever had skin melanoma or other skin cancer are at greater risk.

This skin cancer generally develops in a mole or appears suddenly as a new dark spot on the skin. Growths that change noticeably in size or have irregularities in shape and color could be melanomas. It is important to check your skin from head to toe regularly for lesions that have the ABCDEs of melanoma symptoms.

Asymmetry – One half of the mole is unlike the other half. 

Border – The borders of the mole are uneven, irregular, scalloped or poorly defined.

Color – The mole has a variety of colors; shades of tan, brown or black. Sometimes it may appear to be red, white or blue.

Diameter – Melanomas are usually larger than ¼ inch (the size of a pencil eraser), but may be smaller when first detected.

Evolving – A mole or skin lesion that looks different from the rest or is changing in size, shape or color.

Courtesy of the Skin Cancer Foundation

Pictures of Melanoma

Pictures of skin cancer courtesy of the American Academy of Dermatology

MOHS Surgery

MOHS surgery is a highly specialized skin cancer removal procedure that is very precise and less invasive. MOHS has an impressive cure rate because it allows Dr. Dubow to look for cancer cells during the surgical process. For new cases of the most common types of skin cancer, BCC and SCC, the cure rate is 99%. If the skin cancer has returned after a previous treatment, the cure rate for BCC and SCC is 95%. Dr. Dubow will continue with the removal of the cancerous cell until it is completely removed.  MOHS is a great treatment for skin cancer because Dr. Dubow removes only skin and tissue that contain cancer, allowing the patient to keep as much healthy tissue as possible. This is especially beneficial for skin cancer on face. 

Dr. Dubow performs the MOHS surgery in the Goldman Dubow Dermatology Group office under local anesthetic. Dr. Dubow first removes the visible part of the skin cancer and then begins removing the cancer cells that are not visible to the naked eye. This is done by removing the cancer cells one thin layer at a time. Each layer is checked under a microscope, and this layer-by-layer procedure is repeated until the last layer viewed is cancer free.

 

After MOHS surgery is completed, you will have a wound. The size of the wound and post procedure treatment will differ depending on how much skin and tissue had to be removed. In some cases the wound can be covered and heal itself, while stitches are required in others. Overall, this procedure is the least invasive and is less likely to leave scarring. During your initial consul with an expert Los angeles skin cancer doctor, you're every question and concern will be addressed.

See MOHS surgery before and after pictures.

Other Treatments for Skin Cancer

In addition to MOHS, Los Angeles Dermatologist Dr. Dubow can perform various other treatments of skin cancer, including:

Curettage and Electrodesiccation – The growth is scraped off with a scalpel or curette. The procedure is repeated a few times to ensure that all cancer cells are removed.

Excisional Surgery – Using a scalpel, Dr. Dubow removes the entire growth along with a surrounding border of apparently normal skin as a safety margin. The incision is closed and the growth is sent to the lab to verify that all the cancerous cells were removed.

Cryotherapy - Liquid nitrogen is applied to the lesion to freeze it off.

Photodynamic Therapy (PDT) – A topical agent, Levulan, is applied to the moles and skin cancer at the Goldman Dubow Dermatology Group office and the next day the patient returns and the medicated areas are treated with a strong light. This treatment selectively destroys AKs while causing minimal damage to the surrounding skin.

Topical Chemotherapy Agents – These treat both visible and invisible lesions with minimal risk of scarring. Common topical agents include Aldara, Effudex and Carac.  

Skin Cancer Prevention

Most skin cancers result from too much exposure to the sun’s damaging ultraviolet (UV) rays. The ultraviolet A (UVA) rays can cause wrinkles, age spots and tans, while the ultraviolet B (UVB) rays cause sunburns. Both the UVA and UVB rays are harmful and can cause skin cancer. It is essential to protect your skin from these damaging rays in order to prevent skin cancer.

Sun Protection

Every day you should be applying a broad-spectrum sunscreen with a Sun Protection Factor (SPF) of 30 to your face, neck and chest. Broad-spectrum sunscreens provide protection from both UVA and UVB rays.

On days in which you will be in the sun for long periods of time is important to make sure all of your exposed skin is protected by sunscreen.

Additionally, wearing a hat, sunglasses and protective clothing will further help reduce sun damage to your skin.

Annual Skin Checks

It is important to get annual skin checks with one of our board-certified Beverly Hills Dermatologists, especially if you have:

• A personal or family history of skin cancer
• Have had a bad sunburn
• Have very fair skin

Regular skin exams help people find early skin cancers.

Early detection and treatment is key to surviving melanoma. In addition to visiting the dermatologist for skin cancer screenings, you should become familiar with your skin and your own pattern of moles and freckles. Make sure you look at your entire body every month or two, and consult a dermatologist if you notice any changes.

Frequently Asked Questions About Skin Cancer

Q: What is skin cancer?

A: Skin cancer is the most common cancer, in which malignant cells are found in the outer layers of the skin. There are several different skin cancers, some of which are more threatening than others.

Q: What are the symptoms of skin cancer?

A: The most common skin cancer symptoms are changes on the skin, including a new growth, a sore that doesn’t heal or a change in the appearance of a mole or freckle. All the different kinds of skin cancer do not look the same, so it is important look for skin cancer signs by knowing what your moles currently look like to be able to tell if they have changed and become cancerous. Skin cancers are generally found on areas of the skin that are exposed to the sun, including the head, neck, face, hands and arms.

Q: How do you get skin cancer?

A: While anyone can get skin cancer, the risk is greatest for people who have fair skin that freckles easily. The main causes of skin cancer include ultraviolet radiation from the sun. Both the UVA and UVB rays can damage your skin and lead to skin cancer. Additionally, you have a greater risk of developing skin cancer from tanning beds use.

Q: How can I prevent skin cancer?

A: When preventing skin cancer, it is important to protect your skin from the sun by wearing a broad-based spectrum sunscreen with an SPF of 30, as well as protective clothing. Also, whenever possible you should avoid exposure to the midday sun to help with preventing skin cancer.

Q: How can I detect skin cancer?

A: You should check yourself regularly for new growths or changes in your skin, which are the main symptoms skin cancer. If you find any suspicious spots during your self-examination you should set up an appointment with your Los Angeles dermatologist and have them checked out. Looking at the above picture of skin cancer will help you determine if your lesions are cancerous.

Q: How is skin cancer diagnosed?

A: When an area of skin does not look normal, the doctor will perform a skin cancer biopsy and examine the tissue under a microscope to determine if it is cancerous.

Q: What will my doctor do if I have skin cancer?

A: Depending on the location and size of the skin cancer, the doctor will determine which treatment of skin cancer procedure will be best. The main goal will be to completely remove or destroy the cancer with the treatment of melanoma, leaving as small a scar as possible.

Q: What should I do after I have had my skin cancer treated?

A: Although the skin cancer surgery is completely removed after the procedure, people who have been treated for skin cancer have a greater risk of developing a new skin cancer. Therefore, you should continue to perform self-examinations, visit your dermatologist for checkups and reduce your exposure to the sun. 

Read more Skin Cancer and MOHS Surgery FAQs

To find out more about skin cancer and to schedule a consultation with Dr. Dubow please contact us today!

Goldman Dubow Dermatology Group is an expert with Los Angeles MOHS surgery, Beverly Hills MOHS, skin cancer treatment, prognosis for melanoma and more.

Disclaimer

This site is for information purposes only, and should not be a substitute for seeing an actual doctor. If you feel you have a dermatological condition which you cannot identify or treat, please call our Los Angeles dermatology office directly to schedule an appointment.
Dr. Brian Dubowis a featured contributor of Fraxel on RealSelf.

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