Surgical Science
What it is and How to Treat
Basal Cell
Basal cells are located in the deepest layer of the epidermis and are responsible for generating new skin cells. When these cells grow abnormally, often because of ultraviolet damage, they can form basal cell carcinoma. BCC is the most common type of skin cancer. It is typically a slow-growing lesion on sun-exposed areas and can appear as superficial, modular or invasive.
Treatment determination is based on depth and location. Options entail: chemotherapy, curettage, excision, radiation or mohs surgery.
Intralesional Chemotherapy
Intralesional chemotherapy involves injecting an anti-cancer medication, 5 Fluorouracil, directly into skin cancer. It is commonly used for nonmelanoma skin cancers, like basal or squamous cell carcinoma, especially when surgery is not ideal.
Benefits of Intralesional Chemotherapy include:
Precise, focal treatment targeting the cancerous area
Preservation of healthy tissue, reducing infection and healing problems
Lower surgical risk for patients who are not candidates for excision or Mohs surgery
Potential to treat multiple lesions in a single session
In small doses, the chemotherapy is injected over 2-3 sessions.
Melanoma
Melanoma is the most serious form of skin cancer and is potentially life-threatening. It originates from melanocytes, the pigment-producing cells responsible for skin’s color. It may develop in an existing mole that changes in size, shape, or color or appear as a new, irregular lesion. Melanoma js most typically found on sun exposed areas, but also can appear in nails, eyes or genitals. While it accounts for a small percentage of skin cancer cases, melanoma has a high risk of spreading (metastasizing) to other parts of the body if not detected and treated early.
Warning signs often follow the ABCDE rule:
Asymmetry
Border irregularity
Color variation
Diameter greater than 6mm
Evolving appearance or symptoms (bleeding, itching, rapid growth)
Early detection is critical. When found in its earliest stages, melanoma can often be cured with
surgical removal. Advanced melanoma may require lymph node evaluation, immunotherapy or radiation.
Mohs
Mohs micrographic surgery is a highly precise tissue sparing surgical technique used to treat certain skin cancers. It removes the cancer layer by layer while preserving as much healthy tissue as possible. Each layer is mapped and examined under a microscope during the procedure, allowing for complete cancer removal with minimal scarring. This method offers the highest cure rates for basal cell and squamous cell carcinomas, especially in areas of high risk for recurrence, when the cancer is large or recurrent or is invasive.
Mohs has the highest cure rates, preserves tissue for better cosmetic outcomes and provides an immediate pathology review of the specimen.
Radiation
Radiation therapy uses targeted high-energy rays to destroy cancerous skin cells. Its targeted energy helps to reduce tumor growth by damaging the DNA of cancer cells. It js often recommended when surgery is not the best option due to tumor location, patient health, or cosmetic concerns.
Key points about radiation therapy:
Typically performed over multiple treatment sessions (often weekdays over 4 weeks)
Well-tolerated with minimal downtime for most patients
May cause skin redness, irritation, or scarring in the treated area
Spares healthy surrounding tissue
Squamous Cell
Squamous cells are flat, thin cells that make up the outermost layer of the skin, providing a protective barrier against environmental damage. They continuously shed and renew to maintain healthy skin and protect underlying tissues. Abnormal growth or damage to squamous cells from ultraviolet light; radiation; trauma or immunosuppression can lead to conditions like squamous cell carcinoma.
Treatment determination is based on depth and location. Options entail: chemotherapy, curettage, excision, radiation, newer immunotherapy or mohs surgery.