Hi bluecar,
Before I start, I'd like to remind you of the Google Answers
disclaimer at the bottom of this page: "Answers and comments provided
on Google Answers are general information, and are not intended to
substitute for informed professional medical, psychiatric,
psychological, tax, legal, investment, accounting, or other
professional advice."
I will provide you with explanatory information and further reading
regarding skin cancer treatment options, but will not make any medical
recommendations. For that you should discuss your particular case and
all of the options with your doctor.
Ok, now that that's out of the way, let's talk about your situation
---
It is clear by your question that you have two concerns – the complete
removal of the cancer cells (of course!) and the cosmetic results of
any procedure performed on your face. The selection of a treatment has
to balance these two concerns. You want to be cancer-free, but you'd
like to minimize any scarring.
Below are some of the treatment options available for basal cell
carcinoma. I have focused most of my attention on Mohs Surgery since
that is what your doctor is recommending and that seems to be the
preferred first line of attack for skin cancer that may have advanced
beyond the surface layer of skin. It is also the most-recommended
option for use on the face where there are cosmetic issues to contend
with.
My reading indicates that surgical removal is generally recommended
before trying chemical (either topical or systemic) approaches.
That said, there are other treatment options are available for basal
cell carcinoma. Your therapy will depend upon the type of skin cancer
you have and its stage. I will also address some of these options.
Again, you should discuss them with your doctor.
==============
MOHS SURGERY
==============
The treatment your dermatologist has recommended is called MOHS
SURGERY or MOHS MICROGRAPHIC SURGERY – afterDr. Frederic Mohs.
Mohs surgery, as you have suggested, involves removing a thin layer of
skin. This procedure is done on an out-patient basis and only takes a
few minutes. What sets Mohs surgery apart from other removal
processes, is what is done with the tissue that is removed.
As soon as the tissue is removed, it is frozen, sliced, stained, and
examined under a microscope. This process may take up to an hour. Once
the tissue is prepared, the surgeon examines the bottom-most layer of
it. If this layer is free of cancer cell "roots" then no more tissue
needs to be removed. If it still contains "roots" then the surgeon
removes another layer and the process is repeated.
Until a surgeon begins the procedure, there is no way to predict how
many times the process must be repeated. For cosmetic reasons it is
better to begin conservatively and repeat only as necessary. For this
reason, it is not unknown for the entire process to take up to 4-5
hours. It is recommended that you commit an entire day to the process
and bring something (book, knitting, Gameboy?) to occupy your time.
The beauty of the Mohs technique is that it ensures that all of the
cancerous cells are removed -- cancer cells often spread under the
skin farther than what appears on the surface -- but that no more
skin than necessary is removed. For this reason Mohs surgery is
usually indicated for cancers located on the face, eyelids, hairline,
hands, feet, and genitals, in which preservation of healthy tissue is
critical for cosmetic or functional purposes.
According to Harvard Medical School: " This technique is the most
accurate that exists for removing skin cancers, and it preserves
normal skin adjacent to the tumor, thus providing the smallest
possible defect for cosmetic closure." [see HARVARD link at bottom of
page]
Additionally, Mohs surgery, if done correctly, has a 96% cure rate –
much higher than the average 50% cure rate of other treatment methods.
As with any invasive surgery, some scar tissue will form as the
surgical site heals, however, Mohs surgery leaves the smallest
possible scar of any procedure. The amount of scar tissue will depend
on the size of the site and the technique the doctor uses to close
your excision area. Most patients undergo the Mohs procedure in the
morning, then undergo a reconstructive repair in the afternoon. These
may be performed by the same doctor or by two different doctors.
Once the doctor sends you home it is usually recommended that the site
be allowed to heal naturally.
==================================
POST SURGICAL COSMETIC TREATMENT
==================================
In cases where the surgical area is large and scarring is more
widespread, there are creams and other cosmetic treatments that will
cover or reduce any visible scar. These are treatments that would be
done after the cancer removal site has fully healed and the amount of
scarring is assessed by you and your doctor. Treatments might include
– an implant such as Zyderm collagen, smoothing via laser
resurfacing, chemical peeling techniques, or touch up surgery on skin
flaps or grafts.
=================================
DERMATOLOGIST vs PLASTIC SURGEON
=================================
Either a plastic surgeon or a dermatologist (or dermatology surgeon)
who is trained and certified in the Mohs procedure, can perform your
surgery.
THE AMERICAN SOCIETY OF MOHS SURGEONS – PHYSICIAN LOCATOR
http://www.mohssurgery.org/locator/locator.htm
The reconstructive surgery may be performed by the Mohs doctor or by a
doctor who specializes or is familiar with the repair aspect of Mohs
surgical sites.
If you decide to use a plastic surgeon for your reconstruction, it is
also recommended that you choose a surgeon who is certified by the
American Board of Plastic Surgery (ABPS) – or the equivalent
organization in your country if you are not in the US.
THE AMERICAN BOARD OF PLASTIC SURGERY - FIND A PLASTIC SURGEON
http://www.plasticsurgery.org/find_a_plastic_surgeon/index.cfm
In either case, the more experience your doctor has in performing the
Mohs technique and doing the reconstruction, the better your chances
of having a good medical and cosmetic outcome. You should ask to see
photographs of your dermatologist's or plastic surgeon's previous
patients to assess his/her cosmetic skills.
============================
MORE INFORMATION ABOUT MOHS
============================
MOHS SURGERY PATIENT INFORMATION BROCHURE
http://www.mohssurgery.org/pdf/54288%20Brochure.pdf
THE AMERICAN SOCIETY OF MOHS SURGEONS - ABOUT MOHS SURGERY
http://www.mohssurgery.org/about/about.htm
THE AMERICAN SOCIETY OF PLASTIC SURGEONS – SKIN CANCER
http://www.plasticsurgery.org/public_education/procedures/SkinCancer.cfm
FAQ – MOHS SURGERY
http://www.barnesjewish.org/groups/default.asp?NavID=604
==================================
OTHER TREATMENT OPTIONS
==================================
--------------------------
TOPICAL CHEMICAL TREATMENT
The other treatment you mentioned (Vivifew) is 5-FU.
[a thank you to our resident medical transcriptionist, voila-ga, who
deciphered that for me]
5-FU is fluorouracil – a drug that is commonly used as a topical
chemical treatment for cancer. It belongs to the family of drugs
called antimetabolites.
This treatment is only useful for cancers limited to the top layer of
skin. Since it can only destroy cancer cells near the surface, not
those that have penetrated into the skin or spread to other body
sites, 5-FU is used primarily for precancerous skin conditions. The
5-FU is applied daily for several weeks. Careful and prolonged
follow-up is required, since deep portions of the tumor may escape
treatment and result in cancer recurrence
Intense inflammation is common during treatment. The area also will
be sensitive to the sun for a few weeks and must be protected. In most
cases scars do not occur.
Because of your interest in this procedure and its non-scarring
nature, you should ask your dermatologist why he/she has not
recommended it. It may be due to the depth of your cancer.
----------------
SIMPLE EXCISION
The tumor is cut from the skin along with some of the normal skin
around it. This method may remove more healthy skin or less cancerous
skin than is necessary for effective treatment since it difficult for
the doctor to visually judge the correct amount to remove. Scarring
will occur. There is a 15% tumor recurrence rate with this method.
--------------------------------
ELECTRODESICCATION AND CURETTAGE
This refers to the drying of tissue by a high-frequency electric
current applied with a needle-shaped electrode. This method is the
most widely used method for removing primary basal cell carcinomas.
Although it is a quick method for destroying the tumor, adequacy of
treatment cannot be assessed immediately since the surgeon cannot
visually detect the depth of microscopic tumor invasion. A 15%- 50%
recurrence rate can be expected depending on the size of the tumor.
-------------
CRYOSURGERY
"Freezing" may be used to treat pre-cancerous skin conditions and
certain small skin cancers. In cryosurgery, liquid nitrogen is applied
to the growth to freeze and kill abnormal cells. After the area thaws,
dead tissue falls off. Cryosurgery usually doesn't hurt, but you may
have pain and swelling after the area thaws. Cryosurgery often results
in the formation of a white scar.
----------------------
RADIATION THERAPY
Skin cancer responds well to radiation therapy. Doctors often use this
treatment for tumors that are very large or that occur in areas that
are hard to treat with surgery. Radiation therapy can cause a rash or
make skin dry or red. Changes in skin color or texture may develop
after the treatment and may become more noticeable later.
------------------------------
LASER THERAPY
Laser therapy uses a narrow beam of light to remove or destroy cancer
cells. This approach, still under development, is sometimes used for
cancers that involve only the outer layer of skin.
===================
FURTHER READING
===================
HARVARD MEDICAL SCHOOL / AETNA
NON-MELANOMA SKIN CANCER TREATMENTS
http://www.intelihealth.com/IH/ihtIH/WSIHW000/8297/24556/181337.html?d=dmtContent
NATIONAL CANCER INSTITUTE – SKIN CANCER - PATIENT INFORMATION
http://www.nci.nih.gov/cancerinfo/pdq/treatment/skin
NATIONAL CANCER INSTITUTE – SKIN CANCER - DOCTOR INFORMATION
http://www.cancer.gov/cancerinfo/pdq/treatment/skin/healthprofessional/#Section_35
So, that should do it. I trust that I have answered your question
fully with both my remarks and the links I've provided. If anything
I've said is not clear, or if any of the links don't work, please feel
free to ask for clarification using your CLARIFY QUESTION button.
Thanks so much for your question and best of luck with your surgery –
-K~
search terms:
mohs surgery
skin cancer treatment options
basal cell carcinoma treatment options
5-FU creme / cream skin cancer |
