Non-Melanoma Skin Cancer – An Epidemic
Non-melanoma skin cancer (NMSC) primarily encompasses two types of skin cancer: basal cell carcinoma and squamous cell carcinoma. Basal cell carcinoma (BCC) is the most common type of skin cancer, and it outnumbers squamous cell carcinoma (SCC) by about a ratio of 3 to 1. Recent estimates suggest that 2 million Americans develop over 3.5 million NMSC each year. This is a fairly staggering statistic when you consider that the next highest cancer incidence is not even 10% of this figure – lung cancer (222,520). Non-melanoma skin cancer represents an epidemic in the United States that continues to grow and add to healthcare costs. Estimated costs for the treatment of NMSC exceed $1 Billion per year in the United States.
So why is this epidemic not highlighted by the media? Most likely this is a result of the low mortality from non-melanoma skin cancer. Basal cell carcinomas very rarely metastasize. Cutaneous squamous cell carcinomas do have a higher rate of metastasis than BCC, but their metastatic rate is still astoundingly low. Melanoma, breast cancer, and lung cancer have significantly higher mortality rates; and thus, more media attention is directed towards them. This lack of mainstream attention given to NMSC can unfortunately lead to people trivializing their diagnosis. As a result, these cancers may go long times without diagnosis and treatment and can lead to significant cosmetic disfigurement.
To prevent cosmetic disfigurement from non-melanoma skin cancer, it is important to see a fellowship-trained Mohs surgeon. These physicians are board-certified dermatologists who complete an additional year of training dedicated to skin cancer removal and reconstruction. The training of a Mohs surgeon includes pathology (looking at microscope slides). Mohs surgeons also train extensively in reconstructive surgery so that the best cosmetic outcome can be achieved after skin cancer removal.
What are the advantages of Mohs surgery?
High cure rates: Mohs surgery delivers the highest cure rate of any skin cancer treatment modality. Primary basal cell carcinomas have a 99% cure rate, and primary squamous cell carcinomas have a 95-98% cure rate. This means that you won’t have to go back to get your cancer treated again.
Tissue sparing procedure: Because 100% of the tissue margin is examined with Mohs surgery, the Mohs surgeon can take much smaller margins than when a standard excision is performed. This means that with Mohs, you only need to take 1-2mm of skin around the cancer. With standard excision, this measurement can be 4mm-10mm of normal skin. The result of this is smaller, less noticeable scars.
Real-time results: Because the Mohs surgeon acts as the pathologist, it only takes 30 minutes to one hour to know if all the cancer is out or not. This prevents you from having to make several visits to the doctor to completely remove your skin cancer.
Precise mapping of tumor: If tumor is still present on the pathology, the Mohs surgeon makes a precise map to pinpoint the exact location of the tumor. This allows for normal tissue to be spared, resulting in higher cure rates and smaller scars.