1. Lyndon B. Johnson
2. Bill Clinton
3. George  Bush, Sr.
4. Ronald Reagan

Yes, they were all past presidents of the United States. But can you think of other things that are common among them? The answer is, they all had basal cell carcinoma.

You may now ask me, what is this cancer? Is this cancer very serious or a mild one. If we hear the big C (cancer), we are all scared since most of the time it marks the end of our lives. There are several types of cancer though. There is cancer of different organs like the cancer of the brain, lungs, intestines, bones, muscle, blood, etc.

Basal Cell Cancer Is Cancer of the Skin:
You may ask why I’m discussing this cancer in particular. It is because this cancer is the most common cancer of the skin. It is also the most common cancer overall. It is estimated that it comprise 65% to 80% of all skin cancer. The expected lifetime risk that is the chance that a person will develop basal skin cancer is 30%.  85% of basal cell cancer is found in the head and neck region.

Risk Factors:
One should know the risk factors to prevent getting this type of cancer. This type of cancer is related to the sun exposure although the exact mechanism is poorly understood. People whose job exposes them to sun quite a lot are more to have high incidence to get this cancer. This cancer is very common among older person more than 40 years old. This gives a spin and a new meaning to the old saying that “life begins at 40”. Yes a person at 40 becomes more mentally and physically matures, stable financially and start a family, etc, but it is also the start to have higher incidence of basal cell cancer.

Another risk factor is just being a male. Yes, male person has more chance to develop this cancer. Why is this? I can just guess that male is more exposed to the sun, in their daily activities, job or sports that they play. Traditionally, more woman than men apply sunscreen in their skin before doing outdoor activities so their skin is better protected. 

If your parents or grandparents had basal cell cancer, then most likely you will also develop this cancer.  Is this genetic? If your parents have fair white skin, most likely you also have white skin, and then you have a higher incidence of developing this cancer. Another factor that plays a role is you get involved with outdoor activities that your elders do in their pastime.

Caucasians with blue eyes, with light complexion are affected more compared to Hispanics, Asians, African Americans or darker colored individuals. The greater number of melanin (pigment that makes our skin darker) present in darker colored individuals have a protective effect against this cancer.

How Will You Recognize This Cancer?
Every day when you look in the mirror take an extra time to look for any abnormal skin growth, lump, ulceration or blue-black pigmentation in your skin most specifically on your face and neck. Most often than not you will find abnormal lesions from the sun damage.

How To Prevent This Cancer:
1. The most important technique to avoid this cancer is to avoid too much exposure to the sun. Wear a sun protection factor (SPF) of at least 15.
2. Wearing a wide brim hat is also helpful as well as wearing protective clothing.
3. Carefully plan your outdoor activities. The sun is less damaging before 10 o’clock in the morning and after 4 pm.
4. If your family has history of skin cancer, then you should learn how to examine your skin in front of the mirror regularly.
5. Have the habit to go to your doctor. You pay a lot of money to your insurance and if you don’t use it then it goes to waste, besides you lose the chance of early diagnosis of you cancer. When you go to your doctor for annual examination, have him examine any suspicious lesions in your body. It is very easy to remove skin cancer while it is on its infancy stage.

What Is The Treatment of This Cancer?
1. ELECTRODESSICATION AND USE OF CURETTE. This uses an electric current to burn the cancer cells and then removing it with curette once the cancer cells get burned. This procedure is very simple, quick and less expensive than other procedures. The overall cure rate is 90% for low risk basal cell cancer. As you can see 10 % of the cancer will recur.
2. CRYOSURGERY – This procedure uses a very cold liquid called the liquid nitrogen. This is effective only for superficial basal cell cancer. The deep seated nodular cancer cannot be treated by this since the liquid nitrogen doesn’t penetrate deeper in to the sub dermal layer of the skin.
3. IMMUNOTHERAPY– This is the application of cream like the ALDARA 5% cream to the superficial affected areas 5 times per week. It acts as a topical immunomodulator, that is, it enhances the fighting capacity of the “soldier of the body” to kill the cancer cells.
4. EXCISION BIOPSY– This procedure cuts the cancer lesion including the normal skin surrounding. Removing the normal skin guaranties that cancer won’t come back. Excision permits the histological diagnosis of the normal margins of the skin that is removed. It requires the help of a derma pathologist or somebody that knows how to read specimen slides for presence of cancer. Excision has the advantage of removing the cancer completely, but it is more time consuming and costly than cautery and curettage. But if you are the patient, you would rather have complete excision with very low incidence of recurrence.
5. RADIATION THERAPY – This uses x-ray beams to destroy cancer cells. This is used to elderly debilitated patients who physically cannot undergo excision surgery. This procedure is rarely used today however.
6. MICROGRAPHIC (MOHS’) SURGERY – This is the MOST RELIABLE TREATMENT of this cancer since it has a cure rate of 98% to 99%. It is done by excising the tumor including the normal looking skin around it. The tumor is then examined in the microscope to see that the margin of excision is free of cancer. If the margin still has cancer, then another excision is done, the procedure repeated by examining again the second specimen under the microscope. The MOHS’ SURGEON excises repeatedly (sometimes reaching 4 or 5 excisions) in areas proven to be cancerous until a completely cancer – free plane is reached.

What Is Mohs Surgery?
It is a special procedure developed by Dr.Frederic Mohs in 1930 to effectively and accurately remove skin cancer. It is a very special operation since it removes the whole cancer including its extensions to its surrounding and roots. During the operation cancer is removed by excision, and then cancer tissue is cut into sections, stained and marked on its margins and examined immediately under the microscope. The surrounding skin, the complete edge and the entire undersurface of tissue containing cancer is meticulously examined under the microscope for any remaining cancer. If there is remaining cancer then another small incision is done to remove the cancer. The process on cutting the tissues and examine under the microscope is repeated several times until there is no more remaining tumor. The wound is then closed in a nice way to prevent unwanted scarring especially in the face. The final defect or wound in the face is only slightly larger than the initial size of skin cancer. However if there is a deep root of skin cancer, a bigger defect is produced. Defect I s closed by flaps just like in Plastic Surgery.

Who Can Perform This Surgery?
When we hear skin cancer we always think that any surgeon can remove this type of lesion. Yes they can but there is a highly trained specialist that can do this more effectively and that is a Dermatologic Mohs Surgereon. This surgeon can be a dermatologist, general surgeon and plastic surgeons that have special skill in skin surgery, derma pathology and Mohs Surgery. One of the most respected, brilliant Dermatologic surgeons here in the US is here in Arizona. His name is Dr. Gerardo Brual. Not only he has a background in General Surgery but also finished in Dermatology. He is trained to do Mohs Micrographic Surgery and Dermapathology.  On the average, he OPERATES 20 to 40 MOHS surgeries in one week which he performs in his 6 offices in the valley.

Is Mohs Surgery Covered By Insurance?
es it is covered by insurance like Medicare, AHCCES, private insurances. In my office, we get authorization before Dr. Gerardo Brual does the procedure. The procedure cost thousands of dollars and therefore we don’t want you to pay out of your pocket.

Who Can Have Mohs Surgery?
Not all skin cancers are treated with mohs Surgery. The surgery is indicated for skin cancers located in the nose, lips, ears, eyelids, hairline, genitalia, hand and fee, in which maximal preservation of healthy tissue is retained to have good cosmetic and functional result during the closure of the defect. Mohs surgery is also indicated in removing cancers that has recurred from previous surgeries or that type of cancer that has high incidence of recurrence.

Where Is Mohs Surgery Performed? Does It Hurt? How Long IsThe Procedure?
Even though it is a very specialized procedure, majority of the case are performed in an outpatient office. In my office, I group several patients and they get operated in one day. The patient is awake during the entire procedure. After cleaning the area, a local anesthesia is injected with little discomfort, after which patient doesn’t feel the excision anymore. The procedure usually last for about an hour, however if the cancer have extensive extensions to its surrounding and deep roots, then it may take another 1-2 hours. The Dermatologic surgeon doesn’t stop until all the cancer is removed. There are small numbers o cases that are too deep that patient is transferred to the hospital for more extensive operation.

Pictures of these cancers are available in my office for everybody to see. Please come and see me and I’ll tell if  your skin growth is cancer or not.

To To schedule a FREE Skin Analysis and Consultation, the first part of my Arrowhead Aeshetcs Skin Rejuvenation Program, just give my office a call or CLICK HERE.