Skin Cancer: Understanding the Rise and the Role of Mohs Surgery
By Parth Patel, MD Fellowship-Trained and Board-Certified Mohs Surgeon
PS Dermatology and Surgery
Bridgewater, NJ 08807
Skin cancer represents the most common form of cancer diagnosed globally, and its incidence has been steadily increasing in recent decades. As a fellowship-trained and board-certified Mohs surgeon at PS Dermatology and Surgery in Somerset County, NJ, I have the privilege of witnessing firsthand the impact of this disease and the effectiveness of advanced surgical techniques in its treatment. In this article, we will delve into the primary causes of skin cancer, explore the concerning trends in its rising rates, and discuss the crucial role of Mohs micrographic surgery, particularly in treating common skin cancers like squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and melanoma.
The Underlying Causes of Skin Cancer
The primary culprit behind the vast majority of skin cancers is exposure to ultraviolet (UV) radiation. This harmful radiation, primarily emitted by the sun and tanning beds, can damage the DNA within skin cells. Over time, this cumulative damage can lead to mutations that cause cells to grow uncontrollably, eventually forming cancerous tumors.
While UV exposure is the leading cause, several other factors can increase an individual’s risk of developing skin cancer:
- Fair Skin: Individuals with less melanin in their skin have less natural protection against UV radiation and are therefore at a higher risk.
- History of Sunburns: Severe or blistering sunburns, especially during childhood, significantly increase the risk of developing skin cancer later in life.
- Excessive Sun Exposure: Spending long periods in the sun, even without significant sunburn, contributes to cumulative UV damage.
- Tanning Bed Use: Tanning beds emit concentrated UV radiation, posing a significant risk of skin cancer.
- Family History: A family history of skin cancer can increase an individual’s genetic predisposition to the disease.
- Weakened Immune System: Individuals with compromised immune systems, such as organ transplant recipients or those with HIV/AIDS, are more susceptible to developing skin cancer.
- Exposure to Certain Chemicals: Prolonged exposure to substances like arsenic can increase the risk of certain types of skin cancer.
- Previous Skin Cancer: Individuals who have had skin cancer before are at a higher risk of developing it again.
- Age: The risk of skin cancer generally increases with age due to cumulative UV exposure over a lifetime.
The Alarming Rise in Skin Cancer Rates
Unfortunately, the incidence rates of all types of skin cancer, including SCC, BCC, and melanoma, have been on the rise globally. Several factors contribute to this increasing trend:
- Increased Awareness and Detection: Greater public awareness campaigns and more frequent dermatological screenings are leading to earlier detection of skin cancers, which contributes to higher reported incidence rates.
- Changing Lifestyle and Recreational Habits: Increased participation in outdoor activities and travel to sunnier climates exposes more individuals to higher levels of UV radiation.
- Tanning Culture: Despite growing awareness of its dangers, the use of tanning beds persists among some populations, contributing significantly to UV exposure.
- Aging Population: As the global population ages, the cumulative effects of UV exposure over longer lifespans are becoming more evident in increased skin cancer diagnoses.
- Environmental Factors: Depletion of the ozone layer in certain regions may lead to increased levels of harmful UV radiation reaching the Earth’s surface.
The rising rates underscore the critical need for effective prevention strategies, including diligent sun protection measures like using sunscreen, wearing protective clothing, and seeking shade, as well as regular skin self-exams and professional dermatological check-ups.
Mohs Surgery: The Gold Standard for Many Skin Cancers
When it comes to treating skin cancers, particularly BCC, SCC, and certain types of melanoma, Mohs micrographic surgery often stands out as the most effective and precise treatment option. Developed by Dr. Frederic Mohs, this specialized surgical technique offers the highest cure rates while minimizing the amount of healthy tissue removed.
Here’s how Mohs surgery works:
- Tumor Removal: The surgeon meticulously removes the visible tumor with a very thin layer of surrounding tissue.
- Microscopic Examination: This tissue is then carefully mapped, oriented, and processed onto microscope slides. The Mohs surgeon, who is specially trained in both surgery and pathology, thoroughly examines 100% of the surgical margin under a microscope.
- Precise Identification of Remaining Cancer: If any cancer cells are identified at the margins, the surgeon knows the exact location of these cells on the surgical map.
- Selective Removal of Additional Tissue: Another thin layer of tissue is removed only from the areas where cancer cells were found. This process of removal and microscopic examination is repeated layer by layer until no cancer cells remain.
- Reconstruction: Once the cancer is completely removed, the surgical site is carefully reconstructed, often by the same Mohs surgeon, to optimize cosmetic and functional outcomes.
Why is Mohs Surgery Often the Best Choice?
Mohs surgery offers several significant advantages, making it the preferred treatment for many skin cancers:
- Highest Cure Rates: By meticulously examining the entire surgical margin, Mohs surgery achieves the highest cure rates compared to other treatment modalities for many high-risk and recurrent skin cancers, often exceeding 99% for primary BCC and SCC.
- Maximal Preservation of Healthy Tissue: The layer-by-layer approach ensures that only cancerous tissue is removed, minimizing scarring and preserving the function and appearance of the treated area. This is particularly important for cancers located in cosmetically sensitive areas like the face, ears, nose, and eyelids.
- Immediate Margin Control: The microscopic examination is performed immediately after each tissue removal, allowing the surgeon to ensure complete removal of the cancer in real-time, eliminating the need for guessing or waiting for pathology results days later.
- Treatment of Complex and Recurrent Tumors: Mohs surgery is particularly effective for treating skin cancers that are large, aggressive, have indistinct borders, or have recurred after previous treatment.
- Cost-Effectiveness: While the procedure itself may seem more involved, the high cure rates and reduced risk of recurrence often make Mohs surgery a cost-effective long-term solution.
In conclusion, skin cancer is a significant and growing health concern, driven primarily by UV radiation exposure. Understanding the causes and the increasing rates is crucial for promoting effective prevention strategies. For individuals diagnosed with skin cancer, particularly BCC, SCC, and certain melanomas, Mohs micrographic surgery offers a highly specialized and effective treatment approach that maximizes cure rates while minimizing tissue damage. As a Mohs surgeon at PS Dermatology and Surgery in Bridgewater, NJ, I am committed to providing patients with the most advanced and precise care to combat this prevalent disease and achieve the best possible outcomes.
NOTE to Locals: Whether you are lounging in Johnson Park in Middlesex County, or Fishing or Farming in Hunterdon County or Hiking in Somerset County, sun protection is key.
Consider wearing sunscreen and photoprotection when walking or hiking in Duke Island Park, Washington Valley Park, North Branch Park, Colonial Park, Sourland Mountain Preserve, Great Swamp National Wildlife Refuge, Washington Valley Park Trails, Duke Island Park Trails, Middlebrook Trail System, Sourland Mountain Preserve Trails, D&R Canal State Park Trail, Lord Stirling Park Trails, Chimney Rock Park, Gene G. King Park, Leonard J. Buck Garden, Sourland Mountain Preserve Hiking Trails, Buttermilk Falls Loop, D&R Canal State Park, Lord Stirling Park, Watchung Reservation, Landsdown Trail, Loantaka Brook Reservation, Rutgers Gardens, Black River Wildlife Management Area Trail, Thompson Park, Spruce Run Recreation Area, Voorhees State Park, Ken Lockwood Gorge Wildlife Management Area, Hacklebarney State Park, Hunterdon County Arboretum, Teetertown Ravine State-Natural Area, Round Valley Recreation Area, Cushetunk Mountain Preserve, Union Forge Nature Preserve, Merrill Creek Reservoir, Kittatinny Valley State Park, High Point State Park, Delaware Water Gap National Recreation Area, Ramapo Valley County Reservation, Ringwood State Park, Pyramid Mountain Natural Historic Area, Jockey Hollow National Historical Park, Morristown National Historical Park.
