Are you worried that you might have a skin cancer? Treatment
follows a correct diagnosis, and here are options for non-melanoma skin cancer.
It is difficult for patients and physicians to be absolutely sure
whether a skin growth/lesion is cancerous or benign, unless it
is biopsied and then processed and interpreted by a qualified pathologist.
Sometimes, however, the experienced clinical physician can be sure
enough of the diagnosis so as to consider institution of one of
several types of treatment without preliminary biopsy…based
on a "presumptive diagnosis"
Malignant melanoma (cancerous skin mole) is a particular type
of skin cancer which is very dangerous and is virtually always
treated with surgical removal. This can be an especially difficult
surgical pathology diagnosis, some of the poorest published performances
being by nationally-recognized pathologist melanoma experts ("board-certified
in dermatopathology...Human Pathology 27:528-531,1996)!
We will concern ourselves now with premalignant keratoses (PMK),
basal cell carcinomas (BCC), and squamous cell carcinomas (SCC).
These are by far the most common premalignant and malignant skin
lesions. There are additional rare types of skin non-melanoma malignancies (adnexal, neuroendocrine, soft-tissue, sarcoma, & lymhoma) which have special issues.
The careful and conscientious, properly motivated, and properly
trained clinical physician (most commonly in the specialty of dermatology)
can usually be at least mildly "presumptively" certain
of the diagnosis, among these three conditions, without biopsy.
The PMK can often be treated with superficial freezing, superficial
laser, or topical chemotherapy. They can also be removed surgically
by curetting, shave excision, or thick excision.
Basal cell cancers and squamous cell cancers can be treated by
either of surgical treatment or radiation treatment. Our experience
is that one never sees unbiopsied skin cancer first treated by
radiation therapy, even though so-called superficial therapy treatments
are said to be equally as effective as surgery.
Our pathology group offers "point of service pathology" services which are specifically coordinated
with some of our local dermatologists and surgeons and our radiation
oncologist. We have been involved since 1976 with the above clinical
doctors (and since early 1996 with our radiation oncologist) in
a highly coordinated program of skin cancer treatment, particularly
when it occurs on the head and the face. In this location, our
coordinated program makes the most maximal effort possible/devised
to conserve uninvolved skin. We are a group which has taken special
interest in skin pathology since 1975 and maintains both a system of intra-departmental
consultations between us 7 pathologists and a network of expert
dermatopathologists who are 24 hours away by Federal-Express-type
Our personal experience is that the classical frozen section Mohs
technique has deficiencies in dealing with certain skin cancers
which are not rich in cancer cells. In most situations, this expensive
and highly patient-time-consuming technique can be
avoided with co-ordinated, rapid over-nite processing in a two-stage procedure. Stage (1): the cancer is excised with presumptively very conservatively-clear surgical margins. That excision tissue is processed by pathology and interpreted the next day & completeness or incompleteness of the removal reported to the doctor. If the removal turns out to be incomplete, (stage 2) more tissue is removed in the second stage to get clear margins.
So, in our own hospital system, the skin cancer is surgically conservatively removed
with what is hoped to be a very small surrounding margin of uninvolved
normal tissue (as in the paragraph above). The specimen is submitted to our laboratory with
an exacting orientation (by the doctor) which we are able to maintain
through overnight permanent-section processing, all orientation
being maintained into slide production by use of marker dyes and
agar pre-embedding. By the next morning after quick and comfortable
surgery, we are able to FAX information to our doctors with a very
exacting report on whether the surgical margins were actually clear
or not (additional discussion…when needed…is done
by telephone). If
the margins were not clear, our report can detail exactly where
the margin is positive. Depending on the type of margin positivity,
the skin surgeon makes a determination as to whether to remove
the bandage and cut more tissue or to send the patient for margin “sterilization” by
superficial x-ray therapy following plastic-surgery style final
In other words, while skin cancer can be treated alone by radiation
therapy, our coordinated approach is most commonly tailored toward
the very exacting and skin-conserving cancer surgery performed
in the doctor’s office, followed by the exacting skin cancer
pathology diagnosis and pathology specimen mapping as performed
by Pathology Associates of Lexington, P.A. at Lexington Medical
Center here in West Columbia, S.C.
Because of the special surgical and pathology procedures to enhance
the conservation of skin (again, particularly around the face)
and the resulting plastic surgery repair (almost always by the
dermatologist, but also by surgical plastic-surgeon procedures), our ability to vary both the dose and size of the
site radiated becomes an additional exceptional advantage. A skin
cancer found to be very superficial requires less radiation than
a deeper one.
SUPERFICIAL RADIATION THERAPY is almost a lost art, and our capability
at Lexington Medical Center is one of only a few sites in South
Carolina (the only source in central South Carolina) providing
this expertise. In addition, there are occasional rare cases where
radiation by linear accelerator is required. But, radiation delivery
by linear accelerator cannot be focused down any smaller than the
size of the opening in a coffee cup. With superficial therapy,
the focus can be brought down to a size smaller than a dime, thereby
sparing surrounding tissue from radiation effect/injury.
When superficial radiation is required to a skin site over either
bone or cartilage (such as nose or face), a larger number of less-intense
doses is required (a larger number of visits scheduled) in order
to keep from damaging the underlying bone or cartilage. In delicate
skin or skin more likely to show the scarring effects of radiation,
such effects are lessened by utilizing a larger number of less
intense doses, provided that the skin cancer was not too thick.
Because of the exacting method of processing and diagnosis of
your skin cancer by our pathology department, measurements of the
cancer are available and can be used in optimizing the radiation
dosage and number of treatments (number of separate treatment days)
when treated in the Radiation Oncology Department of Lexington
Medical Center. Treatment visits could be as few as 2 or as many
In order to be in a position to take advantage of this highly
coordinated program, a suspicious skin lesion must be evaluated
and biopsied or removed by one of our participating physicians.
These physician groups are:
- Palmetto Dermatology: 803-796-2500 or 800-432-7546
With office hours in West Columbia, S.C. Lexington, & Newberry, S.C.
- Rebecca Clemenz, M.D. 803-749-0092 Irmo, S.C.
- Lexington Surgical Assoc. 803-359-4133 Lexington, S.C.
- Southern Surgical, West Columbia, S.C.
- Brett Carlin, West Columbia, S. C.
- Peter haines, Irmo, S. C.