Skin cancer is a prevalent health concern, impacting millions each year. Dermatologists, as specialists in skin health, play a central role in addressing this condition. Their expertise allows them to manage skin cancer care, from early detection to treatment and prevention. They identify subtle skin changes, guide patients through diagnosis, and select appropriate therapies.
The Dermatologist’s Role in Skin Cancer Identification
During a skin cancer screening, a dermatologist conducts a thorough examination of the entire body, from head to toe. They meticulously inspect moles, lesions, and any other skin changes that might indicate the presence of cancer. This comprehensive visual inspection extends to areas often overlooked, such as the scalp, back, buttocks, and between the toes.
Dermatologists utilize specialized tools, such as a dermatoscope, which is a handheld magnifying device with a light. This instrument allows them to visualize the outer surface of the skin, the epidermis, and the layers just beneath it in greater detail. Observing subtle characteristics in color, texture, and size of skin growths with the dermatoscope helps them differentiate between benign and potentially cancerous lesions.
Understanding Skin Cancer Diagnosis
Once a dermatologist identifies a suspicious area, a skin biopsy is often performed to confirm the diagnosis. This procedure removes a small sample of skin tissue for microscopic examination by a pathologist. A local anesthetic is administered to numb the area.
There are several types of biopsies, and the choice depends on the lesion’s size, location, and suspected type of cancer. A shave biopsy removes a sample from the topmost layers of the skin using a razor blade, often used for lesions thought to involve only the epidermis. A punch biopsy utilizes a special circular blade to remove a small, round piece of skin that extends into deeper layers, providing a full-thickness sample. An excisional biopsy involves using a scalpel to remove the entire suspicious growth along with a margin of surrounding healthy tissue, particularly if melanoma is suspected.
The pathologist’s analysis of the biopsied tissue provides a definitive diagnosis and helps determine the type and stage of skin cancer, guiding subsequent treatment decisions.
Treatment Approaches by Dermatologists
Dermatologists offer various treatment options for confirmed skin cancers, tailored to the specific type, size, depth, and location of the tumor. Surgical excision is a common approach, where the dermatologist removes the cancerous tissue along with a surrounding margin of healthy skin to ensure all cancer cells are gone. The removed tissue is then sent to a lab to confirm clear margins, meaning no cancer cells remain at the edges of the removed sample.
Mohs micrographic surgery is a specialized procedure often used for basal cell and squamous cell carcinomas, particularly on sensitive or cosmetically important areas like the face. During Mohs surgery, the surgeon removes thin layers of cancerous tissue one at a time, examining each layer under a microscope immediately. This process continues until no cancer cells are detected, preserving as much healthy tissue as possible and achieving a high cure rate.
Other treatments include cryosurgery, which uses liquid nitrogen to freeze and destroy small, superficial cancer cells. Topical chemotherapy involves applying medicated creams directly to the skin to kill cancer cells, used for superficial basal cell and squamous cell cancers or precancerous lesions. Photodynamic therapy uses a special light to activate a topical medication, destroying unhealthy skin cells while leaving normal cells unharmed.
Prevention and Ongoing Management
Dermatologists play a significant role in guiding patients on preventing new skin cancers and managing existing conditions or high-risk situations. They emphasize the importance of sun protection, including the consistent use of broad-spectrum sunscreen with an SPF of at least 30, wearing protective clothing, and seeking shade, especially during peak sun hours.
Patients are encouraged to perform regular self-skin exams, becoming familiar with their skin and noting any new or changing moles or lesions. Dermatologists educate patients on what to look for, such as the ABCDEs of melanoma (Asymmetry, Border irregularity, Color variation, Diameter greater than 6mm, and Evolving changes). Ongoing follow-up appointments with a dermatologist are also recommended, particularly for individuals with a history of skin cancer or multiple risk factors. These routine professional checks allow for early detection of recurrence or new lesions, significantly improving treatment outcomes.