Dr. Edward Buckingham: Now, obviously because I'm a facial plastic surgeon, this talk is going to be just about skin cancer on the face and because . . . To talk about each separate skin cancer location on the face would be a huge topic that would require hours of video time and probably bore you to death. So, we're going to really talk about it in more of a general term about the process of treating skin cancer and why we do it that way.

So, there's three main types of skin cancer, and there's many other varieties of much more rare skin cancer that I won't go into what the treatments are for those individually. So, the three main types are squamous cell skin cancer, basal cell skin cancer, and melanoma. Basal cell skin cancer is by far the most common type of skin cancer, but luckily it's also the most indolent. That is the least aggressive and the least dangerous. Squamous cell skin cancer is the second most common and is intermediate in the way that it behaves between basal cell carcinoma and melanoma, melanoma being the rarest form of skin cancer, but also the most aggressive as far as its ability to cause metastasis and eventual death if left untreated.

The first two skin cancers tend to present as nodules, ulcers, scaly skin, things that you would normally think of as looking like that. A melanoma typically presents as a pigmented lesion. Although, there are varieties of melanoma that don't have any pigment in them, referred to as amelanotic melanomas. So, there are other more subtle signs that you look for in determining whether or not you might have a melanoma.

So, any time you have an area of skin that is itching, bleeding, won't heal, has nodularity to it, is pigmented, is growing, has an irregular border, any of those things, I would strongly encourage you to visit your primary care doctor or probably, more importantly, a dermatologist to look at those areas and determine what they might be, whether it be benign or malignant. We don't do skin checks in our practice, as we're involved in the reconstruction of these skin cancers primarily. But on occasion, we do find these in our patients.

So, once you determine that you might have something, and you present to your doctor, and a biopsy is performed, and the diagnosis of skin cancer is made, that's where we typically come in. With a basil cell skin cancer or a squamous cell skin cancer on the face, it depends upon the location of that cancer as to whether we would recommend just having an excision done by us . . . When we do that, we just localize or put an injection of local anesthetic in the area, mark out what we think is the skin cancer, and remove it. Then, sew the wound closed.

We then send the specimen off for a pathologist to check the edges and determine whether we got it all or not. If we didn't, then we need to go back into that area and take more out. So, in certain areas of the face, that's appropriate, forehead, cheeks, areas where you have lots of skin around the area to reconstruct things. So, if it comes back being positive, it's not that big a deal.

More preferably however, and as an essential feature of those basal cell and squamous cell skin cancers that show up in anatomic areas that are difficult, like the lips, ears, nose, eyelids, we team up with somebody called the Mohs surgeon. What a Mohs surgeon is is a specialized dermatologist who's done extra training in a technique called Mohs surgery. That's spelled M-O-H-S, and is named after a gentleman, Frederick Mohs, who developed the technique back in the '60s.

What the technique is is basically microscopic removal of the skin cancer. It's appropriate for basal cell skin cancer, squamous cell skin cancer, and some of those other more rare varieties that I won't mention this evening. What the technique involves is, again, under local anesthesia, scraping out of the tumor cells that will easily come out. So, they use a curette first, because tumor cells are not adherent like normal cells are, to scrape out and better define what the gross margins of the tumor are.

The Mohs surgeon will then remove a small rim of tissue around the cancer, will section it, provide stains so that they can look at it, and then they'll look at that tissue underneath the microscope while the patient is waiting in their office, and literally map microscopically whether or not they have all the tumor removed. If there's an area that they map that the tumor is not all removed, they'll go back with that same patient in that day and take a little extra around that edge to make sure that they get all of the tumor removed.


Treating Facial Skin Cancer and Three Most Common Types

Dr. Edward Buckingham discusses the process of treating skin cancer on the face. Basal Cell, Squamous Cell, and Melanoma are the three most common types of skin cancer.