Melanoma and non-melanoma skin cancers are some of the most commonly diagnosed malignancies in young adults, and melanomas tend to be more aggressive in this demographic. Daniel Bax, MD, Dermatologist and Mohs Surgeon for the Roswell Park Care Network, discusses treatment options for these aggressive types of melanoma and how minimally invasive approaches like Mohs Surgery can preserve more healthy tissue, resulting in a better appearance.
Hello, my name is Daniel Becks and I am a dermatologist and mo surgeon within the Roswell Park Care Network. And I practice primarily in our depute and Lockport locations. Most providers break things up into Melanoma and non melanoma skin cancers. Considering Melanoma, skin cancers, they are thought of generally as more aggressive than the majority of non Melanoma skin cancers. They can also be more difficult to while the average age of diagnosis of Melanoma skin cancer is around 65 years old. It does tend to be one of the most common types of cancer that occur in young adults, especially under the age of even 30 years old. For reasons we don't fully understand. It also tends to occur more often in young female patients. Melanoma can also arise from multiple genetically inherited family cancer syndromes. And when this is the case, melanomas tend to onset earlier. Some cases when caught very early are treated by a very straightforward simple excision. While other cases can require a procedure to check the lymph nodes or even more advanced cases can require surgical oncology or oncology to administer chemo or immunotherapy here at Roswell Park. We not only have a robust dermatology department, but also a very strong pathology, radiation oncology, surgical oncology and oncology departments. And we can help patients make those difficult decisions for their specific skin cancer. I can recall a young female patient in her early thirties with a young family who is actually pregnant with her third child. She had a lesion of concern on her thigh that was biopsied and shown an intermediate thickness melanoma. This means that it's not very clear cut on whether she should get a sentinel lymph node biopsy or not. And so instead of having to make that decision on her own or just with having a conversation with myself, I was able to tie her in with surgical oncology who could have a conversation with the patient and explain to her the wrist and not only herself but to her unborn child. In addition to that, we were able to send her tissue for gene expression profiling. This is a newer test that actually test an individual patient's melanoma for different mutations. And with that tries to make a decision about how aggressive their individual skin cancer is. After those conversations, the patient decided to just have a simple excision and was followed closely. But I feel that Roswell Park has that to offer to patients to coordinate and really streamline care to make a well educated as well as a timely decision in a case where that decision is very personalized to the patient. And their specific cancer. Melanoma. Skin cancer is generally more aggressive than non Melanoma skin cancer. But one must consider that non Melanoma skin cancer is much more common. Overall, young adults have been shown to have increased rates of basal cell carcinoma. The most common type of non melanoma skin cancer dissecting these studies. Again, young females tend to be at particular risk. Patients with light hair, light eyes and light skin, as well as patients with history of sunburns or history of tanning bed use are particularly high risk. I'm fortunate to be part of the most surgery team here at Roswell Park for non Melanoma skin cancers, namely basal cell carcinoma, and squamous cell carcinoma. Most surgery allows us to take a minimal margin around a tumor. If a tumor is located on the upper arm or the back, there's generally a fair amount of lax skin to repair a wound after a cancer has been removed. And that's usually easy to facilitate when a skin cancer is on the face. We generally want to take a much narrower margin, but we do risk cutting through the tumor and having a positive margin. For that reason, we perform most surgery where an orientation, usually a nick in the skin or sometimes with certain color coding, we remove the tumor with narrow margins and we actually ink the tissue so that it acts as a map. We make very thin sections of the tissue and we look at it under the microscope. If the tumor is clear, then we'll see all normal skin under the microscope. If the tumor isn't, we mark the tumor in such a way that we can correlate just where we need to go back and take more tissue. Whether that's between 12 and three o'clock or at nine o'clock or circumferentially around the whole wound. Given the prominence of the skin cancers in aesthetically concerning locations like the central face that an older patient who may have had three or four procedures may not be terribly concerned about their scarring. While I find my young adult patients are chiefly concerned about their scarring. And this method really helps to achieve that for our young adult patients. I treated a young male patient in his late twenties. Recently, he was referred from an outside dermatologist and that had a biopsy and we were performing mo surgery for basal cell carcinoma on his cheek. After the first stage of the mo surgery, it was evident that the patient had a fair amount of extension that was only detected microscopically. We did another layer of mo surgery and that too was positive. He ended up spending about four hours with us and had five rounds of most surgery which left quite the sizable defects on his left cheek. He was a bit distraught but we closed the area and we were able to treat him within one visit. He returned about one week later and was very happy with the appearance of his wound already offering the specialized procedure um that takes a lot of training and finesse and having a team dedicated to it. Uh is really yet another reason that young adult patients would benefit by coming to Roswell Park for their skin cancer.
BROADCASTMED