Skin health is Dr. Steele Johnson’s priority, so our first step to skin enhancement is ensuring skin health. With our mole evaluation, skin cancer, and melanoma treatment treatment center, we’ll evaluate all of your skin moles and growths to make sure that they are not potentials for skin cancer and then develop a schedule for regular evaluation and monitoring. If you do have a skin cancer, Dr. Steele Johnson will offer the most advanced and comprehensive treatment options to ensure that your lesion is completely removed and effectively, you are cured. Dr. Steele Johnson is always happy to examine any lesion because we understand that the potential for any sort of cancer or pre-cancer is scary and early detection and treatment is critical. Optimal skin health is our priority.
So, What Are We Looking for?
One main reason that it is so important for Dr. Steele Johnson (or another qualified dermatologist) to evaluate your skin is that patients often say that they’re not entirely sure what they’re looking for when they do a home skin exam. Although you often see guidelines about how to look for abnormal moles, the rules may not apply if it’s not a “mole” (i.e. it’s a brown spot that’s technically not a mole) or if you have atypical moles. Most importantly, get familiar with your skin and know what’s normal for you so that you can identify what’s abnormal, new or changing. Look for things that are a different color, red, rough or scaling, larger or darker than other lesions, or lesions that never seem to heal or go away.
There are 3 main types of skin cancer that Dr. Steele Johnson diagnoses and treats commonly: Melanoma, Basal Cell Carcinoma and Squamous Cell Carcinoma. Additionally, there are pre-cancerous lesions (dysplastic moles and actinic keratoses) associated with these cancers that should be treated to avoid progression to skin cancer.
Treatment of Pre-Cancers
Actinic keratoses (AKs) tend to be rough (sandpaper-ish) spots that may be red or brown, but are more easily felt than seen, on sun exposed areas—especially the face, hands, arms, scalp, ears, and chest. They have a very small risk of becoming skin cancer over time, so they do require treatment– although it is not urgent.
AKs can be treated chemically, by cryotherapy, or photodynamic therapy. All are reasonable options depending on the location and number of lesions, your history, and lifestyle factors. Cryotherapy involves freezing individual lesions. The procedure is uncomfortable although it’s only takes a few seconds. This is the most reasonable treatment for few isolated lesions but can be used for multiple. It is the most common treatment for AKs and the most direct. Topical Treatment relies on a cream that you apply at home for several days that causes your own immune cells to attack the abnormal cells during which you will see and feel a response. Upon healing from the treatment, the treated area becomes smooth and should remain clear of AKs for a sustained period of time.
One benefit to this treatment modality is the ability to treat an entire “field”, i.e. a broad area that may have multiple lesions and multiple developing lesions that have not yet come to the surface. For these reasons, it is a great option for someone with numerous AKs, a history of skin cancer, and/or significantly sun damaged skin. Photodynamic Therapy (also known as PDT or Blue Light) is similar to a topical treatment in that Dr. Steele Johnson treats a whole area rather than individual lesions. A medicine (aminolevulinic acid (ALA)) is applied to the skin to be treated and allowed to sit for a period of time (1-3 hrs). The ALA works it’s way into the most active cells (i.e. the ones that are dividing too quickly and are pre-cancerous). After the incubation time, you are placed in front of a light that activates the ALA for 16 minutes. You are asked to stay out of the sun for 2 days following treatment. You generally need 2 treatments for the best results.
Dysplastic nevi (moles) which can be a precursor to melanoma cannot be treated topically or with cryotherapy like AKs because we are dealing with melanocytes which have a greater ability to move into deeper layers of skin. Dysplastic nevi tended to be graded as mild, moderate, or severe. They first must be biopsied to know if they are dysplastic and following biopsy, if they are abnormal then we must follow up with treatment. In the mildest cases, we can monitor the are to make sure the lesion doesn’t recur. If the lesion looks more severe then it must be excised in a small surgical procedure at the office.
In cases of treating both AKs and dysplastic nevi, the goal to is to remove any cells that may potentially go on to become cancer.
Treatment of Skin Cancer
Like for any other cancer, the goal of skin cancer treatment is to completely remove any cancerous cells. However, the extensiveness of the treatment in skin cancer is matched with the aggressiveness of the cancer. Thankfully, not all skin cancers are as aggressive or threatening as others.
Melanomas can be aggressive and life threatening so the treatment is similarly aggressive. When a melanoma is biopsied, the pathologist reports not only on the diagnosis but also depth of invasion and other characteristics of the tumor to better understand it’s potential for spread. With that diagnostic information a treatment plan is made. All melanomas are excised (cut out) with a wide rim of normal tissue to ensure clearance of the lesion. This is usually done in the office with Dr. Steele Johnson. Since the margin of tissue around the mole is large, the scar is really large (except in the cases of the smallest melanomas). If a melanoma is thick or appears to be aggressive then doing further evaluation (like a sentinel lymph node biopsy) may be indicated, in which case, Dr. Steele Johnson will refer the patient to a oncologic or general surgeon for treatment.
For some select types of melanoma, Dr. Steele Johnson will refer you to a special skin cancer surgeon for Mohs Surgery when appropriate. In any of these scenarios, Dr. Steele Johnson and the staff at Steele Dermatology work swiftly to make sure your melanoma is treated as quickly as possible and you receive the best care.
Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma(SCC) are not as threatening as melanoma, but do generally require Dr. Steele Johnson to do an excision with a margin of tissue around the lesion. The margins required for SCCs and BCCs are much smaller than that for melanomas though so excisions are generally much smaller. When a BCC or SCC is on some areas of the face or scalp, Dr. Steele Johnson will refer you to a Mohs surgeon who specializes in skin cancer surgery in these areas.
Often Basal Cell Carcinomas and Squamous Cell Carcinomas are only superficial (i.e. they don’t go deeper than the epidermis) and if the pathology from the biopsy reveals this then Dr. Steele Johnson will present more skin cancer treatment options including a topical chemotherapy-like cream or a brief in office procedure to scrape away the cancerous cells. Again, in any case, at Steele Dermatology we strive to make sure that you are well taken care of in your skin cancer treatment and also, that you receive the proper follow up and monitoring.