Three common treatments for basal cell carcinoma (BCC) are shown and described in this video, with pros and cons discussed. These include excisional surgery, electrodessicaton and curettage and topical imiquimod.
Mohs Micrographic surgery and radiotherapy are not covered.
This video does cover the most pertinent options for most patients and is a valuable educational resource.
is an innovtive company that has created a system for diagnosing skin lesions with a specal emphasis on melanoma. They have developed a handheld skin imager and intuitive cloud-based software to take, store, and send clinical quality 3D images from any user to a trained dermatologist. Their imager matches or exceeds industry standards in lighting, polarization, and magnification - ensuring that every image taken with a 3Derm device is diagnostically useful. The 3Derm web platform was built from the ground up to be HIPAA secure, and allows patients and dermatologists to connect easily with a modern interface. These innovations are designed to improve access to and frequency of standardized skin imaging - detecting skin cancer at the earlier, more treatable stages. See 3Derm Website.
Mohs surgery is the best approach for patients with skin cancers in specific areas. These include the eyelids, and certain areas on the nose and ears and scalp. It can be a very expensive proposition, so the prospective patient should be aware of the charges beforehand. In addition, some Mohs surgeons will perform the procedure on lesions that can be removed by simpler procedures.
This topic was addressed in a recent NY Times article: "Patients’ Costs Skyrocket; Specialists’ Incomes Soar" by Elisabeth Rosenthal. In our opinion, Ms. Rosenthal's article is accurate although it may generate some heat from Mohs surgeons and the American Academy of Dermatology.
The article centered on the experience of a woman in Arkansas. It described "a daylong medical odyssey through different private offices on the manicured campus at the Baptist Health Medical Center that involved a dermatologist, an anesthesiologist and an ophthalmologist who practices plastic surgery. It generated bills of more than $25,000."
Caveat emptor. If you are referred for Micrographic Mohs Surgery, it is probably appropriate. But read the article carefully and ask questions. If your skin cancer is not around the eyes, nose or ears or on the scalp, get a second opinion.
The New York Times, today, had an article about new sunscreen regulations. If one is interested in this topic, it's a good starting point.
Comment: Please keep in mind that there is controversy as to whether the rising incidence of melanoma referred to in the Times article is related to sun exposure or the result of diagnostic drift. Pathologists now call lesions melanoma where years ago they would have labeled the same lesions dysplastic moles. Also, screening tends to increase melanoma incidence (see work of Sam Shuster). Melanoma incidence is rising, but death rate not nearly as much. This is a complicated topic that needs to be be addressed. Researchers' conflicts of interests should be clearly noted. The heavy funding of The Skin Cancer Foundation by "industry" and the grants given to researchers muddy the waters. "No one should enter the Temple of Science with the soul of a money changer." Sir Thomas Browne
In 2010, almost 780 000 skin cancers were diagnosed and treated in Australia. Only 1% of these were invasive melanoma. The vast majority were nonmelanoma skin cancers (NMSCs) in people aged 60 years and over. Nonmelanoma skin cancers in Australia are now nearly seven times more common than all other cancers combined; approximately half of these are removed by general practitioners.
This is a valuable about skin cancer screening from a Professor of Dermatology at the University of Melbourne, Victoria, Australia.
For article with helpful tables: Download Skin Cancer Screening Sinclair
There is no evidence that the skin cancer screening saves lives. Yes, screening may pick up some early skin cancers, but they are very, very unlikely to cause death or even suffering. Screening is a marketing tool for physicians' services and skin cancer screening is no exception. It brings people into dermatology practices and increases the number of lucrative procedures dermatologists perform.
A spate of recent articles in the press has addressed breast, prostate and cervical screening. Gina Kolata summarized the data in a recent lucid article: Considering When It Might Be Best Not To Know About Cancer (NY Times, October 29, 2011). Read this article if you want a good summary of this topic.
One can extrapolate from Kolata's article to skin cancer screening. "The disease [cancer] was defined in 1845 by a German pathologist, Rudolf Virchow, who looked at tumors taken at autopsy and said cancer is an uncontrolled growth that spreads and kills. But, of course, he was looking only at cancers that killed. He never saw the others.
Now we are backing away from that, experts say. In recent years, researchers have found that many, if not most, cancers are indolent. They grow very slowly or stop growing altogether. Some even regress and do not need to be treated — they are harmless."
While this is true for skin cancers as well, dermatologists are still scaring patients. Isn't it time to stop doing this? It will be interesting to see if the American Academy of Dermatology and the Canadian Dermatology Association come clean.
The U.S. Preventive Services Task Force's reccomendation on skin cancer screening states: "the current evidence is insufficient to assess the balance of benefits and harms of screening for skin cancer by primary care clinicians or by patient skin self-examination. If this service is used, patients should be made aware of the uncertainty about the balance of benefits and harms."