Rajiv Nijhawan, M.D. Answers Questions On: Skin Cancer

Basal cell carcinomas, squamous cell carcinomas, and melanomas are the three major types of skin cancer that we see. But because we are a referral center and a tertiary care institution, we also treat a lot of the more rare tumors, such as dermatofibrosarcoma protuberans (DFSP), atypical fibroxanthoma (AFX), and sebaceous carcinomas. 

Rare skin cancers such as these make up less than 1 percent of total skin cancers, but we see a fair amount of them because other dermatologists and Mohs surgeons in the community often will refer patients with these tumors to us.

Increased evidence in the medical literature supports the use of Mohs surgery in higher risk locations such as around the eyes and lips and for many different tumor types, including early stage, noninvasive melanoma on the head and neck areas as well as the rare tumor types. In addition, Mohs surgery reduces the rate of recurrence in these cases.

But we don’t always need to use Mohs surgery – in some cases, especially skin cancers that appear on the chest, the back, or the legs, we use other dermatologic surgical techniques to treat the tumors.

A scar can be really devastating to patients, and one of our main goals with any skin cancer treatment is to maximize a patient’s quality of life by minimizing any scarring. 

When patients come in with cancers that are large or that are located on delicate areas of the face or scalp, they are sometimes afraid that they’re going to be sent home with big holes in their faces. But through skin flaps or skin grafts, we’re able to replace a lot of the tissue we remove. And we do everything possible to hide suture lines among natural lines in our skin, such as smile lines, crow’s feet near the temple, or forehead lines.

We also make sure that important structures in delicate areas such as the face can maintain function – normal breathing if we remove some or part of a nose, normal blinking if a tumor is near the eye, or normal eating if it’s around the mouth.

Many people don’t realize how forgiving our skin is. In many cases, the healing time is only a few weeks to months, and after that, a stranger may not be able to tell that a surgery was ever done.