DERMATOLOGY

Myrtle Dennis has spent a lifetime enjoying Florida's temperate climate.

"I've lived in Lake Worth and West Palm all my life," she explains. "Then I retired and moved from West Palm Beach to Okeechobee."

Unfortunately, the cumulative effects of sun damage took their toll on the native Floridian, and she found herself with a cancerous lesion on her nose.

"Prior to meeting Dr. Sanders, I had three separate surgeries on it," says Myrtle, "but apparently they never got all of the cancer. Finally, my ear, nose, and throat doctor gave me a referral to Treasure Coast Dermatology."

Jonathan S. Sanders, MD, JD, is board certified in dermatology by the American Board of Dermatology.

He notes that skin cancer is of particular concern to Floridians and the physicians at Treasure Coast Dermatology make sure that every examination includes a rigorous focus on skin cancer detection.

"Most of all," adds Dr. Sanders, "patients who come in to see us always see a doctor who has been extensively trained in dermatology. Protecting the health of the skin and preventing skin cancer and the problems it may cause has never been more important."

The procedure used for Myrtle was Mohs micrographic surgery, Dr. Sanders reports.

"Mohs surgery is a highly specialized technique for precise, minimally invasive surgical treatment of skin cancer," he says.

"This procedure has the highest surgical cure rate for both basal cell carcinoma and squamous cell carcinoma," adds Treasure Coast Dermatology founder Tim Ioannides. MD.

The Mohs technique involves removing successive layers of tissue and immediately examining them with a microscope to determine at what point all signs of cancer have been excised.

"Mohs surgery has a number of indications," adds Dr. Ioannides. "Location is an important one, especially in areas such as the face and hands. However, size of the lesion and whether it's recurrent may also lead a dermatologist to perform the Mohs procedure."

The entire procedure may take a few hours to complete, but actual surgical time is much less. Most of the time is spent in careful preparation and scrutiny of the excised tissue.

"If cancer cells are still evident in a layer of tissue, another thin layer is excised during the same procedure," explains Dr. Sanders. "The process is repeated until all the cancer cells are removed, preserving as much healthy tissue as possible around the site of the lesion."

Great results

"I didn't realize basal cell could become so bad," confides Myrtle.

"I grew up in Florida," she reminds, "but I never knew skin cancer could go like that. Dr. Sanders appeared to know exactly what he had to do, though. I think he was a little surprised by how bad it was, because I'd had surgery done three times before in the same place, but he handled it well."

And she emphasizes that Dr. Sanders and his staff took excellent care of her.

"I think they did a great job," she says. "The staff are all very organized, very good."

Myrtle cautions anyone with skin cancer to seek help from specialists like the board-certified dermatologists at Treasure Coast Dermatology.

"I think when people have skin cancer, they should have it taken care of right away," says Myrtle. "I would recommend Dr. Sanders to anybody."

Skin cancer: an overview

"Every year, there are more cases of skin cancer diagnosed than all other cancers combined," warns Dr. Ioannides.

There are three main types of skin cancer: melanoma, basal cell carcinoma, and squamous cell carcinoma.

"Melanoma, the deadliest, will claim approximately 10,000 lives this year," notes Dr. Sanders. "The majority of melanomas occur on the head, neck, arms and back, areas of the skin that are most exposed to sunlight. The majority of them are very dark or black but may sometimes be lighter brown or even speckled. The surface is usually raised and sometimes rough. Melanomas are not normally circular in shape, but some can be quite close to a circle.

"In their early stages, they often look like moles, but with a ragged outline or different shades of color in them. Sometimes a melanoma appears to be a mole that is bleeding, oozing, or crusty. However, the most important thing to note is that melanomas usually change shape or color as they grow. Any spot that changes color or shape should be reported to a dermatologist.

"Malignant melanoma can be one of the most dangerous types of cancer. All types of skin cancer have the potential to spread into nearby tissues, but some grow faster and spread farther than others. If diagnosed late, treatment is not usually able to cure the cancer."

"The most common skin cancer, basal cell carcinoma, affects one in five Americans on average," adds Dr. Sanders. "These lesions tend to be shinier in appearance. The vast majority of basal cell carcinomas occur on the face. They start as a small, pink, pearly, or waxy spot, often circular or oval in shape. As they grow, they become a raised, flat spot with a rolled edge, and they may develop a crust. Next, they begin to bleed from the center, and an ulcer develops. If left long enough, the ulcer can become quite large and eat away the skin and tissue underneath."

"Squamous cell carcinomas are more scaly or crusty in appearance, and lesions called actinic keratoses often develop into them. Squamous cell carcinomas are most common on the limbs, head, and neck. They are pink and irregular in shape, usually with a hard, scaly, or horny surface, although they can sometimes become an ulcer. The edges are sometimes raised, and they can be tender to the touch.

"Squamous cell carcinomas also spread, but most of them spread slowly. Even the ones that spread more rapidly can be effectively treated as long as they are diagnosed reasonably early."

"An annual dermatologic examination is similar to a mammogram or colonoscopy for cancer detection," says Dr. Ioannides, "and patients should not be satisfied with someone giving them a cursory exam. Regular evaluations by a dermatologist are crucial, and our offices strive to secure timely appointments for our patients because the sooner we catch skin cancers, the sooner we can treat them."

Sun protection for the ages

To decrease skin cancer risk factors, the following tips are suggested.

- Avoid the sun when it is at its brightest.

- Always wear protective clothing.

- Use sunscreens with a minimum of 30 SPF even if you will not be in the sun long.

- Patients with skin cancer history should be examined every six months.

- Patients with no cancer history should be checked once a year. Everyone should do monthly self-exams.