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Skin Cancer

Johns Hopkins offers a full spectrum of coordinated care for all types of skin cancers.  Experienced surgeons and dermatologists are world-leaders in spotting, diagnosing and removing skin cancers.

Skin Cancer Experts

Johns Hopkins experts in the Department of Dermatology and Kimmel Cancer Center coordinate skin cancer care through the Melanoma Program and Department of Dermatology Cutaneous and Oncology Unit.

About Skin Cancer

Three types of skin cancer account for about 95 percent of all skin cancers that occur: melanoma, squamous cell carcinoma and basal cell carcinoma. Basal cell and squamous cell carcinomas are sometimes called "nonmelanoma skin cancers."

Nonmelanoma skin cancer is the most common type of cancer that affects humans. There are generally more than 1,000,000 cases diagnosed and treated in the United States alone. This exceeds the number of all other cancers combined. There are two main forms of nonmelanoma skin cancer:

  • basal cell carcinoma (BCC)
  • squamous cell carcinoma (SCC)

Both types of cancer appear to be related to sun explosure. BCC outnumbers SCC by a ratio of 3 or 4 to 1, and develops most commonly as a waxy spot that may crust and bleed when bumped. It tends to grow very slowly, over months to years, and although potentially quite disfiguring and locally invasive, BCC rarely spreads (metastasizes) to other parts of the body. SCC often looks like a mound of tissue or wounded skin that just "won't heal". Although not as dangerous as melanoma or many forms of internal cancer, SCC will occasionally spread to the local lymph glands and on to the rest of the body, and cause death in addition to local impairment. Thus, both types of nonmelanoma cancer need to be treated promptly once diagnosed.

Most cases of nonmelanoma skin cancer do not require the expertise of multidisciplinary care; however, there are a number of uncommon and even rare types of skin cancer that do benefit from our multidisciplinary approach to diagnosis and treatment at Johns Hopkins. These rare skin cancer types are:

  • Merkel cell carcinoma
  • microcystic adnexal carcinoma
  • apocrine carcinoma
  • Paget's and extramammary Paget's disease
  • dermatofibrosarcoma protruberans
  • sebaceous carcinoma
  • angiosarcoma
  • cutaneous leiomyosarcoma
  • advanced or metastatic squamous cell or basal cell carcinoma

Risk Factors

How Can I Protect Myself from Developing Skin Cancer?

The best protection from skin cancer is to avoid the harmful ultraviolet rays of the sun. Even if you tan easily, the sun can contribute to skin cancer. Minimize your exposure by:

  1. Wearing a broad brimmed hat and sun protective clothing whenever possible.
  2. Avoiding sun exposure during midday hours (10 a.m. to 2 p.m.).
  3. Do not stay outdoors unprotected on cloudy days since the ultraviolet light penetrates easily through the clouds.
  4. Using a sunscreen with a sun protective factor (SPF) of at least 20 on all exposed skin surfaces any time in the sun.

If you follow this advice, it may not be necessary to restrict your outdoor activities or change your lifestyle.

Current Treatments

Melanomas are treated with surgery, chemotherapy and radiation or a combination.  Some patients also may benefit from new, biologic agents that target melanoma cell specifically.

The most common and effective treatments for nonmelanoma skin cancer are surgical. Pre-cancerous actinic keratoses (AKs), which can go on to become SCCs in a small percentage of cases, present as rough, scaly bumps, most commonly on sun-exposed parts of the face. These growths are often treated with liquid nitrogen spray or 5-fluorouracil cream. Very shallow BCCs and SCCs are often treated by scraping them and cauterizing the base, especially if a soft, flat, white resulting scar is not a problem. This is called "curettage and electrodessication" or "C + E". More invasive tumors are best excised with margins to insure complete removal. Finally, the most invasive and difficult-to-visualize tumors, including recurrent cancers, those with infiltrating histology under the microscope, and those located in areas of high cosmetic concern, such as on the ears, eyes, nose, or lip, may benefit from the use of Mohs micrographic surgery.

What is Mohs Micrographic Surgery?

Mohs surgery is a highly specialized treatment for the total removal of skin cancer. This method differs from all other methods of treating skin cancer by the use of Complete Microscopic Examination of all the tissues removed surgically as well as detailed mapping techniques to allow the surgeon to remove all of the roots and extensions of the skin cancer.

The procedure is begun after the skin is injected with a local anesthetic to make it completely numb. Then the visible cancer and a very thin layer of skin are removed with a scalpel, carefully mapped, and examined microscopically. If there is still cancer seen under the microscope, another very thin layer of skin is removed from that exact location. This may be repeated as often as necessary to completely remove the cancer.

What are the Advantages of Mohs Surgery?

By using the detailed mapping techniques and complete microscopic control, the Mohs surgeon can pinpoint areas involved with cancer that are otherwise invisible to the naked eye. Therefore, even the smallest microscopic root of cancer can be removed. The result is: 1) the removal of as little normal skin as possible, and 2) the highest possible of curing the cancer.

What is the Cure Rate?

Mohs surgery is the most accurate method for removing skin cancers, even when previous forms of treatment have failed. In untreated cancers the percentage of cure is 99 percent. In previously treated cancers, where other forms of treatment offer only 80 percent chance of success, Mohs surgery is 95 percent effective.

Is Hospitalization Necessary?

No. Mohs surgery is performed in a pleasant outpatient surgical suite and you may return home the same day.

Will the Surgery Leave a Scar?

Yes. Any form of treatment will leave a scar. However, because Mohs surgery removes as little normal tissue as possible, scarring is minimized. Immediately after the cancer is removed, we may choose 1) to allow the wound to heal by itself, 2)to repair the wound with stitches, or a skin graft or flap, or 3) to send the patient to the referring physician or another surgeon for wound repair. The decision is based on the safest method that will provide the best cosmetic results.

 

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