BASAL CELL CARCINOMA (BCC) is
the most common form of skin cancer. It develops in areas of sun exposure
and may take 20 - 30 years to grow. Also,
known as "Rodent Ulcers" for there propensity to burrow through
skin, muscle and bone if neglected. These skin cancers rarely spread to
other organs. The most common appearance is an elevated, pearly white
colored, irregular shaped and ulcerated lesion. However, they can be pigmented,
nodular shaped or appear as an irritated reddish plaque.
Treatment:
Complete surgical removal is the primary mode
of therapy.
Cryotherapy (freezing), Topical 5 - Fluorouracil
may have value in very early BCC.
Radiation therapy can be used to help maintain
local spread of the disease.
What is Moh's Surgical Treatment:
This is a form of serial excision where the
skin cancer is removed, the specimen then placed on a grid and inspected
under a microscope. The tumor cells are then mapped out. If the cells
involve or come close to the cut surgical margin, further skin is removed
precisely in the mapped out area. The process is repeated until no tumor
cells are visible under the microscope.
What is Rapid Frozen Section Treatment:
The skin cancer is removed and then the tissue
specimen is frozen. Next, several cuts are made through the frozen tissue
and inspected for tumors cells either close or touching the surgical
excisional margin. If the cells are found in this area, another specimen
of skin is removed, analyzed in a similar manner and repeated until
no tumor cells are present under the microscope. Since the skin cancer
is not completely mapped out and only isolated areas are looked at,
rapid frozen section has only about a 95% accuracy rate. Therefore,
about 5% of the time, when the same tissue specimen is examined fully
a few days later, tumor cells may be found to be present, thereby requiring
further treatment.
Advantages and Disadvantages of Either Moh's or Rapid Frozen Section Treatment:
Moh's has the advantage of a more accurate
initial analysis of the tissue. This is of value in areas where preservation
of skin is important for reconstruction of the area, such as the nose
and lip. The main disadvantage of Moh's is that it might take several
hours to complete. Moh's is many cases is unnecessary and time consuming,
especially in those areas of the face and body which have plenty of
skin available for reconstruction.