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What is Skin Cancer?

Everyone has interesting forms of skin discoloration such as freckles and moles, most of which are completely normal. However, some of these spots do have the potential to turn into cancer. Watch for new skin growths or changes in existing moles, freckles, bumps and birthmarks.

Not all lesions will stand out or have symptoms when they turn into cancer. Cancer and precancerous spots can exist in areas of your skin that aren’t exposed to the sun. Cancer can appear on your head (in your hair), between your toes and other inconspicuous areas.

Contact our office for an appointment if you or your partner finds a suspicious lesion. Inform our front office staff why you want to see the doctor. Skin cancer has a high cure rate when detected early.

Facts, Types

Pre-Cancerous Spots

Pre-Cancerous Spots are also referred to as actinic keratoses or “AK’s” are common skin conditions caused by excessive sun exposure.   They usually appear in areas that are exposed to the sun like your face, lips, ears, neck, chest and hands.

Precancers before and after

They can range in size from a pencil led to the size of a pencil erasure. They will start out looking like a scaly patch of skin and will turn into a scaly, wart-like bump. One out of ten AK’s going untreated will likely turn into Basal or Squamous Cell Carcinoma.

Basal Cell Carcinoma (BCC)

Basal Cell Carcinoma (BCC) is the most common form of skin cancer, mostly occurring on areas of the skin that are excessively exposed to the sun.  They occur in one of five people and rarely spread to other areas of the body.  BCC’s are abnormal, uncontrolled growths or lesions that arise in the skin’s basal cells, which line the deepest layer of the epidermis (the outermost layer of the skin).

Ulcerated Basal Cell Carcinoma
Ulcerated basal cell carcinoma (left panel) and ulcerated basal cell carcinoma with characteristic pearly rim (right panel), Source

BCC’s often look like open sores, red patches, pink growths, shiny bumps, or scars.  When they are small they can look like a pimple, ingrown hair or scrape, the key warning is that they don’t resolve.  Early treatment is a quick and easy outpatient procedure or a prescription cream and leaves very little scarring.  A large BCC can require a big surgery to remove and can be cosmetically disfiguring.

Squamous Cell Carcinoma

Squamous Cell Carcinoma is the second most common form of skin cancer and can be found in inconspicuous areas such as the mucus membranes, and genital area, but is most commonly found in areas exposed to the sun.  One out of ten people develop SCC but it rarely spreads when surgically removed early.

Squamous Cell Carcinomas
Squamous cell carcinoma on the face with thick keratin top layer (left panel) and squamous cell carcinoma on the leg (right panel). Source

SCC is an uncontrolled growth of abnormal cells arising in the squamous cells, which compose most of the skin’s upper layers (the epidermis). SCCs often look like scaly red patches, open sores, cysts, or warts; they may crust or bleed.

Melanoma

Melanoma is the most dangerous form of skin cancer. Melanoma begins on the surface of the skin where it is easy to see and treat. If given time to grow, melanoma can grow down into the skin, ultimately reaching the blood and lymphatic vessels and spread through the body (metastasize), causing life-threatening illness.

Skin Melanomas
Melanomas with characteristic asymmetry, border irregularity, color variation, and large diameter. Source

Melanoma Examples
More examples of Melanoma moles.

Melanoma is completely curable when detected early, but can be fatal if allowed to progress and spread. Melanoma is thought to be related to lifetime sun exposure but it can form “where the sun doesn’t shine”.

Melanoma can appear anywhere on the body including the scalp, under nails, palms and soles, back of the eye and in the genital area.  Early on most Melanoma are flat, brown-black spots on the skin. Over time, they can increase in size, change in shape, have multiple colors, raise up, itch or bleed.    Early melanoma are usually asymptomatic and can only be detected by visual exam.  The American Academy of Dermatology recommends a minimum of once yearly full body exams by a Board Certified Dermatologist and monthly self skin exams.

Make an appointment if you notice a mole that is different from the others, or if it changes, itches, or bleeds even if it is smaller than 6 millimeter.  Skin cancer has a high cure rate when detected early.

Skin Cancer Prevention

Dr. Monica Scheel Dermatology is dedicated to preventing skin cancer to the best of our abilities. We take the time to educate our patients in the current medical science of skin cancer prevention.

Ways to prevent Skin Cancer:

  • Eat lots of fruits and vegetables every day.
  • Seek the shade, especially between 9 am and 5 pm
  • Do not get sunburned
  • Avoid sun tanning and tanning beds.
  • Use sun protective clothing, such as long sleeves, a broad – brimmed hat, and UV blocking sunglasses to protect from the damaging rays of the sun
  • Do not expose newborns to the sun. Sunscreens should be applied to babies over 6 months
  • Vitamin C serum applied to the skin each morning and Retinol applied at night
  • Use a zinc based sunscreen (minimum 7%) with an SPF of 30 or higher every day.
  • Apply one ounce (a shot glass) of sunscreen to your entire body 30 minutes before going into the sun. Reapply every two hours or immediately after swimming or excessive sweating
  • Check your skin regularly and report changes to your doctor.
  • See your dermatologist once a year for a full body skin check

Nurses performing a dermascope check up

For those who have had a skin cancer or pre-cancer, prevention includes all of the above and these additional measures:

  • Niacinamide 500 mg twice daily
  • Exfoliating treatments such as chemical peels and hydrafacials
  • Photodynamic Therapy (PDT)
  • Topical chemotherapy or immunotherapy medications
  • CO2 Laser skin resurfacing
  • Daily use of SPF 30 or higher
  • SPF 30 or higher lip balm for Pre-Cancers of the lip (Actinic Chelitis)
  • DNA Repair Enzymes applied to the skin
  • Exfoliative body lotion such as Amlactin or Retinol Firming Body Lotion
  • Regular checkups with your dermatologist for early detection

Mohs Micrographic Surgery

What is Mohs?

Mohs Micrographic Surgery is a specialized form of skin cancer surgery in which specially trained surgeons can precisely identify and remove an entire tumor while leaving the surrounding healthy tissue intact and unharmed. The Mohs procedure involves surgically removing skin cancer layer by layer and examining the tissue under a microscope until healthy, cancer-free tissue around the tumor is reached.

Specialized laboratory equipment is used to stain the specimens and help to identify the cancer cells. The Mohs surgeon is specially trained as a cancer surgeon, pathologist, and reconstructive surgeon. Because of this, Mohs surgery has the highest success rate of all treatments for skin cancer – up to 99%.

Even if the repair of the wound is complex it is usually accomplished on the same day, which frees the patient to be finished with the entire process in one day rather than having to return for multiple visits for reconstructive surgery.

“I am so excited to bring this technology to the state of Hawaii,” said Dr. Scheel. “We all spend a lot of time in the sun enjoying our beautiful islands, increasing our chance for skin cancer. Melanoma is treatable if caught early. I hope this new, non-invasive device will encourage everyone to have their skin checked yearly.”

MelaFind

melafind monitor and toolMelaFind is the only FDA approved medical device that non-invasively sees into and under the skin to give dermatologists more information about suspicious moles, which may be melanoma. Our office is the only one in the State of Hawaii to offer Melafind.

Using 10 different wavelengths of light, MelaFind produces a 3-dimensional image of an atypical mole, up to a depth of 2.5 millimeters. Until now dermatologists could just see the surface of a mole. But because MelaFind allows the doctor to see under the skin’s surface, Dr. Scheel may not need to do a biopsy or cut the skin unnecessarily .

“Once I have determined a mole is atypical we can scan it with the hand-held device. The procedure takes only a minute and is very comfortable for the patient,” explained Dr. Scheel, likening the procedure to getting an ultrasound.

The machine analyzes lesions using proprietary algorithms that were developed, trained and tested on over 10,000 moles in the system’s database.

“This information makes a big difference to me and my patients when it comes to the decision to remove and biopsy the mole. It’s like having a second opinion right at my fingertips,” she said.

Melafind 2MelaFind is only issued to Board Certified Dermatologists because a mole in question needs the scrutiny of a professional and must have one or more of the characteristics of the ABCDE’s of cancer screening.

When combined with the experience of a Board Certified Dermatologist, MelaFind was proven to have a 98.38% accuracy rate during trials.

Things to Know

  • Analyzes irregular growth beneath the skin’s surface
  • Used on pigmented lesions
  • Takes less than a minute
  • Non-invasive and painless
  • Clinically proven, FDA approved
  • Inexpensive: $39 for the first mole, $13 for each mole after that

Our Mohs Surgeons

Dr. Scheel is proud to have two visiting Mohs surgeons to provide this much needed service to the people of the Big Island.

Dr. Ronald Moy

Dr Ronald MoyAs one of the leading cosmetic and plastic surgeons in Los Angeles, Dr. Moy is also a Diplomate of the American Board of Dermatology and American College of Mohs Surgery. He specializes in Cosmetic and Facial Plastic surgery, face lifts, liposuction, laser skin resurfacing, eye lifts and Mohs Micrographic Surgery. Dr. Moy is also a diplomate of the American Board of Dermatology and the American Board of Cosmetic Surgery, a member of the American Academy of Facial Plastic Surgery and has published more than 200 scholarly articles.

He has executed more than 30,000 cases of Mohs micrographic surgery and facial plastic surgery over the past 25 years.

Dr. Moy’s medical background and accomplishments include completing his dermatology residency training at UCLA. Dr. Moy then completed his Facial Cosmetic and Mohs Micrographic SurgeryFellowship training at the University of Pittsburgh Center for Health Services.

Scott Dale, M.D., FAAD

Dr Scott DaleScott Dale, M.D., FAAD grew up in Minnesota and graduated from Carleton College. The University of Chicago Pritzker School of Medicine awarded his doctorate in 1998. Dr. Dale interned in General Medicine, and completed Dermatology residency at The University of Chicago Hospitals. Dr. Dale has been practicing medical, surgical, and cosmetic dermatology, including Mohs Micrographic Surgery, at Northern Arizona Dermatology Center since graduating from the University of Chicago. Dr. Dale’s primary professional interest is skin cancer, but he enjoys treating all conditions of the skin, hair, and nails.

Dr. Dale is Board Certified by the American Board of Dermatology, a member of the American Society for Mohs Surgery, and a fellow in the American Academy of Dermatology, and American Society for Dermatologic Surgery. He is passionate about music, food, and travel.

From Our Patients

From the minute you walk through the doors, the experience starts! I love everything about this office. From the staff, the products, and the many different procedures they offer. I have had everything from Botox , chemical peels and basal cell skin cancer removals. Regardless of the treatment or procedure the staff is extremely qualified and there to help you every step of the way.

This office is not just for the ladies. My wife got me a gift certificate at one of the office’s events for a full body skin check. While they were doing my skin check, they used MelaFind and detected a basal cell carcinoma on my cheek. Dr Scheel’s team did a great Mohs surgery on it. Was very impressed and glad I went in for a routine checkup.

If is was not for Dr Monica Scheel Dermatology Office, I would still not know that I had Melanoma on my leg. The spot was so small that I had not noticed it, and was discovered when I had my full body cancer screen check at Monica’s Office, with their professional and caring dedication to the customers.

Patient who attended our Free Skin Cancer Screening – 13 years in Hawaii…. Lots of fun and sun, but I want to take a few minutes and tell you the importance of getting your skin checked regularly. Hopefully we caught this and another spot on my back soon enough. A week later, I got the phone call that I’ve been praying about all week … Melanoma. A nasty skin cancer that if not detected early can grow downward and once in your bloodstream can ultimately kill you. The good news is, with such an early detection, the doc is confident they removed all of the cancer.

Read full story for this patient here