Difficult Skin Cancers: How to approach

May 11, 2016

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Difficult Skin Cancers: How to Approach

Skin cancers can become quite tricky to operate on when other factors come into play, such as current medications a patient is on, or even immunosuppressed patients. When presented with these predicaments, it requires a well trained and highly knowledgeable Skin Cancer Surgeon to know what steps to take. Dermatology Consultants is proud to have on staff ACMS (American College of Mohs Surgery) Fellowship Trained Mohs Surgeons and board certified Dermatologists Kathleen S. Viscusi, MD and Fiona Zwald, MD. Dr. Zwald is one of the first in Atlanta to offer a multi-disciplinary Dermatological Transplant Clinic for immunosuppressed and transplant patients. She currently is working with a patient who presented with a 4-cm ulcerated lesion over part of his right temple and to the right helical crus; the lesion had developed over 3 months. Dr. Zwald consulted with the patient’s medical oncologist; treatment with ruxolitinib continued, albeit at a reduced dosage in light of recent events. She performed Mohs surgery on the patient. It was a challenging case, she said, not the least because adequate anesthesia could not be achieved with local anesthetic.

Dr. Zwald currently is treating this patient under her care and has reached out to the medical community to search for similar cases to better help find the appropriate, successful treatment of care. What many people don’t realize is that skin cancer can form in many ways. As dermatologists we instruct for patients to use sun protection, reapply and avoid peak summer heat hours directly in the sun, but that isn’t the only way skin cancers develop. Skin cancers can be genetic, passed down from generation to generation. Skin cancers can even appear on parts of the body that rarely gain any sun exposure. They can also develop in patients with a history of cancer, who have gone through skin cancer therapy treatments, and who are taking immunosuppressive medications.

We don’t always have the immediate answers for tricky skin cancer cases, but we must remember that our body is what we put into it. Focus on living a healthy, active lifestyle; remembering to always wear sun protection to block the sun’s harmful rays. Perform regular self examinations (Remember the ABCDE’s) and be sure to visit your board certified dermatologist for your annual skin cancer screening. As with everything, early detection is key. For those tricky cases we mentioned, you can always count on the experts at Dermatology Consultants to help you and your loved ones out.



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