Staged Excision for Melanoma, sometimes called “slow Mohs,” is similar in some ways to Mohs surgery. It involves surgical removal of the visible melanoma. The margins of the specimen are tested using a process that is similar to Mohs testing, such that the entire peripheral margin may be evaluated. This testing may increase detection of residual melanoma cells and thereby enhance the chance of a cure.
Electrodesiccation and Curettage, sometimes referred to as ED&C, involves removal of the visible tumor by scraping and then cauterizing the exposed tissue below, plus a margin of surrounding skin. This method may be used to treat small, primary (non-recurrent) basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs). Scarring may appear as a hypopigmented (white-ish) circle, often about the size of a dime.
Cryosurgery involves freezing the visible tumor with liquid nitrogen. The frozen cells are destroyed, and the underlying normal skin heals from beneath. Like ED&C, this method may be used to treat small, primary basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs).
Topical Treatments, including imiquimod and 5-fluorouracil creams, may be considered for skin cancer treatment. Imiquimod recruits the body’s immune system to mount an immune attack against the skin cancer cells. 5-Fluorouracil preferentially destroys the malignant cell population while bypassing normal skin cells. Both offer the advantage of a potentially superior aesthetic outcome, though other treatment options can provide statistically higher cure rates.
Laser Surgery involves vaporizing and destroying cancer cells that are close to the surface of the skin. This method has been used to treat some skin cancers, though it lacks the ability to confirm that all tumor cells have been eliminated. For this reason, laser surgery is not offered for the treatment of skin cancer at Dermatology Specialists of Saint Louis.
Wide Excision involves surgical removal of the skin cancer plus a margin of normal-looking skin. This method may be appropriate for smaller skin cancers and skin cancers in less cosmetically sensitive areas, such as the back. It also is used as part of the treatment approach for melanoma. Microscopic examination is performed by a dermatopathologist after removal, though the results are delayed for several days following excision. If the pathology report indicates that any cancer cells remain, the patient must return for further excision.
