MOHS SURGERY & SKIN CANCER

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Our dermatologists have received specialty training in Mohs Micrographic surgery
and are fellowship trained Mohs surgeons.

Dr marcuson standing near mohs technology
Dr. Mazzurco smiling in doctor office

What is Mohs Surgery?

Mohs surgery is a highly skilled and precise surgical technique, developed by, and named for Dr. Frederick E. Mohs. Mohs surgery is used for the management of numerous types of skin cancer including basal cell carcinoma and squamous cell carcinoma and is the treatment of choice for certain basal cell and squamous cell cancers of the skin.

Not all skin cancers will qualify for treatment with Mohs surgery. Mohs surgery is most commonly used to treat skin cancers on the head and neck. It is the treatment of choice for cancers that have recurred or re-grown in a prior scar, have poorly defined edges, are particularly large, are aggressive appearing under the microscope, or are in a cosmetically sensitive area.

Skin cancers are removed in small sections, one layer at a time. The removed tissue is examined under the microscope, in our state-of-the-art high-complexity tissue processing laboratories, to precisely map out any remaining tumor to be removed.

Mohs Surgery yields the highest cure rates possible for numerous forms of skin cancer. Patients treated with Mohs surgery to treat basal cell carcinoma and squamous cell carcinoma will have cure rates of up to 99%, while at the same time offering maximal preservation of normal skin, resulting in the best functional and cosmetic outcome. Surgery to remove skin cancer will result in a scar. Mohs surgery will help minimize the amount of scarring by removing the least amount of normal skin necessary to remove the skin cancer while at the same time resulting in the highest cure rate possible.

Reconstruction following the Mohs procedure will often be performed the same day by your Mohs surgeon, though your surgeon may work with other specialized consultants in certain instances.

Mohs surgery is an out-patient procedure performed in our offices by our fellowship trained Mohs surgeons, Dr. Marcuson and Dr. Mazzurco. For more information, please call our office or visit the American College of Mohs Surgery Website. All procedures are performed in our out-patient facilities. All surgeries, including biopsies, are performed by our physicians only. 

Watch to learn more about Mohs Micrographic Surgery.

Watch and learn the important role sunscreen plays in helping prevent skin cancer.

Watch and learn the about the importance of catching Melanoma early with screening.

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Dr marcuson using microscope to analyze samples
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Dr. Mazzurco analyzing mohs sample
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SKIN CANCER
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At Peninsula Dermatology Skin Cancer Surgery Center, we offer comprehensive skin cancer care to include diagnosing and treating skin lesions, monitoring patients who have had melanoma, basal or squamous cell carcinoma, utilizing total body photography to monitor patients with abnormal moles and melanoma, as well as education and discussion of techniques for preventing future cancers. 

It is well known that sun damage to the skin has a cumulative effect. Over time, the accumulation of sun exposure causes the DNA in skin cells to mutate or change, growing out of control and forming a mass of cancer cells.

 Skin cancer is the most common type of cancer. If you have been diagnosed with skin cancer, it is critical to obtain an accurate diagnosis of the type of cancer so that the treatment options will be the most effective.

The American Cancer Society recognizes numerous types of skin cancer including the three most common:

• Basal Cell Carcinoma
• Squamous Cell Skin Cancers
• Melanoma

Your skin cancer will need to be treated. Different treatments are used depending on a number of factors including the type of cancer, the location of the skin cancer, size, histologic features, if the cancer has been previously treated and your personal medical history. Most of these skin cancers can be treated in the office using a local anesthetic.

Your dermatologist will help determine which treatment is the best for you and your skin cancer.

COMMON SKIN CANCERS

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Basal Cell Carcinoma

This cancer begins in the basal cells located in the lower epidermis of the skin. Of all of the skin cancers, the basal cell carcinoma (BCC) is the most common.

What is Basal Cell Carcinoma?

Basal cell carcinoma begins in the basal cells located in the lower epidermis of the skin. Of all of the skin cancers, the basal cell carcinoma (BCC) is the most common, it is the most common cancer diagnosed in the world with millions diagnosed every year. These cancers are likely to develop on sun-exposed areas, especially on the head and neck. They are slow-growing, and it is rare that basal cell cancer spreads to other parts of the body. However, if left untreated, it can grow into nearby areas such as the bone and other tissues beneath the skin. Basal cell carcinoma is usually a slow growing cancer and may not form until many years after sun exposure.

Basal cell carcinoma is caused by long-term exposure to ultraviolet radiation (UV) from sunlight. Over time, UV rays damage the DNA in your skin cells. The process of generating new skin cells is controlled by the basal cell DNA. If the DNA has been damaged due to UV sunlight exposure (including tanning beds), it will create abnormal skin cells which may result in cancerous lesions.

Basal cell carcinomas that develop on areas of the skin that are not exposed to much sunlight may form as a result of other risk factors, such as:

  • Radiation therapy
  • Fair skin
  • Increasing age
  • Family history of skin cancer
  • Immunosuppressive medications
  • Exposure to toxic chemicals and metals

Symptoms of basal cell carcinoma usually begin as a change in the skin, such as a growth or a sore that is slow to heal. Basal cell carcinomas may also present as fragile areas that tend to bleed easily. Not all basal cell carcinomas present the same and may have various appearances depending on their histologic growth pattern. Some of the characteristics associated with basal cell carcinoma include:

  • Translucent, pearly white, skin-colored or pinkish lump
  • Brown, black or blue lesion which may be flat or raised (mole may or may not be slightly raised)
  • Flat, scaly, reddish patch with a raised border which may itch (and may possibly itch)
  • White, scar-like lesion without a clearly defined border
  • Basal cell carcinoma can be mistaken for benign lesions such as moles or warts
  • Translucent, pearly white, skin-colored or pinkish lump
  • Brown, black or blue mole may or may not be slightly raised
  • Flat, scaly, reddish patch with a raised border and may possibly itch
  • White, scar-like lesion without a clearly defined border
  • Basal cell carcinoma can be mistaken for warts

At Peninsula Dermatology Skin Cancer Surgery Center, our board certified dermatologists are experts in diagnosing and treating skin cancer.

In accordance with the American Cancer Society, we encourage all people to perform regular skin exams once a month. You should be familiar with the pattern of moles, freckles and other marks on your skin so that you will notice any new moles or changes in existing moles.

Early detection is key in having the most successful outcome. If you notice any changes in a mole, freckle or patch of skin, we encourage you to make an appointment today (757)873-0161.

During your routine skin exam, we will thoroughly inspect your skin and monitor any changes that may occur. Our primary goal is to provide an accurate diagnosis for any skin concern (anomalies) and treat/remove skin cancer before it becomes a bigger concern. At Peninsula Dermatology Skin Cancer Surgery Center, we may perform a skin biopsy in which we remove a sample of the lesion for further testing in the laboratory. All biopsies and procedures are performed by our physicians.

The best treatment of basal cell carcinoma will depend on a number of factors.  The type of treatment will depend on the location, size of the lesion, histologic pattern, whether it is a recurrence and how much (if any) it has grown. Some of the treatment options available include the following:

  • Excision – cutting the cancerous lesion out with some of the healthy skin around it (margin) and close it with stitches
  • Mohs’ Micrographic Surgery – remove the skin cancer in sections, one at a time, while examining it under a microscope until no more abnormal cells are observed.
  • Curettage and electrodessication – removing the surface of the skin cancer with an instrument and then searing the base of the cancer with an electric needle.
  • Topical therapy – applied in the form of a gel or a cream to treat the cancerous lesion. Topical therapy may be an option for some basal cell carcinomas.

Your dermatologist will help determine which of the treatments is the best treatment for you and your skin cancer.

Basal cell and squamous cell skin cancers are almost always curable when detected and treated early; however, it is ideal to prevent them in the first place. The Skin Cancer Foundation suggests making these sun safety habits part of your daily health care routine:

  • Spend the majority of your time in the shade, especially between 10 AM and 4 PM.
  • Do not burn.
  • Avoid tanning and never use UV tanning beds.
  • Use clothing to protect your skin from the sun, including a broad-brimmed hat and UV-blocking sunglasses.
  • Use a broad-spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher daily. For extended outdoor activity, use a water-resistant, broad- spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher.
  • Apply sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or after swimming and/or excessive sweating.
  • Keep newborn babies out of the sun. Sunscreens should be used on babies over the age of six months.
  • Perform a self-skin examination from head-to-toe every month.
  • See your doctor or a dermatologist for yearly skin exams.

Squamous Cell Carcinoma

Squamous cell carcinoma (SCC) occurs in the squamous cells located in the epidermis, or the topmost layer of skin and most often in sun exposed areas.

Squamous cell carcinoma (SCC) occurs in the squamous cells located in the epidermis, or the top-most layer of skin and most often in sun-exposed areas such as:

  • Face
  • Ears
  • Back of hands
  • Lips
  • Neck

Squamous cell is the second most common form of skin cancer, but it is more likely to grow deeper into the layers of skin and more likely to spread to other parts of the body than basal cell cancer. It is usually not life-threatening, but it can be aggressive and therefore needs to be removed and treated.

It is thought that long-term, unprotected exposure to UV rays from sunlight (including tanning beds) causes changes in the DNA of the skin cells. These DNA mutations can lead to squamous cell carcinoma by generating abnormal skin cells at a rapid rate. In addition to UV ray exposure, there are specific factors that increase the risk of squamous cell carcinoma, such as:

  • Advanced age
  • Fair skin
  • Male
  • Certain diseases that suppress the immune system such as HIV, AIDS and Bowen’s Disease
  • Exposed to radiation
  • Living in sunny regions or at a high altitude
  • Light colored hair, red hair and blue or green eyes
  • History of multiple, severe sunburns especially if they occurred early in life
  • Exposure to harsh chemicals, such as arsenic

Not all squamous cell carcinomas present the same and may have various appearances depending on their histologic growth pattern. In its early stages, squamous cell carcinoma may begin as a rough, scaly, red patch of skin or as a small bump resembling a pimple that grows in to a lump or nodule.   Over time, it progresses and will continue to grow unless treated. Squamous cell carcinoma tends to bleed easily if scraped or hit accidentally. Larger growths can potentially itch or become painful. Additional signs and symptoms of squamous cell carcinoma include:

  • Firm, red nodule
  • Flat, scaly crusted sore
  • A new sore or raised area on an existing scar
  • Rough, scaly sore on lip that may become an open sore
  • Rough patch inside your mouth

At Peninsula Dermatology Skin Cancer Surgery Center, our board certified dermatologists are experts in diagnosing and treating skin cancer. In accordance with the American Cancer Society, we encourage all people to perform regular skin exams once a month. You should be familiar with the pattern of moles, freckles and other marks on your skin so that you will notice any new moles or changes in existing moles. Early detection is key in having the most successful outcome. If you notice any changes in a mole, freckle or patch of skin, we encourage you to make an appointment today  (757)873-0161.

  • During your routine skin exam, we will thoroughly inspect your skin and monitor any changes that may occur. Our primary goal is to provide an accurate diagnosis for any skin anomalies and treat/remove skin cancer before it becomes a bigger concern. At Peninsula Dermatology Skin Cancer Surgery Center, we may perform a skin biopsy in which we remove a sample of the lesion for further testing in the laboratory. All biopsies and procedures are performed by our physicians.

The best treatment of squamous cell carcinoma will depend on a number of factors.  The type of treatment will depend on the location, size of the lesion, histologic pattern, whether it is a recurrence and how much (if any) it has grown. Some of the treatment options available include the following:

  • Excision – cutting the cancerous lesion out with some of the healthy skin around it (margin) and close it with stitches
  • Mohs’ Micrographic Surgery – remove the skin cancer in sections, one at a time, while examining it under a microscope until no more abnormal cells are observed.
  • Curettage and electrodessication – removing the surface of the skin cancer with an instrument and then searing the base of the cancer with an electric needle.
  • Topical therapy – applied in the form of a gel or a cream to treat the cancerous lesion. Topical therapy may be an off label option for some superficial  squamous cell carcinomas.

Your dermatologist will help determine which of these treatments is the best option for you and your skin cancer.

Squamous cell skin cancers are almost always curable when detected and treated early; however, it is ideal to prevent them in the first place. The Skin Cancer Foundation suggests making these sun safety habits part of your daily health care routine:

  • Spend the majority of your time in the shade, especially between 10 AM and 4 PM.
  • Do not burn.
  • Avoid tanning and never use UV tanning beds.
  • Use clothing to protect your skin from the sun, including a broad-brimmed hat and UV-blocking sunglasses.
  • Use a broad-spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher daily. For extended outdoor activity, use a water-resistant, broad- spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher.
  • Apply sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or after swimming and/or excessive sweating.
  • Keep newborn babies out of the sun. Sunscreens should be used on babies over the age of six months.
  • Perform a self-skin examination from head-to-toe every month.
  • See your doctor or a dermatologist for skin exams at least yearly or more often if needed as recommended by your dermatologist based on your specific history.

Melanoma

Melanoma is one of the most serious forms of skin cancer. It is more likely to grow, spread and cause significant health consequences if it is not caught and treated early.

Melanoma is the one of the most serious forms of skin cancer. It is a less common form of skin cancer than basal cell carcinoma and squamous cell carcinoma; however, it is more likely to spread if it is not caught early. Melanomas can appear as brown or black moles, but they may also take on a pink, tan or white color. They can develop anywhere on the body, but are more likely to develop on the chest, back and legs. Dark pigmented skin lowers your risk of melanoma, but melanomas can also form on the palms of the hands, soles of the feet and under the fingernails.

Melanomas develop from melanocytes, the pigment-producing cells in the epidermis. Dermatologists have created the ABCDEs of melanoma and the Ugly Duckling sign to help you check over your skin and identify possible concerns.. Look for the following signs:

  • Asymmetry – mole is not round or symmetrical when divided in half
  • Border irregularities-uneven borders or notched edges
  • Color – multiple colors with different shades of  black, brown or tan
  • Diameter – greater than 6mm
  • Evolving – changing in size, color or shape over time

The Ugly Duckling is another possible warning sign for melanoma. This concept indicates the importance of comparing your moles with each other.   Any spot that stands out or looks different than the rest should be evaluated by your dermatologist.

Melanomas are aggressive cancers, so early detection is crucial to getting the best prognosis. At-home monthly exams and yearly dermatologic examinations are among the best tools to catch melanoma early. If you are even slightly suspicious of anything, call your doctor right away. Peninsula Dermatology Skin Cancer Surgery Center encourages everyone to get a yearly skin examination. The Melanoma Research Foundation offers a melanoma fact sheet, which provides useful information regarding the statistics of melanoma cases in the United States – Melanoma Fact Sheet.

There are many risk factors associated with melanoma. Ultraviolet (UV) rays from sunlight (including tanning beds) is considered the major cause of melanoma. The UV rays damage the DNA in the skin cells causing mutations to occur. The mutations affect certain genes that control how the cells grow and divide possible at a more rapid rate. The affected cells can become cancer cells.

The risk factors that increase the chance of melanoma include:

  • Ultraviolet (UV) light exposure
  • Atypical moles – not all moles become cancer, but having many moles increases the likelihood of developing melanoma
  • Fair skin, freckling and light hair
  • Family history of melanoma
  • Personal history of melanoma
  • Weakened immune system
  • Over the age of 50

The first signs and symptoms of melanoma include a change in an existing mole as well as a new or unusual growth on the skin. If you are suspicious of a mole, remember the letters ABCDE (discussed above in “What Is Melanoma?”) to help you identify the characteristics of melanoma. Peninsula Dermatology Skin Cancer Surgery Center recommends regular self skin exams to not only become familiar with your skin and moles, but to help you recognize any changes that may be occurring with your existing moles. Early detection and diagnosis of skin cancer leads to prompt treatment and better outcomes for patients.

If you are suspicious of a mole or a new growth on your skin, it is imperative that you take action and call Peninsula Dermatology Skin Cancer Surgery Center at (757)873-0161. We cannot stress the importance of performing self skin exams as well as having a skin exam by your dermatologist. Skin cancer screenings save lives!

To make an accurate diagnosis of melanoma, you will need a biopsy of the suspicious mole or area. A biopsy is a procedure that removes all or part of the mole/growth and it is sent to pathology for analysis. The most common biopsy procedures are:

  • Punch biopsy – removes a round piece of skin in the mole using a special tool
  • Shave excision or excisional biopsy – removes the entire mole or growth as well as a small border of normal skin around the mole
  • Incisional biopsy – removes the most irregular part of the mole or growth and sent to the laboratory for testing

In some instances your doctor may recommend a pigmented lesion assay or gene expression skin test.  This test uses adhesive strips to remove and sample skin cells without cutting into the skin for genetic mutations that may help identify the risk of a lesion being a melanoma.

Your doctor will determine the best procedure for your unique circumstance. If a melanoma is suspected, the doctor will prefer to use a procedure that removes the entire mole or growth. To determine the best treatment option, your doctor will want to know the thickness of the melanoma (measured under a microscope) and if the melanoma has spread into nearby lymph nodes.

The treatment of melanoma is dependent on the the histologic features of the melanoma under the microscope and the thickness of the melanoma.  Fortunately, many melanomas are caught early and can be treated with surgery and follow-up skin checks.

Surgical Treatment of Melanoma

Surgical removal is the first-line treatment for melanoma skin cancer. When caught early, while the melanoma is still localized and thin, surgery is often curative. An excision is performed under local anesthesia to remove the melanoma as well as the margin (or normal tissue) around the cancer to make sure that all of the cancer was removed. Further surgeries may be required if melanoma cancer cells are found in the margin.

Treatment for melanomas that are thicker or have spread depends on the stage of melanoma. Other treatments may be needed to combat the spread of the disease such as: surgical removal of lymph nodes, chemotherapy, radiation therapy, biological therapy and targeted therapy.

At Peninsula Dermatology Skin Cancer Surgery Center, we encourage everyone to wear sunscreen! Unlike other cancers, you can help minimize your risk of skin cancer by reducing your exposure to UV rays from the sun. Getting too much sun is harmful.“It takes only one blistering sunburn, especially at a young age, to more than double a person’s chance of developing melanoma later in life.” ~ Melanoma Research Foundation. Regular skin checks save lives. Learning the facts, monthly skin checks and annual visits are also your tools to leverage against the ever-increasing rates of skin cancer.

If you would like to learn more about melanoma and how it is diagnosed and treated at Peninsula Dermatology Skin Cancer Surgery Center, please call us at (757) 873-0161.

REQUEST AN APPOINTMENT WITH OUR SKILLED DOCTORS TODAY

We deeply value the relationships we create with our patients and look forward to caring for you and your family.

NEWPORT NEWS
LOCATION

Newport news dermatolgoist

11844 Rock Landing Drive, Suite B
Newport News, VA 23606

Phone: (757) 873-0161
Fax: (757) 873-0205

WILLIAMSBURG
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Williamsburg dermatologist

1601 Commonwealth Avenue Williamsburg, VA 23185

Phone: (757) 259-9466
Fax: (757) 259-7907

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