Skin Deep

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More than a million new cases of skin cancer will be diagnosed in the United States this year. In fact, dermatologists say more people have skin cancer than any other form of cancer. But a state-of-the-art treatment, now available in Colorado Springs, offers patients a 98% cure rate. Betty Sexton examines this cutting edge procedure in a Call For Action report called “Skin Deep.”

Dermatologists say most of their skin cancer patients used to be seniors. But these days, they're seeing a lot more younger folks. Men and women in their 20's, 30's and 40's are finding little bumps, like pimples, that just won't go away. They're shocked when they learn it's cancer.

“Even if it's skin cancer---you hear that big ‘cancer’ word. It's kind of like. ‘Oh, okay. This is something that I'm going to have to deal with for awhile.’" Jennifer Zimmer grew up on the beach in California, where sunscreen was a foreign word. "My mom wasn't very good about putting sun block on me. But I don't know that the knowledge was there then either. And I can recall having quite a few severe sunburns to the point of blistering," she says. Now at the age of 31, this mother of three is undergoing Mohs Micrographic surgery.

"About a millimeter of normal tissue--we're hoping that gets all the cancer out." Dermatologist Brett Matheson will remove the two bumps, which are basal cell carcinomas, on either side of Jennifer’s nose. "Mohs surgery is most useful for tricky areas on the face, where skin cancer needs to be completely removed, but we need to leave the smallest hole behind," says Dr. Matheson.

Two other local patients are also undergoing Mohs surgery. They went to dermatologist Susan Ellis to remove their basal cell carcinomas. Walter Illian is 84 years old and Liz Devins is 71 years old. The common factor among all three patients---they spent a lot of time in the sun.

Doctors Ellis and Matheson are fellowship-trained in this advanced technique. They like the precision Mohs surgery offers for removing various types of skin cancer. Both start by surgically cutting out the visible portions of the tumor, then color-coding the sections so they have a map of the diseased tissue.

Then it's time for the technicians to go to work in the lab. They freeze and slice the specimens using a cryostat and a linear stainer. Then both doctors examine the slides under a microscope. They're hoping the cell’s edges look normal. That means all the cancer's been removed.

But if any abnormal color remains, their map will show them exactly where to go to repeat the same steps---scraping away more skin in that particular spot and testing it until all the cancer's gone.

Jennifer's specimen looks good. "I'm seeing normal skin tissue---no more cancer cells remain," says Dr. Matheson. But Walter's cancer has deeper roots, so Dr. Ellis will go back to work. "I can see that it is still present on the red edge all the way to the center," says Dr. Ellis.

While Walter prepares for more surgery, Jennifer gets stitched up and in a few minutes, is ready to go home. She's lucky---her cancer was caught early so it only penetrated the top layer of skin and didn't go deeper. "Eventually, the cancer can get down to cartilage and bone. It can invade nerves and blood vessels and be very destructive," says Dr. Matheson.

The good news for Walter---although his cancer was four times larger than it first appeared, after five rounds of treatment, it was totally removed.

Both doctors use various techniques to ensure the wounds not only heal, but look good cosmetically. "I do find that I have to counsel people and say, ‘ Look, you're going to be black and blue. You're going to be swollen. You have a lot of stitches right now. But you're going to be amazed at how good this looks,’” says Dr. Ellis.

Jennifer's wounds are almost invisible six weeks later. Walter and Liz's photos also show significant progress. And these patients say they've learned the importance of limiting their sun exposure. "Stay out of the sun or wear sunscreen," says Walter. "Wear a big hat," says Liz. And Jennifer has the best advice: "Anybody who thinks they might have something, whether it's on their face or anywhere else, you need to get it looked at because you let it go, it could be something major."

Unlike other tumors, skin cancer typically does not spread to other parts of the body. But all three patients will need to have their skin checked every 6 months to a year. Doctors say they stand a much greater risk of developing another cancerous lesion.

Doctors also say most insurance companies will cover the cost of Mohs surgery. It runs anywhere from $600 to $2,000.