When to See a Skin Cancer Doctor: Understanding Diagnosis and Treatment

Skin cancer is the most common form of cancer globally, but early detection and treatment by a qualified Skin Cancer Doctor significantly improve outcomes. This article provides a comprehensive overview of skin cancer diagnosis and various treatment options available, guiding you on when and why consulting a skin cancer doctor is crucial for your health.

Diagnosing Skin Cancer: What to Expect from Your Skin Cancer Doctor

The first step in addressing any skin concern is a thorough examination by a skin cancer doctor. This initial consultation is vital to determine whether skin changes are indicative of cancer or another condition.

Skin Examination: Your skin cancer doctor will meticulously examine your skin, paying close attention to moles, lesions, or any unusual changes in skin texture or color. They are trained to identify subtle signs that might be easily overlooked. This visual inspection is often the first step in diagnosing skin cancer, but further testing is usually necessary to confirm the diagnosis definitively.

Skin Biopsy: The Definitive Diagnostic Tool: To confirm a suspicion of skin cancer, your skin cancer doctor will perform a skin biopsy. This procedure involves removing a small sample of the suspicious skin for laboratory analysis. A biopsy is the gold standard for diagnosing skin cancer, as it can accurately determine:

Whether cancer cells are present.
The specific type of skin cancer.

Your skin cancer doctor will choose the appropriate biopsy technique based on the lesion’s size, location, and appearance. This might involve a shave biopsy, punch biopsy, excisional biopsy, or incisional biopsy. The biopsy is typically a quick procedure performed in the doctor’s office, often under local anesthesia to minimize discomfort.

Determining the Extent (Stage) of Skin Cancer: Why Staging Matters to Your Skin Cancer Doctor

Once skin cancer is diagnosed, determining its extent, or stage, is the next critical step managed by your skin cancer doctor. Staging helps to understand how far the cancer has progressed and is crucial for formulating the most effective treatment plan.

Understanding Cancer Staging: Staging is a process used to determine if cancer has spread beyond the original site. For many superficial skin cancers, like basal cell carcinoma, which rarely metastasize, a complete biopsy removing the growth may be sufficient for staging. However, for more aggressive types such as squamous cell carcinoma, Merkel cell carcinoma, or melanoma, further evaluation is often required.

Additional Tests for Staging: Your skin cancer doctor might recommend additional tests to assess the extent of the cancer, which can include:

Imaging Tests: CT scans, MRI scans, or PET scans may be used to examine nearby lymph nodes and other areas for signs of cancer spread.
Sentinel Lymph Node Biopsy: For certain types of skin cancer, particularly melanoma, a sentinel lymph node biopsy may be recommended. This procedure involves identifying and removing the first lymph node(s) to which cancer cells are most likely to spread. Examining these nodes helps determine if the cancer has spread to the lymphatic system.

The Stages of Skin Cancer: Doctors use Roman numerals (I through IV) to classify skin cancer stages:

Stage I: Cancer is small and confined to the original location.
Stage II & III: Cancer has grown larger or spread to nearby lymph nodes.
Stage IV: Cancer is advanced and has metastasized to distant parts of the body.

The stage assigned by your skin cancer doctor is a critical factor in deciding the most appropriate and effective treatment strategy.

Treatment Options for Skin Cancer: Your Skin Cancer Doctor’s Toolkit

Treatment for skin cancer and precancerous conditions like actinic keratoses is highly personalized and depends on various factors, including the type, size, depth, and location of the lesions, as well as the patient’s overall health. Your skin cancer doctor will discuss the most suitable options based on your specific diagnosis and staging.

Common Treatment Modalities Offered by Skin Cancer Doctors:

Freezing (Cryosurgery): A skin cancer doctor can use cryosurgery to treat actinic keratoses and some small, early skin cancers. Liquid nitrogen is applied to freeze and destroy the abnormal tissue, which then sloughs off.
Excisional Surgery: This is a common treatment for all types of skin cancer. Your skin cancer doctor surgically removes the cancerous tissue along with a margin of surrounding healthy skin to ensure complete removal of cancer cells. The extent of the excision depends on the type and stage of the cancer.
Mohs Surgery: Mohs surgery is a specialized technique, often performed by a skin cancer doctor who is a Mohs surgeon, particularly for larger, recurring, or high-risk skin cancers, especially in cosmetically sensitive areas like the face. This precise surgery involves removing the skin cancer layer by layer and examining each layer under a microscope until no cancer cells are detected. Mohs surgery minimizes the removal of healthy tissue and has a high cure rate for basal cell and squamous cell carcinomas.
Curettage and Electrodesiccation or Cryotherapy: After removing the bulk of the growth, a skin cancer doctor may use a curette to scrape away layers of cancer cells, followed by electrodesiccation (using an electric needle to destroy remaining cells) or cryotherapy (freezing) to treat the base and edges. These methods are effective for basal cell carcinomas and thin squamous cell carcinomas.
Radiation Therapy: Radiation therapy uses high-energy beams to kill cancer cells. A skin cancer doctor might recommend radiation therapy when surgery is not feasible or when cancer cells may remain after surgery. Radiation therapy can be an effective treatment for various types of skin cancer.
Chemotherapy: Chemotherapy involves drugs to kill cancer cells. For superficial skin cancers, topical chemotherapy creams or lotions can be applied directly to the skin. Systemic chemotherapy, administered orally or intravenously, may be used for skin cancers that have spread to other parts of the body. Your skin cancer doctor will determine the appropriate chemotherapy approach.
Photodynamic Therapy (PDT): PDT combines a photosensitizing drug with laser light to destroy skin cancer cells. The drug makes cancer cells sensitive to light, and when activated by laser light, it destroys the targeted cells. PDT is often used for actinic keratoses and certain superficial skin cancers.
Biological Therapy: Also known as immunotherapy, biological therapy enhances your body’s immune system to fight cancer cells. Certain biological therapy drugs can be used to treat advanced skin cancers. A skin cancer doctor specializing in immunotherapy can guide this treatment approach.

Preparing for Your Appointment with a Skin Cancer Doctor

Being well-prepared for your appointment with a skin cancer doctor ensures that you make the most of your consultation. Here are steps to take before your visit:

Be Aware of Pre-Appointment Restrictions: When scheduling, ask if there are any specific instructions, such as avoiding certain skincare products before your exam.
Document Your Symptoms: Write down all skin changes you’ve noticed, even if they seem minor. Note when they started, how they’ve changed, and any associated symptoms like itching or bleeding.
Compile Key Personal and Medical Information: Be ready to discuss your medical history, including any previous skin conditions or treatments, family history of skin cancer, and lifestyle factors like sun exposure history.
List Medications and Supplements: Prepare a list of all medications, vitamins, and supplements you are currently taking.
Bring a Companion: If possible, bring a family member or friend. They can provide support and help remember information discussed during the appointment.
Prepare Questions: Write down questions you want to ask your skin cancer doctor. Prioritize them to ensure you address your most important concerns.

Questions to Ask Your Skin Cancer Doctor

During your appointment, don’t hesitate to ask questions to fully understand your condition and treatment options. Consider asking questions like:

Do I have skin cancer?
What type of skin cancer do I have?
Are further tests needed?
How aggressive is this type of skin cancer?
What are my treatment options?
What are the risks and benefits of each treatment option?
Will surgery leave a scar, and how can scarring be minimized?
Am I at increased risk for developing more skin cancers?
How can I reduce my risk of future skin cancers?
How often should I have skin exams going forward?
Should I see a specialist, and is a referral needed?
What are the costs associated with treatment, and what will my insurance cover?
Are there reliable resources or websites you recommend for more information?
What follow-up care will be necessary?

In addition to these, feel free to ask any other questions that arise during your consultation.

Conclusion

Seeking timely advice from a skin cancer doctor is paramount for effective diagnosis and treatment of skin cancer. With a range of diagnostic tools and treatment options available, early intervention guided by a skin cancer doctor can significantly improve prognosis and outcomes. If you notice any suspicious changes on your skin, promptly schedule an appointment with a skin cancer doctor to ensure your skin health is in expert hands.

References:

Habif TP. Premalignant and malignant nonmelanoma skin tumors. In: Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 6th ed. St. Louis, Mo.: Saunders Elsevier; 2016.
Niederhuber JE, et al., eds. Melanoma. In: Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2014.
Jameson JL, et al., eds. Cancer of the skin. In: Harrison’s Principles of Internal Medicine. 20th ed. New York, N.Y.: The McGraw-Hill Companies; 2018.
Sarcoma-Kaposi. American Society of Clinical Oncology. https://www.cancer.net/cancer-types/sarcoma-kaposi/view-all. Accessed Dec. 12, 2018.
Sebaceous carcinoma: Signs and symptoms. American Academy of Dermatology. https://www.aad.org/public/diseases/skin-cancer/sebaceous-carcinoma#symptoms. Accessed Dec. 12, 2018.
Warner KJ. Allscripts EPSi. Mayo Clinic, Rochester, Minn. July 19, 2018.