Sunday, Jun 24, 2018
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Many fail to heed skin cancer warning signs

This is one of a series of columns about health issues written by staff members of ProMedica Physician Group and Mercy Health Partners, University of Toledo Medical Center, and the Toledo Clinic.

Over one million Americans will be diagnosed with skin cancer this year. Most of them are fair skinned persons older than 40. Despite these frightening statistics, many people are not taught how to screen themselves or their loved ones for the warning signs.


Basal cell carcinoma is the most common skin cancer. In fact, it is so prevalent that it is the most common cancer to strike Caucasians. It usually appears as a painless sore that won't heal or a pearly, shiny bump. Commonly, they can intermittently bleed after washing, and then seem to heal for days at a time. Basal cell carcinoma only rarely will break off and travel in the blood stream. However, it can destroy local tissue and cause massive deformity if untreated.

Squamous cell skin cancer (SCC) is the second most common skin cancer. It usually arises from an actinic keratosis. These are red scaly lesions, commonly seen on the head, hands and arms. They usually measure only an eighth to a quarter of an inch. Actinic keratoses should be treated early, before they become an invasive cancer.

Squamous cell carcinoma is often a painful red, scaly plaque. Unlike basal cell, squamous cell cancer can get into the lymph nodes and blood stream and become a threat to a patient's life. While the overall chance of spread is low, the risk can be higher in large, untreated tumors, cancers on the lips and ears, or in patients that have received organ transplantation. In these patients with improperly functioning immune systems, SCC can be very aggressive and life threatening.

Melanoma is the most deadly skin cancer. Though melanoma can occur anywhere on the skin, it is seen most often on the legs of women or the backs of men. It is usually a brown to black lesion which is not uniform in border, color or surface.

The “ABCDE's of melanoma,” have been described to help distinguish a regular mole from melanoma. The acronym stands for Asymmetry (most normal moles are either round or oval shaped), Border (normal moles should have a smooth border), Color (normal moles will be only one color), Diameter (any mole greater than 0.7cm should be evaluated), and Evolving (in adults, moles generally should not change with time).

Melanoma cancers can be very deadly and need to be treated surgically. They should not be treated with laser, frozen, or burned off the skin.

For this reason, it is important for you to see your Dermatologist if you are concerned about new or changing growths on your skin. A Dermatologist certified by the American Board of Dermatology is the expert who can analyze any skin lesions to help determine your risk. You can reduce your risk of developing more skin cancers by protecting your skin from further sun damage and by performing regular skin exams.


The gold standard for removal of skin cancers is the Mohs micrographic surgical method. Th is is a safe outpatient procedure that does not require any general anesthesia.

Th e term “Mohs” refers to Dr. Frederic Mohs who developed this technique. Dr. Mohs recognized that a skin cancer often resembles a “tip of the iceberg” with more cancer growing downward and outward into the skin, like the roots of a weed. These “roots” can only be seen under a microscope. Mohs Micrographic Surgery is a highly precise treatment for skin cancer in which the cancer is removed in stages, one layer at a time so that all of the sample is examined. Th is method ensures the highest possible cure rate of any treatment method. A fellowship trained Mohs surgeon is an expert at removing these skin cancers and performing reconstructive surgery after the cancer is gone.

In summary, people of all ages should avoid sunburns. Also, periodic self-screenings , examination of loved ones, and body scans by your Dermatologist are all critical to early detection of skin cancer.

After receiving his Dermatology training at the Johns Hopkins Hospital, Dr. Kouba joined the staff of the University of Maryland School of Medicine where he held the rank of Assistant Professor. After two years, Dr. Kouba left to pursue advance surgical training in Los Angeles with Dr. Ronald Moy. After receiving training in the Mohs surgery technique as well as advanced cosmetic surgery, Dr. Kouba accepted a position as the chief of cosmetic dermasurgery at Henry Ford Health System in Detroit. Dr. Kouba joined the Toledo Clinic in 2008. He received his BS from Haverford College and his MD/PhD from Jefferson Medical College.

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