Cost-Effective Treatment for Skin Cancer

Complete surgical excision offers the best chance for long-term survival.
by Carl W. Soderstrom, MD, Soderstrom Skin Institute
Carl Soderstrom, MD

Though almost completely preventable and curable, skin cancer is still overlooked by many as a medical threat. This year alone, more than 5.4 million new cases of skin cancer will be diagnosed—and over 7,200 of them will be fatal, according to the American Cancer Society.

Skin cancer is a mutation that occurs in the DNA of skin cells, causing them to grow out of control and form a mass of cancer cells. Skin cancer begins in your skin’s top layer, the epidermis, which contains three main types of cells: 

- Squamous cells lie just below the outer surface and function as the skin’s inner lining.
- Basal cells, which produce new skin cells, sit beneath the squamous cells.
- Melanocytes produce melanin, the pigment that gives skin its normal color, and are located in the lower part of the epidermis. Melanocytes produce more melanin when you’re in the sun to help protect the deeper layers of your skin.

The cost of skin cancer surgery is foremost on the minds of physicians, patients, insurers and payers, but the key question involves absolute cure rates and the effectiveness of treatment. Office surgery—whether scraping cancer cells off or cutting them out—does not tell you if any cancer cells are left behind. Freezing, drugs and radiation therapy, likewise, do not tell if any malignant cells are left behind.

With diagnoses of melanoma, an extensive set of guidelines predicts the chances of survival based on a variety of factors, including depth of the tumor; ulceration; nerve, vessel or lymph node spread; and more. Complete surgical excision, combined with expert pathological evaluation, is the only way to define the extent of the melanoma—and the treatment that offers the best chance for long-term survival or a cure. These analyses, including genetic studies of the tumor variabilities, will render the best course of treatment.

For basal and squamous cell cancers, eliminating all of their invasive roots offers potentially curative results. Because these malignant cancers can invade surrounding tissues, vessels, lymph channels and nerves, the best treatment is often Mohs micrographic surgery, where the surgeon reads the pathology from the tumor being excised in real time and proceeds through stages until all of the cancer is removed. The results and reassurances are done on the same day—no guessing, no multiple visits for radiation, and no surgical guesswork. 

Mohs surgery also tends to be the most cost-effective technique, since complete removal is the most effective and reassuring for both patient and physician. It is the treatment of choice when other efforts have failed and cancers recur, because all of the cells must be confirmed as having been removed. Because of its high removal rates, nearly all insurance plans pay for Mohs surgery for skin cancer. PM

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