Blake Phillips, MD earned his medical degree from the University of Texas McGovern Medical School, followed by a Dermatology Internship and Residency at UAB. He also did a Fellowship in Micrographic Surgery and Dermatologic Oncology at UAB.
What are the different
types of skin cancers?
Let me start by saying that skin cancer is incredibly common, and unfortunately, rates are on the rise.
There are multiple different subtypes, including everything from the tiny structures that lead to rare forms in the skin to the more common versions. The most common three are basal cell, squamous cell, and melanoma.
Basal cell and squamous cell generally come from the types of cells that make up the structure of the skin. Sometimes these can look like a non-healing sore or a bump or a pimple. They might have bleeding, and they can be a little tender. Basal cell, which is the most common subtype of skin cancer, has a lower overall risk profile than most cancers that are commonly tracked.
Melanoma, by contrast, tends to be more pigmented because it comes from the melanocytes, cells that actually produce pigment. Most of those lesions tend to be brown or have multiple colors, sometimes brown and black and red.
What do you look for in considering signs of melanoma?
Generally, the rule of thumb is we use the A, B, C, Ds as a sign for melanoma. So A is for asymmetry. B is for borders or having border irregularity. Rather than having a sharp edge, it looks like it’s a little bit moth-eaten or irregular. C is for color. It’s either very, very dark out of proportion to someone’s typical moles or multiple colors in one lesion. D is for diameter, which is not an entirely specific indicator, but generally larger than a pencil eraser. And E would be for evolution, which means it’s changing or growing.
How often do people come in when it’s late in the process?
Unfortunately, fairly often. Sometimes people who lack access to care, or are nervous about the costs will wait to come in. And we also see people who think it’s something else.
Basal cell is very locally destructive so if someone comes in late with that, they will not only have a big wound that’s non-healing and tissue that’s being lost, but you can have real functional compromise. It’s very rarely metastatic though.
Squamous cell actually causes more deaths than melanoma. But the rate is lower because, in general, it’s not as an aggressive per unit cancer, but it is more prone to metastasis and local recurrence. Melanoma is widely advertised as one that can misbehave pretty quickly.
I understand that Dr. Monheit with your practice was the first Mohs surgeon in Alabama. How does Mohs surgery differ from a local excisional procedure?
They differ in their approach and degree of precision. Excisional surgery removes a larger area of tissue in one go. With Mohs, the surgeon cuts away the tumor in layers, starting with the visible, raised portion of the tumor and a margin of skin cells around it. The surgeon also removes a thin layer of tissue from the site which they examine by microscope. If there are any cancer cells in that sample, the surgeon identifies their location, and removes an additional thin layer of tissue from the area with the cancer cells. You do this until you have it all. The point is to remove as little skin as possible so it’s mostly used for areas that are either cosmetically or functionally sensitive, or just tissue limited.
