Cutting-edge technology, sophisticated surgery can help save the skin you're in
August 04, 2013 10:24 PM | 3851 views | 1 1 comments | 28 28 recommendations | email to a friend | print
Dr. Elizabeth Richwine, left, and Dr. Mark Knautz of Marietta Dermatology & The Skin Cancer Center pose with MelaFind, a new noninvasive hand-held skin scanning device which uses 10 different wavelengths to help determine whether a mole needs to be biopsied or watched for further changes. Richwine said Marietta Dermatology is the first practice in Georgia to help diagnose patients with MelaFind and has been doing so for less than a year. It is among the newest medical technologies in the U.S. in the detection and diagnosis of skin cancer. <br> Photo courtesy of Marietta Dermatology & The Skin Cancer Center
Dr. Elizabeth Richwine, left, and Dr. Mark Knautz of Marietta Dermatology & The Skin Cancer Center pose with MelaFind, a new noninvasive hand-held skin scanning device which uses 10 different wavelengths to help determine whether a mole needs to be biopsied or watched for further changes. Richwine said Marietta Dermatology is the first practice in Georgia to help diagnose patients with MelaFind and has been doing so for less than a year. It is among the newest medical technologies in the U.S. in the detection and diagnosis of skin cancer.
Photo courtesy of Marietta Dermatology & The Skin Cancer Center
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Richwine scans a patient’s skin with MelaFind. MelaFind looks as deep as 2.5 millimeters into the skin.
Richwine scans a patient’s skin with MelaFind. MelaFind looks as deep as 2.5 millimeters into the skin.
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Above left: A patient is left with a small circular hole on his nose after Mohs surgery. Mohs surgery is one of the many methods of obtaining complete margin control during removal of a skin cancer. Above right: The patient has recovered after skin cancer reconstructive surgery at Marietta Dermatology & The Skin Cancer Center.
Above left: A patient is left with a small circular hole on his nose after Mohs surgery. Mohs surgery is one of the many methods of obtaining complete margin control during removal of a skin cancer. Above right: The patient has recovered after skin cancer reconstructive surgery at Marietta Dermatology & The Skin Cancer Center.
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Editor’s note: This is Part 3 in a series of articles about skin cancer. Today’s article discusses the latest technology in treating and diagnosing skin cancer and skin cancer reconstructive surgery.

Dermatologists in Marietta are fighting skin cancer with the use of cutting-edge technology in both diagnosis and treatment of the disease.

Marietta Dermatology & The Skin Cancer Center is the first practice in Georgia to help diagnose patients with a new device called MelaFind.

MELAFIND

According to Dr. Elizabeth Richwine, MelaFind is a noninvasive hand-held scanning device that uses 10 different light wavelengths to help determine whether a mole needs to be biopsied or watched for further changes.

Traditionally, dermatologists would have to cut into any suspicious lesions for a biopsy and submit it for analysis. Among the first of its kind, MelaFind is able to identify more precisely which lesions are in need of further analysis and thereby avoid some unnecessary biopsies.

“The dermatologist does the full-scale exam, and we visually identify moles that meet some of the criteria for being suspicious,” said Richwine, who has been practicing at Marietta Dermatology for three years. “And then we can scan those moles with MelaFind. … Once it scans it — which is painless, there’s no scarring involved — it creates a sort of a composite picture. And it will tell the physician if the cells in the mole are disorganized. And they will rate it as low disorganized or high. When you get moles that are highly disorganized, and they believe that the pattern in the skin is irregular, that will drive a dermatologist to decide to biopsy it. It doesn’t necessarily say this is cancerous or not cancerous, it just says something is very irregular about this mole and usually it warrants a biopsy.”

High disorganization means the mole has patterns similar to that of melanoma and should be considered for biopsy. Low disorganization means that the mole has benign patterns and might not need to be biopsied.

MelaFind looks as deep as 2.5 millimeters into the skin, Richwine said. Skin cancers are categorized into three types: Basal cell, squamous cell and malignant melanoma. MelaFind looks for atypical and/or precancerous cells and melanoma. It does not look for basal cell or squamous cell cancers.

“It’s just nice to have that additional information. … This helps us decide which can be watched and which truly need to be removed and checked in the pathology lab.” Richwine said.

Like all cancers, the survival rate of skin cancer is highly contingent on early diagnosis. MelaFind, in combination with yearly full-body scans, can help catch melanomas early.

“All skin cancers, no matter what they are — whether it be a basal cell, squamous cell or melanoma — if we catch them early, the cure rate is phenomenal,” said Dr. Mark Knautz, a dermatologist with Marietta Dermatology & The Skin Cancer Center. “(MelaFind has) been in the literature, and I know that the doctors who developed it have been working on it for a long time, and I was excited when it was finally available.”

Although it is FDA approved, MelaFind scans are not currently covered by insurance.

MOHS SURGERY

Beyond diagnosis, sophisticated treatment can beat back skin cancer with reconstructive surgery helping patients return to social engagements with no self-consciousness.

At Marietta Dermatology, Mohs surgeon Dr. Jared Friedman along with facial plastic surgeon Dr. Seth Yellin assist patients through treatment and reconstruction.

According to the Skin Cancer Foundation, Mohs surgery is currently the most successful treatment for basal and squamous skin cancers available today. It is usually reserved for anatomical areas such as the face where normal tissue preservation is of special importance. During Mohs surgery, after each removal of tissue, while the patient waits, a pathologist examines the tissue specimen for cancer cells, which informs the surgeon where to remove tissue next. Beneath the skin, the cancerous cells cover a much larger region and there are no defined borders. Mohs surgery has the highest cure rate of any treatments for skin cancer, up to 99 percent for basal and squamous skin cancer. It is usually performed under local anesthesia.

“You can remove thin layers and really preserve as much normal tissue as possible (with Mohs surgery),” Yellin said. “When it comes to reconstruction, I can tell you the more normal tissue that is preserved, many times, the easier the reconstruction. It does provide me an advantage, it provides the patient an advantage and it gives the patient and myself the confidence level that the skin cancer is removed.”

Other forms of skin cancer treatment include excision, cryosurgery, electrodesiccation, curettage, laser surgery and dermabrasion.

RECONSTRUCTION

Once the Mohs surgeon has completed treatment, a reconstructive surgeon will then begin the process of rebuilding the patient’s pre-surgery appearance. According to Yellin, reconstruction may require more than one procedure to achieve the best results.

“If the Mohs surgeon feels that the defect will be the type of defect that warrants my skills, we see them preoperatively before anyone ever touches them,” said Yellin, who was director of the Emory Facial Center and Chief of Facial Plastic Surgery at Emory Healthcare for more than 12 years. “Some of the procedures I perform are routinely three-stage procedures, where you bring in attached tissue from either the cheek or the forehead to reconstruct the nose and it stays connected with like a bridge and that bridge is there for three weeks in nonsmokers and four weeks in smokers. Then we bring them back a second time and take the bridge down and make things look reasonably normal. Then three to four months later, we will do contouring procedure.”

Reconstructive skin cancer surgeries can be done with skin flaps and skin grafts. For a skin graft, a surgeon removes skin from one area of the body and relocates it to the wound site. They should be used for this type of surgery only as a last resort, if the affected area is too large to be covered using a flap, Yellin said.

“A flap is when you move tissue from one spot to another and leave it attached to it’s current blood supply,” Yellin said. “Then you place it into the defect to allow the local tissue in the defect to grow into the moved tissue and then you go and you clip the blood supply from the original site. … A flap requires much more creative thinking.”

Flaps are common and often look better than skin grafts.

But the simplest way to repair a surgical wound is primary closure. This procedure closes the wound from side to side with sutures.

Reconstructive skin cancer procedures today often result in minimal scarring and color variation. With skin flaps, a suture line is positioned to follow the natural creases of the face to minimize the appearance of a resulting scar.

Recovery typically takes about two weeks, Yellin said. However, it usually takes a full year for the area to completely heal.

“Here it’s under one roof,” Yellin said. “We have surveillance, diagnosis, treatment and reconstruction, so it really is a nice vertically integrated skin cancer center that we’ve created.”

For more information about Mohs surgery, visit the American Academy of Dermatology website at aad.org and the American College of Mohs Surgery website at mohscollege.org. Also visit cancer.wellstar.org for information about skin cancer treatment at Kennestone Hospital.

Find out more about Marietta Dermatology & The Skin Cancer Center and MelaFind, visit mariettaderm.com.

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Dr. Susan Lovelle
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August 09, 2013
It is always easier to treat any kind of disease in its early stage. We should be thankful that medical technologies today continue to advance so physicians can detect and treat early forms of skin cancer. Because of these advancements in technology, skin cancer patients now have safer and more precise options for surgery.
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