Skin Cancer

The Total Skin Center knows that the key to curing the majority of skin cancer cases is early detection and treatment. In the case of BCCs and SCCs, treatment is based on site, size, stage and type of tumor. Unlike BCCs and SCCs, malignant Melanomas always require surgical excision and microscopic examination. They should not be treated by “freezing” or “burning”.

Currettage and Cautery

This surgical procedure can be used in the treatment of superficial BCCs. Using a surgical curette, the tumor is scraped at its base to remove it from underlying tissue. Next, electrocautery is used to destroy any remaining tumor cells and for controlling bleeding. This procedure leaves a flat, round, white scar that usually has a good cosmetic appearance. When performed by a specialist the cure rate is over 90%.

Surgical Excision

Surgical excision can be used for most BCCs, SCCs and all melanomas. Using a scalpel, the entire tumor is removed. Repair is performed with suture. This results in a more cosmetically acceptable scar, when compared to curettage and cautery.

Moh’s Micrographic Surgery

This technique is for skin cancers in difficult areas such as the corner of the eye. Using careful mapping techniques, the amount of tissue to be removed can be minimized. As with other excision techniques, a flap or skin graft may be needed to close larger wounds.


Liquid nitrogen is sprayed onto the tumor to freeze it to –20˚C to -40˚C, the point at which tissue dies. This process is repeated in a series of freeze-thaw cycles, until the tumor has been completely destroyed. Cryosurgery is usually limited to smaller tumors.

Photodynamic Therapy (PDT)

A photosensitizing cream is applied to the treatment area. A special light is placed over the area. This results in an interaction between the cream and the light, which in turn destroys cancer cells. This procedure may need to be repeated at 2 to 4 week intervals and has a lower cure rate than surgical excision.


Stimulating the immune system, Imiquimod helps the body to fight and destroy skin cancer cells. This cream is applied 5 to 7 times a week for a period of weeks to months. Cure rates are lower but cosmetic results are excellent.

Surveillance and Subsequent Management

If you have had one skin cancer, then you are more likely to develop others. Depending on the type of tumor you have, this may be more or less frequent in the development of subsequent cancers. Surveillance scheduled at regular intervals is advised.

Before & After:
(Click on Photos to View Larger)

Basal Cell Carcinoma

Basal Cell Carcinoma (BCC) is the most common type of skin cancer. It is also the most commonly diagnosed cancer in the United States. It is estimated that 3.5 million cases are diagnosed every year. This skin cancer usually develops on sun exposed skin  including head, neck or back of the hands. BCC is very common on the face especially on the nose. While BCC often develops on skin that has had the most sun, it can also appear on any part of the body including the trunk, legs and arms. It usually appears as a pearly patch or shiny bump or pimple that will not go away and easily bleeds.

Squamous Cell Carcinoma typically appears as a red scaly patch or bump that never heals. It can also be tender to touch. Both Basal Cell and Squamous Cell Carcinomas are rarely deadly but if they are present for a long period of time can invade deeper structures of the skin and surrounding tissues that can lead to disfigurement. Squamous Cell Carcinoma can rarely spread.

The treatment for Non-Melanoma Skin Cancers is simple excision. Cancers on the Head and Neck are associated with the greatest risk of reoccurrence and occur in functional or cosmetically sensitive areas. In these cases Mohs Surgery is performed.


Melasma, known also as “the mask of pregnancy” is best known as patchy dark lesions (hyperpigmented patches) on the face. Classically, melasma is most frequently seen in patients during periods of hormonal changes and/or significant sun exposure that includes teenage years and in reproductive life when planning a family. Oral contraceptives and pregnancy are known to exacerbate this condition. Ultraviolet A radiation (UVA) typically has a direct role in the worsening of melasma. For patients at risk for melasma, or with a history of hyperpigmentation, sun protection is essential to both the prevention and treatment of melasma. Treatment of melasma consists of topical agents (over the counter and prescription), chemical peels, and some laser and light treatments to achieve optimal results.

Melanoma is far less common than Basal Cell Carcinoma or Squamous Cell Carcinoma. Melanoma rates in the United States have doubled from 1982 to 2011. Melanoma in Caucasian women younger than 44 years of age has increased 6.1% annually. If found early, melanoma is highly treatable with a cure rate approaching 100%. Melanoma that has spread to a distant site is unfortunately associated with a poor prognosis. Dr. Darling believes in the importance of sun protection with sun screen and sun protective clothing as well as regular self-examination of moles at home and annually in our clinic. Dr. Darling provides Total Body Skin Exams for skin cancer both non-melanoma and melanoma. He will also review your risk factors for melanoma and how to lower them.

Your skin is your first defense against the elements. It protects your body’s bones, muscles, and organs, and guards against infection. However, the skin is also vulnerable to damage, especially by the sun, which often results in premature aging and an increased risk for skin cancer.

The sun is the primary culprit of skin damage. When your skin is exposed to the harsh rays of the sun, the top layer of skin cells become uneven and scaly. Even after your skin heals, fine lines, wrinkles, and freckles may develop. Even if you don’t sunburn often, direct exposure to the sun generates free radicals that further damage your skin on the cellular level. Free radicals alter skin cell DNA, resulting in changes in skin texture and increasing your risk of cancer.

Skin damage can also result in premature aging. Your skin’s firmness and smoothness relies on an underlying layer of collagen that supports muscles and tissues. After sun damage occurs, collagen begins to break down, resulting in sagging or lumpy skin. Smoking and genetics also affects how your collagen develops and breaks down.

The best way to prevent damage to your skin from the sun is to wear sunscreen and re-apply often. Use sunscreen any time you will be outside for an extended period of time, even  during the winter. The more damaged your skin is, the harder your body has to work to repair your skin cells, so it is important to remain vigilant about protecting your skin. 

Taking care of your skin is an art. Dr. Darling customizes your treatment recommendations based on the cancer type, location, functionality of the treatment (how a treatment affects you) and your cosmetic outcome after treatment.

Sun Damage / PreCancers

Actinic keratosis (AK) are precancerous skin lesions due to chronic, prolonged sun exposure. Classically, AKs are considered to be a pre-cancerous form of Squamous Cell Carcinoma. When present, patients describe AKs as rough, scaly, flat sand-paper feeling growths. If left untreated, these lesions may progress to non-melanoma skin cancer known as  squamous cell carcinoma. Early intervention can help in the progression of the disease, as well as making the skin appear more healthy and youthful.

Traditionally each individual lesion is treated with liquid nitrogen (“freezing” or “burning”).

Photodynamic Therapy, often referred to as “blue light” or Photodynamic Therapy, is an office based procedure with long lasting suppression of actinic keratosis lesions. Photodynamic Therapy is minimally painful, non-invasive, and requires little effort or discomfort on the part of the patient.

Dr. Darling can instruct you on prevention of Sun Damage and Precanerous lesions with our Visia Photographic analysis with UV photography. Please call today for your skin sun damage assessment.

Sun Spots

The appearance of sunspots are very common as we age. Sunspots or lentigines are discrete, flat brown lesions in areas that have had significant sun exposure – typically the face, backs of hands, upper chest, and forearms. To help minimize your risk of developing sunspots, we strongly recommend the daily use of a broad-spectrum sunscreen. The American Academy of Dermatology and the American Cancer Society recommend a minimum of SPF 30 applied regularly, every 90 minutes to achieve the best protection.

To treat these cosmetically concerning brown spots, various treatments including prescription strength bleaching creams, and cosmeceuticals are effective. Laser treatment will often result in complete resolution of sun spots. Remember, while sun spots themselves are not dangerous they are a marker for the extent of past sun exposure over your lifetime and represent skin damage from sun exposure. Be careful.