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nauru

Are skin cancers mostly treated by dermatologists or radiation oncologists?

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Depends on what type of skin cancer and what stage, as well as exactly what treatment goals are.

 

You could have everyone from family, Derm, gen Surg, rad Onc and med Onc involved (plus possible other surgeons).

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They don't? They certainly do local excisions that sometimes require wide re-excisions with grafts done by plastics around here.

 

But, yes, generally plastics, ENT, and gen surg do the resections. Surgeons will always be involved in the staging for SCC or melanoma.

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They don't? They certainly do local excisions that sometimes require wide re-excisions with grafts done by plastics around here.

 

You're right, family docs and dermatologists do excise small lesions in the office.

 

I was thinking of the fact that around here once there is a diagnosis of cancer made*, the patient invariably sees a surgeon. The derms won't touch them again.

 

*with involved margins, of course

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Saying that derms don't treat skin cancers simply isn't true. As someone mentioned earlier, Mohs surgery is performed by dermatologists. They also perform excision and electrodissecation for small BCCs.

General surgeons and plastic surgeons are also involved in treating skin cancers (melanomas, some BCCs SCCs, benigns entities such as cysts). Plastic surgeons and ENTs often perform a post removal reconstructive surgery. Some skin cancers (eg: SCCs or BCCs of the tip of the nose) can be treated by radiation therapy only.

There is no systematic staging of every skin cancer (unlike lungs, breast, GI, prostate etc). There is little room for medical oncology in the management of skin cancers. BCCs don't metastasize unlike SCCs and melanomas. Oncologists mostly manage metastatic diseases (which is uncommon). There are new medical oncological treatment for metastatic melanomas (anti TNFs etc).

 

PS: a Mohs surgery is usually performed to treat a BCC or an SCC, most often located in the face. In this procedure, the dermatologist acts as both a surgeon and a pathologist and performs a frozen section procedure after each excision for minimum removal of healthy tissue with maximum margin control in only one appointment.

BCC = basal cell carcinoma, most common kind of skin cancer

SCC= squamous cell carcinoma

melanoma = deadliest skin cancer

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Depends on what type of skin cancer and what stage, as well as exactly what treatment goals are.

 

You could have everyone from family, Derm, gen Surg, rad Onc and med Onc involved (plus possible other surgeons).

 

Not sure I follow; could you please give an example of how treatment goals would differ? I thought the main goal in cancer treatment is for the patient to be alive and not have problematic cancer anymore. Or in the case of untreatable cancer, perhaps the goal would be to maximize the quality of life within the limits of reasonable resource use, and not have a horribly unpleasant death. But is this really skin cancer treatment, seems more like palliative care. Thanks.

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I've never heard of Mohs surgery - is it being done in Canada?

 

I think it's done pretty much everywhere of Canada. It's becoming the standard of care. There are at least 3 places that offer it in Montreal and 1 in Quebec city, and thats only for the province of Qc.

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I've never heard of Mohs surgery - is it being done in Canada?

 

It's basically a procedure where the tumour is excised by the dermatologist who is trained as a Mohs Surgeon (requires a fellowship after dermatology residency). The dermatologist acts also as the pathologist and views all of the slides of the removed tumour to ensure that the tumour is completely resected. If there is any remaining tumour, he or she will go back to the exact location of where it remains and remove more skin. It is meant to be conservative, while ensuring complete removal of the tumour. It is definitely becoming the standard of care.

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First you should be realized the what kind of tumor you have in this way you can chose the doctor and concern with him about tumor and follow his suggestion and i think the physical therapy is very helpful for you to solve this.

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