You never leave the house without applying sunscreen. You visit your dermatologist for annual skin checks, and you make a concerted effort to steer clear of the sun’s rays. Those are all great ways to protect yourself from skin cancer, but did you know you could still be at risk?

The most significant contributor to developing skin cancer is your sun exposure over a lifetime. “That means any previous sun-worshipping or tanning could still catch up to you no matter how long it’s been,” says Hari Nadiminti, MD, a fellowship trained Mohs micrographic surgeon with expertise in diagnosing and treating skin cancer and benign growths.

“The skin cancer epidemic is at the highest rate we’ve ever seen in our population,” he says. “In the last 10 years alone, we’ve treated more than 35,000 cancers at Summit Health.”

According to the American Academy of Dermatology, it’s estimated that one in five Americans will be diagnosed with skin cancer in their lifetime. Here’s what experts want you to know about skin cancer and what to expect if Mohs surgery is recommended.

Skin cancer: who it affects and cancer types

Skin cancer is the unregulated, abnormal growth of cells in the skin tissue. It’s usually caused by overexposure to ultraviolet (UV) light, either from the sun or sources like tanning beds. Skin cancer most often develops in sun-exposed areas such as the scalp, face, hands, and lower legs. It can form anywhere, including areas like the palms and genitals, although those locations are rare.

Anyone can get skin cancer, but factors that may increase your risk include:

• Fair skin color
• Skin that freckles or burns easily, or a history of sunburns
• Blue or green eyes
• Blond or red hair
• Having many moles or abnormal moles
• A family history or personal history of skin cancer
• Older age

There are three main types of skin cancer, based on the type of cell it originates from. They do not change into one another, only progress as that specific type of skin cancer.

• Basal cell carcinoma (BCC) is the most common type of skin cancer. BCCs commonly develop on the head, neck, and arms but can occur anywhere on the body. It may look like a flesh-colored or pearl-like bump or a pinkish patch of skin.
   
• Squamous cell carcinoma (SCC) is the second most common skin cancer type. SCCs tend to form on the ears, face, and hands, among other sun-exposed areas. It typically looks like a red, firm bump, a scaly patch of skin, or a bleeding, scabbing sore that heals and returns.
  
  SCC can also develop from a precancerous growth called actinic keratosis (AK). An AK can appear as a flat or raised scaly patch on the skin.
   
• Melanoma is formed by melanocytes, the cells that make pigment in skin. It is the third most common type of skin cancer. It’s often considered the most serious skin cancer because it tends to spread to other parts of the body.

Not all skin conditions are cancer, but if you notice any changes to your skin that worry you, make an appointment with a dermatologist.

How skin cancer is diagnosed

Your provider will examine your skin, learn about the skin symptoms you’ve noticed, and ask about any risk factors for skin cancer.

If your provider suspects skin cancer, they will perform a biopsy in office that removes a part of the suspicious skin area which gets sent to a lab for testing.

Treatment options for skin cancer vary and are also based on factors such as the skin cancer type, size, and location on the body. Surgery for squamous cell and basal cell cancers is common, and various techniques are used, including Mohs surgery.

What is Mohs surgery?

Mohs micrographic surgery (MMS) is a specialized technique used to remove certain tumors that are considered high risk or located in areas where maximum preservation of tissue is desired.  In contrast to usual skin cancer surgery where the entire tumor is removed in one step, in a Mohs procedure the skin cancer is removed, section by section, and immediately examined under a microscope to ensure all cancerous cells have been fully removed. This technique allows surgeons to remove cancerous tissue while usually preserving more of the normal surrounding skin than is possible with other methods.

The surgery is typically an outpatient procedure performed at a medical office under local anesthetic, so you’ll be awake during it.

What Mohs surgery is used to treat

“Mohs is often recommended for squamous cell and basal cell carcinomas when they are large, growing rapidly, or recurring,” says Dr. Nadiminti. “It’s also recommended when the cancer is in an area where removing as little tissue as possible is important to facilitate healing and help minimize scarring.” These areas may include:

• Ear
• Eyelid
• Fingers
• Genitals 
• Hairline
• Nose 
• Toes and feet

Mohs can be used to treat a specific type of early melanoma. The procedure is called “slow Mohs” in this case because more time is needed to analyze the removed skin for cancer cells.

What to expect after surgery

After the surgeon removes the cancerous tissue, he or she will usually repair the wound with stitches in order to maximize healing. More complicated cases may call for skin grafts or skin flaps. Recovery time varies and may include swelling, redness, or bumpiness, which should fade in the following weeks and months. 
At first the area is usually bandaged. Post-operative care may involve using certain ointments to the area.  There are certain post-operative techniques that can help the appearance of scarring, such as injections, lasers, and micro-needling.

Life after skin cancer 

“A skin cancer diagnosis doesn’t mean you have to spend the rest of your life indoors,” says Edward Monk, MD, a dermatologist and Mohs surgeon at Westmed Medical Group, A Summit Health Company.

“I don't usually tell patients that they cannot enjoy outdoor life, although they may need to make some adjustments to protect their skin going forward,” he says. “There are many good ways to protect skin in the sun,” he says.

Practice sun protection

“Sun protection includes anything you can do to limit your exposure to sun rays. It includes using broad spectrum sunscreen and sun protective clothing. This along with having regular head-to-toe skin checks with a dermatologist are the best ways to prevent the trouble caused by skin cancer”, says Dr. Monk. 

“In addition, when I counsel patients on sun protection, I always remind them to consider taking a vitamin D supplement or at least speaking with their primary care provider about doing so,” he adds. “The sun is one way we get this vitamin, but taking a supplement is probably safer, especially when it comes to skin health.”

Don’t forget to check your skin

“It's critical to continuously monitor your skin for any changes or troublesome spots outside of yearly check-ups with a dermatologist,” says Dr. Nadiminti.

“Early detection is key,” he says. “If you have any concerns or find a suspicious lesion, make sure to be evaluated quickly."