Dr Todd Schlesinger: Surgical Decisions for Skin Cancer Are Multimodal

The characteristics of the tumor and the presence of surgical fatigue can help determine patients’ candidacy for skin cancer surgery, explained Todd Schlesinger, MD, FAAD, director, Dermatology and Laser Center of Charleston and Clinical Research Center of the Carolinas.

Transcript

Why might patients with skin cancer not be candidates for surgery, and what are some of the functional incapacity risks for those who are?

Assessing risk for surgical intervention for skin cancer, nonmelanoma skin cancer, is a multimodal consideration. One of the main considerations that you might think of if you're deciding whether a patient will or will not be a candidate for surgery might be location of the tumor. If a tumor happens to be located near a large structure—the eye, the nose, the ear—or the surgery may result in significantly more morbidity for the patient, such as removal of an eye or a large part of the ear of the nose, other considerations may come to mind as well. Or if it's a particularly very large tumor, some tumors are just not surgical candidates. You may be presented with a very large advanced skin cancer covering half the back or maybe in the genital area that just isn't a good candidate.

There's other patients who may present who may be considered a nonsurgical candidate: They have just a lot of tumors, surgical fatigue, or just the tiredness of having multiple surgeries over time can also be another factor to consider. So there are several things to think about. Also, the subtype and aggressiveness of the tumor being dealt with is a consideration. Whether the tumor has been treated before with radiation or prior surgery, whether it's recurrent or not, these are all things that we think about when it comes to surgery.

And then we also have patients who are just of advanced age, and they may not desire to have another surgical procedure and they also may have the option of using one of these medical therapies. So it's a multimodal consideration that we have to think of as dermatologists.