Deep Margin Assessment,” said Dr. Mandel. “Basically, the cancer and a margin of tissue around it is removed. Then, a thin layer of tissue is carefully shaved all around the outermost edge of the sample. That entire layer of tissue is examined by a pathologist for any trace of cancer. If there is no cancer in the tissue, we know we got it all. If cancer is found, we know we need to go back and remove a larger section of tissue from the cancer location.” CCPDMA gives surgeons a complete look at every part of the tissue margin. It is a significant improvement over a standard surgical pathological analysis, which looks at cross-sectional samples of the tissue. The standard analysis is similar to looking at only the crust on a few slices from a loaf of bread rather than the entire crust. Minimal scarring Thoroughly removing the cancer while taking the smallest amount of tissue necessary helps patients have a good recovery with minimal scaring. Cure rates are between 95 and 98 percent. The entire procedure can be done in the doctor’s office with only a local anesthetic. The tissue margin is examined by a pathologist while the patient waits. If more tissue must be removed, it is done at that same visit, along with reconstructive surgery. “There is a psychological aspect to our faces and wanting to feel that we look our best,” said Dr. Mandel. “Doing surgery on the face presents an intellectual and visual puzzle to solve. As a plastic surgeon, I have trained in a variety of techniques so I can choose the best one to minimize or hide the scarring.” CCPDMA is similar to another surgical technique, Mohs, named after general surgeon Frederick Mohs, M.D., who introduced it in the 1930s. Today, Mohs surgery may only be performed by dermatologists who do their own pathological evaluations during the procedures. As with all health conditions, an ounce of prevention is worth a pound of cure. “Remember to limit sun exposure,” said Dr. Mandel. “Use a mineral-based sunscreen with an SPF of at least 30 to 50, depending on how much time you will be in the sun. Taking basic precautions today will pay off with better skin health when you are older.” Need a consultation? For an appointment with Kootenai Clinic Plastic and Reconstructive Surgery, visit KH.org/plastic-and -reconstructive-surgery. For Kootenai Clinic Dermatology, visit KH.org/dermatology. Both practices can also be reached at (208) 625-4333. Sun Sense Because exposure to UV light is the most preventable risk factor for all skin cancers, the American Academy of Dermatology encourages everyone to stay out of indoor tanning beds and protect their skin outdoors by seeking shade, wearing protective clothing—including a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses with UV protection—and applying a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher to all skin not covered by clothing. For more effective sun protection, select clothing with an ultraviolet protection factor (UPF) number on the label. Because severe sunburns during childhood and adolescence may increase one’s risk of melanoma, children should be especially protected from the sun. Know the Signs Skin cancer warning signs include changes in the size, shape or color of a mole or other skin lesion; the appearance of a new growth on the skin; or a sore that doesn’t heal. If you notice any spots on your skin that are different from the others, or anything changing, itching or bleeding, the American Academy of Dermatology recommends that you make an appointment with a boardcertified dermatologist. KH.ORG 15
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