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Skin cancer is the most common form of cancer in the United States and navigating a diagnosis can feel overwhelming.
In this Q&A, Dr. C. Blake Phillips and Dr. Callie Hill of Total Dermatology share expert insight on everything from what to do after a diagnosis to the differences in treatment options — including Mohs micrographic surgery.
Whether you're newly diagnosed, supporting a loved one, or simply looking to stay informed, this guide offers clarity, reassurance, and valuable expertise from two board-certified specialists.
Q: What’s one piece of advice you’d give to someone who’s just been diagnosed with skin cancer and is feeling uncertain about their next steps?
A: “I would first seek the counsel of a board-certified dermatologist to discuss your specific situation. If you are not established with a local dermatologist, asking trusted medical professionals for recommendations or referral is a great place to start. While some dermatology subspecialists tailor their practices toward managing challenging skin cancers, many patients do not require advanced services and can be effectively treated by any reputable dermatologist”, says, Dr. Phillips.
Q: Many people feel overwhelmed after hearing they have skin cancer. How do you help patients understand the type of cancer they have and what it means?
A: As physicians, we have a responsibility to act in the best interest of our patients, both in terms of medical care and communication.
“I find that open dialogue and setting clear expectations are key to helping patients feel more at ease,” says Dr. Hill.
When a skin biopsy confirms a cancer diagnosis, I typically begin by reviewing the pathology report with the patient and any family members who are present. The report provides important information that helps us determine the best course of action. From there, I take time to answer any questions and develop a care plan tailored to the patient’s specific needs and circumstances.
Q: What are the most common types of skin cancer you see, and how do they differ in terms of treatment approach?
A: The three most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and melanoma. Each behaves differently, and even within each type, subtypes can affect how the cancer grows and is treated. Factors like the cancer’s stage, location, and a patient’s overall health help determine the best approach.
- Basal cell carcinoma is the most common and usually grows slowly. It rarely spreads but can cause serious local damage if left untreated.
- Squamous cell carcinoma is generally more aggressive and can spread more quickly, especially in high-risk cases.
- Melanoma is the most serious but is highly treatable when caught early.
Dr. Phillips adds, “The key takeaway is that early detection and treatment allow for less invasive procedures and high cure rates. The longer skin cancer goes untreated, the greater the risks and the more complex the treatment becomes.”
Q: Can you explain what Mohs micrographic surgery is and how it differs from a traditional surgical removal (excision)?
A: Wide local excision is a common method for removing skin cancer. It involves removing the visible lesion along with a measured ring of normal tissue around and beneath it. The area is then closed with sutures, and the tissue is sent to a separate pathologist who examines vertical slices (like a loaf of bread) to check for any remaining cancer at the edges. Results are shared with the patient later, usually confirming clear margins. This approach has very high cure rates for low-risk cancers and is an excellent option in many cases.
Mohs surgery is a specialized combination of excision and real-time pathology that aims to remove less tissue and achieve higher cure rates than with traditional excision. Tissue edges are more thoroughly examined with the Mohs technique, and clear margins are confirmed prior to repairing the surgical wound. Mohs specialists are trained in both surgical removal and microscopic examination of skin cancers. The surgeon first removes a visible cancerous lesion with a very narrow protective ring. While the patient waits, the tissue is processed and examined to ensure complete removal. If there are roots extending beyond the initial removal, these roots are mapped, and additional corresponding tissue is narrowly re-excised until the entire lesion is confirmed to be clear. Complete cancer removal and wound repair are most often completed during the same visit.
Q: What types of skin cancer are best treated with Mohs surgery, and how do you determine when it’s the right choice for a patient?
A: Mohs surgery is generally preferred for cancers with high-risk features, large cancers, lesions located in cosmetically or functionally critical body sites (such as the face or hands) or areas with limited tissue laxity (such as the scalp, lower legs, feet, ears). It is also used in cases where traditional excision failed to adequately remove the lesion. The goal is to achieve higher cure rates and spare as much healthy tissue as possible, resulting in smaller repairs.
Q: Once a patient has had skin cancer, what preventive measures do you stress to avoid future skin cancers?
A: “Skin cancer often develops years after the initial sun damage,” says Dr. Hill. “If you’ve had significant sun exposure, used tanning beds, or worked outdoors, regular skin checks with a dermatologist are an important part of early detection and prevention.”
To help protect your skin and lower your risk:
• Wear sunscreen daily
• Use hats and sun-protective clothing
• Avoid tanning beds
• Try to stay out of direct sun during peak hours (10 a.m. to 4 p.m.)
Q: How can our readers schedule a skin cancer screening or consultation with Total Dermatology?
A: Total Dermatology has a team of highly trained providers ready to evaluate your skin or guide you through a skin cancer diagnosis. Our board-certified dermatologists, experienced PAs and NPs, and two fellowship-trained Mohs surgeons are here to provide expert care.
To schedule an appointment, call 205-933-0987 or visit totalskinandbeauty.com.
We proudly serve patients at convenient locations in Birmingham, Gardendale, Bessemer, and Trussville.
