Mountain View Family Medicine

04/29/2026

Erin’s take on it…

This pretty much sucks. The first couple of weeks were okay, the spot on my lip lit up really quickly, and I was surprised at how fast. You can see a white patch in the middle of that growth; it's actually scar tissue from where a Basal Cell patch was removed several years ago. I am guessing that I will need to have additional tissue removed when this is done. Clearly, there is still cancer at the borders of that scar. By mid-week 2, most of the right side of my face was starting to glow red; however, interestingly, there is a significant difference in the amount of skin cancer from the left side to the right side. The lesions are painful, opening and scabbing over, and extremely tender to the touch. Sometimes my face on the pillow will wake me up if it is hitting the wrong spot. As the cells die, the lesions will scab over and eventually heal. This is not a short-term process, but it is not the worst thing I have ever experienced. It’s a good reminder to wear sunscreen every single day!

04/29/2026

Skin Cancer -

Prevention

It can’t be said enough that prevention is always better than treatment. You have heard it before, but it is worth repeating.

Sunscreen- Wear it every day, apply it liberally and often when outside. Make sure to cover the tips of your ears!

Cover- Wear a hat! The shade that a good brim offers protection from sun damage.

Don’t Tan- Color is damage! Don’t lie out in the sun to tan and don’t use tanning beds. Tanning beds accelerate the damage-google it.

Protect your children- kids rely on us to keep them safe from all kinds of worldly dangers. This includes sun exposure from an early age. Make sunscreen the everyday norm, not the special outing afterthought.

Avoid the sun during peak hours! Generally, the sun is strongest from 12 noon -2pm, take a nap, stay in the shade, or cover up.

04/28/2026

Skin Cancer 4/4

MOHs Sugery

Typically, an MOH surgery is done in a dermatologist’s office. The provider will take shavings from the area of concern and immediately view them under a microscope to determine whether there is a clean margin. A clean margin means that there are no cancer cells near the edge of the excised piece. If they still see cancer cells, they will shave a slightly larger area and examine the tissue to ensure clean margins. This is repeated over and over until the provider is confident that the cancer is completely excised. The area that was removed is then closed with sutures. MOH's surgery is good because, in real time, you know that you have clean margins.

Excision

For cancers that have invaded deeper into the tissue, the only way to remove them is by excision. The Provider will numb the area and, using a scalpel, will remove the lesion and some of the surrounding tissue (looking for clean margins), which will be sent to the Pathologist. The Provider will suture up the site, and then we all wait for the path results. The Pathologist will examine the tissue under a microscope to identify the type of tissue (basal cell, squamous cell, AK, or normal), and will determine whether there are clean margins. The hardest part of this procedure can be when not enough tissue is removed, and the provider has to go back in a second time. This delays healing, can be painful to do the procedure twice, and can take a toll emotionally. This new tissue is sent to Pathology for evaluation.

Radiation, Immunotherapy, Chemotherapy

While rare, these skin cancers can spread; if ignored long enough, cancer cells can travel to other parts of your body. In this case, an oncology specialist would manage your care.

04/28/2026

Skin Cancer 3/4

Treatment:

Cryotherapy/Electrocautery

For Actinic Keratosis, there are a couple of options. For small areas, cryotherapy (freezing) or electrocautery can kill affected cells and stop progression. However, this only works for small, visible areas.

Topical Chemotherapy

A common treatment for AK’s, very early BCC, and SCC is a topical chemotherapy called Efudex. Efudex targets abnormal precancerous and cancerous cells and kills them by affecting the cells' DNA. The abnormal cells are destroyed while leaving most healthy cells untouched.

Efudex is a topical lotion applied daily to the targeted areas for approximately 4 weeks. Important to note that treatment times can vary. As the medication is targeting the abnormal cells, you will start to notice some changes. The first week of treatment, there might be some redness, tingling, or irritation. The second week will generally bring more pronounced redness, areas of sun damage that are “lit up”, burning, and even some open sores. While difficult to experience, this is exactly the response we are looking for. This is where Efudex performs a little miracle, revealing hidden damage to the skin that the naked eye cannot see. Week three is where things start to get tough. Your skin is bright red, inflamed, and painful, with small erosions (open sores) that may be crusted or scabbed. This is when the abnormal cells are being destroyed. It is not uncommon for certain areas of the skin to become inflamed and sore more quickly than others. This indicates that these areas have faster cell turnover, meaning they are more significant areas of concern. That brings us to week four, the final week of treatment in most cases. It is common to still have crusty, patchy areas and open sores. You might start to see the inflammation decrease and healing begin.

The unique feature of Efudex is that even when the treatment is stopped, it continues to work. However, in the first few weeks after treatment stops, you will notice that your skin starts to heal, the redness fades to pink, and the inflammation, irritation, and pain slowly subside. Your skin is returning to its normal state. I can’t emphasize enough how important sunscreen is during the treatment, healing, and post-treatment phase. Your skin is very vulnerable during this treatment and will be especially vulnerable to the sun.

After healing, it is important to assess your skin closely. Looking for any patchy, red, inflamed areas that remain after treatment. These may need to be biopsied and treated accordingly.

04/28/2026

Skin Cancer 2/4

In the pre-cancerous realm, there is the actinic keratosis. These are very common, especially with a history of sun exposure. Often these are felt in the skin before they are seen. These are rough, scaly patches that feel like dry skin, but don’t respond to moisturizers. These can progress to squamous cell carcinoma if left untreated. So it is important to identify these and treat them early.

04/28/2026

Skin Cancer 1/4

We’ve heard a lot over the years about various skin cancers, the scariest being a malignant melanoma. This type of skin cancer can spread very quickly with devastating results. However, there are a couple of other types of skin cancers that don’t get as much press, but can have significant consequences if left untreated.

Basal cell carcinoma is the most common skin cancer that is diagnosed. It is very slow-growing and rarely spreads to other parts of the body. But it is not an innocent skin cancer; it can cause serious local damage if ignored. It starts off looking like a pearly bump, shiny patch, or possibly a sore that won’t fully heal.

These are diagnosed by visual inspection and a biopsy. A biopsy means a small piece is taken from the concerning area and sent to a lab, where a pathologist examines the cells to determine the underlying issue. Once diagnosed, treatment is generally removal.

Squamous cell carcinoma is the second type of skin cancer commonly seen. These tend to look like scaly red patches, crusty bumpy areas that feel rough, or a sore that heals, then reopens. These are more concerning if left untreated because they can spread to underlying tissues, through your lymphatic system, and into other organs. This too is diagnosed via biopsy and treated with excision.

04/27/2026

If you have seen Erin working lately, you might have noticed that her face is looking a little rough. She is on week 3 of 4 weeks of skin cancer treatment using Efudex, a topical chemotherapy for those with pre-cancerous and early skin cancer lesions. I thought I would share a few pics with you and then explain a bit more as we go. So stay tuned for some skin cancer information as we head into Summer!

02/12/2026