Skin cancer is the most common form of cancer in the United States, and those who have been diagnosed know that the treatment process is far from quick or easy. From going in for a skin check and the biopsy to diagnosis and treatment that may include Mohs surgery – the experience can be quite lengthy and certainly take a toll. But what if it was possible to cut down the experience to one day and eliminate the need for physical cutting? Thanks to modern medicine, it may be an option for many.
So, what is this non-surgical skin cancer treatment method, and who is it for? The AEDITION spoke with Orit Markowitz, MD, a board certified dermatologist and founder of Optskin in New York City, to discuss her pioneering method that involves an optical coherence tomography (OCT) for skin cancer diagnosis paired with a non-ablative YAG laser for removal of basal cell carcinoma (BCC). Here, we get a full biopsy on this minimally invasive option.
Understanding Basal Cell Carcinoma
For those unfamiliar with the various types of skin cancer, the three most common are:
- Basal cell carcinoma (BCC)
- Squamous cell carcinoma (SCC)
While melanoma is considered the most deadly, BCC is the most frequently occurring (eight out of 10 skin cancer cases are BCC). Classified as abnormal, uncontrolled growths, BCCs stem from the skin's basal cells in the epidermis and, as Dr. Markowitz notes, can be hard to spot by the untrained eye. They typically appear on areas of the body that get the most sun exposure, such as the face, arms, back, and legs.
Despite the fact that it is rarely fatal, BCC still requires treatment to prevent growth and the need for more invasive surgery down the line. If detected in its infancy, traditional BCC removal is relatively straightforward, but it will require multiple doctor’s office visits. What separates OCT (at times combined with reflectance confocal microscopy (RCM)) from the alternatives is the timeframe of the treatment and the efficacy without incisions.
The Markowitz Method
A one-and-done appointment is virtually unheard of when it comes to procedures that fall at the intersection of medical necessity and cosmetic desire, however, Dr. Markowitz is utilizing a multi-modal approach to leave patients cancer-free and walking out the same day without so much as a bandage. Here’s how it works:
If there are any suspicious spots on the patient, Dr. Markowitz scans the area with OCT — an infrared, broadband light that was originally created for ophthalmologists — to narrow down the depth for the tumor. This step bypasses the need for unnecessary cutting and allows for rapid diagnosis without the stress of waiting for a biopsy result. Following the diagnosis, in lieu of surgery, Dr. Markowitz uses a non-ablative YAG laser to penetrate the epidermis and gently shrink the cancerous tumor.
Who Is a Candidate?
Needless to say, the treatment is not for every BCC. “The laser is not good for the eyes, so the periorbital area or the eyelids I will not touch,” Dr. Markowitz shares. Superficial lesions are also tougher to treat, as they appear much wider in diameter. To utilize the modality on such a concern could lead to a less-than-favorable cosmetic outcome. Additionally, more advanced stages of BCC may be too far along for this form of treatment, but it does offer relief to many who are diagnosed early.
Another category of patients it can offer relief for? Those with tattoos. Compared to looking at tattooed skin with the naked eye, OTC delivers greater results at a faster rate. “Non-invasive imaging is helpful when diagnosing skin cancer under a tattoo,” Dr. Markowitz explains. “Because the tattoo pigment goes deep, it is not in the way of imaging as the lesion tends to be more superficial.”
Even patients who choose (or need) a surgical excision to remove their lesion may benefit from OTC as a form of diagnosis, Dr. Markowitz says, because it can prevent further scarring and ultimately make the surgical removal process easier. “They will have a better cosmetic outcome because cutting creates inflammation and scar tissue, making it harder to visualize,” she shares. “You will have to go around the inflammation and scar when managing the lesion.”
Recovery & Life After
Those who have had BCC removal with Dr. Markowitz through this non-surgical method know that the aftercare is virtually nonexistent. OTC, when combined with a non-ablative laser, allows for a quick and painless recovery that leaves no scarring and a lot of physical (and mental!) relief. “After this treatment, they can go run a marathon the next day if they choose to,” Dr. Markowitz says. Those with more advanced cases, however, may experience some crusting and bruising post-treatment. After the removal, patients are told to apply a gentle moisturizer and limit sun exposure (yes, this is the same protocol as many cosmetic laser treatments).
For the majority of her patients, Dr. Markowitz only needs only one session, though she does require a follow-up appointment at the two-month mark to ensure the full eradication of the tumor. In a pilot study, 82 percent of the patients were able to have 100 percent of their BCC removed in one treatment, but Dr. Markowitz continues to refine her skill set. “I’m still evolving my treatment protocols to get the most optimal cosmetic outcome and to get to the point where 100 percent of my patients are treated in one visit,” she notes.
Because of the nature of this cancer, recurrence is possible, which is why patients must be extra diligent with their skin cancer screenings. Dr. Markowitz has her own technique for these cases, too. “In my studies, we look under the skin for recurrences of cancer,” she says. “In the past, it was done by looking at it with the naked eye.”
Staying Safe Before or After Skin Cancer
Even those proficient in their ABCDEs will attest that keeping an eye out for potential skin cancer growths can be tricky – especially in those hard-to-reach areas. But that is not an excuse for inaction. Performing self-checks alongside annual visits to the dermatologist is a must, but Dr. Markowitz advises everyone (read: not just those at higher risk of skin cancer) to ensure all of their most-visited experts have their back.
Due to the nature of skin cancer, it can appear anywhere on the body, so speaking with your gynecologist or urologist, hairdresser, and even partner will be beneficial to early diagnosis. That means everyone who comes in close contact with you on a semi-regular basis should be on the lookout for any new or unexpected growth. Another requirement that Dr. Markowitz instills in her patients? Say it with us: sunscreen. It’s far and away the best form of prevention for skin cancer.
Basal cell carcinoma, the most common type of skin cancer, may be treated in a non-invasive way that allows patients to fastrack their healing. Through an innovative combination of imaging for diagnosis and non-ablative lasers for treatment, Dr. Markowitz is proving there can be a cut-free solution for treating nonmelanoma skin cancers. As always, the best way to prevent cancer is to avoid tanning beds, wear SPF, practice safe sun, and be vigilant with your skin checks. When in doubt, consult with your dermatologist.
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