Skin cancer, a common type of cancer affecting millions of people worldwide, can be both preventable and treatable, especially when detected early. Despite successful treatments, such as Mohs micrographic surgery, patients remain at risk for recurrence.

Understanding the factors that influence skin cancer recurrence and knowing the proper ways to monitor and follow up can help ensure better long-term health outcomes.

In this article, we’ll delve into the topic of skin cancer recurrence, monitoring strategies, follow-up care, and how skin cancer surgeons in Singapore, particularly those skilled in Mohs micrographic surgery, are crucial in managing post-treatment care.

 

What is skin cancer?

 

Skin cancer is the uncontrolled growth of abnormal skin cells. The three most common types are:

• Basal cell carcinoma (BCC): The most common form, typically occurring in areas exposed to the sun, such as the face, nose and neck. BCCs are generally considered a low-risk type of skin cancer as they rarely metastasise or spread to other parts of the body. If left untreated, however, BCCs can slowly erode into the surrounding and deeper tissues.
• Squamous cell carcinoma (SCC): This cancer is commonly found in sun-exposed areas, including the face, ears, neck and the back of the hands. SCCs carry a small risk of metastasis, usually to the lymph nodes around the cancer.
• Melanoma: A less common but more aggressive form of skin cancer that can spread to other parts of the body. Melanomas tend to affect younger people compared to BCCs or SCCs.

Skin cancer often presents itself as unusual growths, changes in existing moles, or lesions that don’t heal. Early detection and treatment are critical to reducing mortality and recurrence rates.

 

The importance of Mohs micrographic surgery in skin cancer treatment

 

Mohs micrographic surgery is one of the most effective and precise treatments for skin cancer, particularly for BCC and SCC. This surgical technique involves the removal of cancerous tissue in thin layers while simultaneously examining each layer under a microscope. The process continues until no cancerous cells remain, ensuring minimal damage to surrounding healthy tissues.

Advantages of Mohs micrographic surgery include:

 

• High cure rates: The technique boasts cure rates of up to 98% for non-melanoma skin cancers, even in high-risk areas.
• Tissue preservation: The method allows for the conservation of as much healthy skin as possible, making it ideal for delicate areas such as the face.
• Precision: Mohs surgeons are able to ensure that all margins are cancer-free, significantly reducing the chances of recurrence.

 

For patients undergoing Mohs surgery, the likelihood of recurrence is significantly reduced, but as with any treatment, recurrence is still a possibility.

 

Skin cancer recurrence: What you need to know

 

Skin cancer recurrence refers to the reappearance of cancer cells after initial treatment. It can happen at the original site or elsewhere on the skin. Understanding why recurrence occurs and what to look for is crucial for prevention and early detection.

 

1. Reasons for recurrence

 

Several factors contribute to the risk of skin cancer recurrence, including:

• Incomplete removal of cancerous cells: In some cases, despite successful surgery, microscopic cancer cells may remain, leading to recurrence. Mohs micrographic surgery minimises this risk, but it’s not zero.
• Location and size of the tumour: Larger tumours or those in difficult-to-treat areas, like the ears, eyelids, and nose, may have a higher risk of recurrence due to difficulty in achieving clear margins. These are also areas which are thought to be where embryonic fusion plates merge when a fetus is developing, and are areas of “weakness” in the skin that can hide cancer cells.
• Type of skin cancer: Certain types of BCCs, such as morpheaform or infiltrative types, are more aggressive and have a higher chance of recurrence after treatment. These aggressive types of BCCs should be treated by Mohs micrographic surgery. SCCs which are poorly differentiated (meaning more abnormal-looking) also have a higher risk of recurrence.
• Immune system health: Individuals with weakened immune systems may be at higher risk of recurrence due to a less robust defence against cancerous cells.
• Sun exposure: People who are frequently exposed to the sun or who have a history of tanning or sunburns are at a higher risk of developing skin cancer again. UV radiation can damage the skin and increase the likelihood of recurrence.
• Previous skin cancer diagnosis: Having had skin cancer in the past, especially melanoma, increases the risk of recurrence or developing a second primary skin cancer.

 

2. Types of recurrence

 

There are two main types of skin cancer recurrence:

• Local recurrence: This occurs when cancer returns at or near the original site where the tumour was first removed. This is more common with non-melanoma skin cancers like BCC and SCC.
• Distant recurrence: This is when cancer spreads to other parts of the body, a phenomenon more commonly seen in melanoma. Although this type of recurrence is rare, it requires more aggressive treatment.

 

Monitoring and follow-up care after treatment

 

Once skin cancer has been treated, ongoing monitoring is essential to detect any recurrence early. Early detection allows for prompt intervention and increases the chances of successful treatment.

 

1. Regular skin exams

 

Patients should undergo routine skin exams by a skin cancer surgeon, dermatologist, or healthcare provider. These exams typically involve:

• Full body skin examination: The healthcare provider will check all areas of the skin, including hard-to-see places, for any suspicious growths or changes. This should be performed once a year for most people. 

Your dermatologist in Singapore will usually use a Dermoscope (dermatoscope) to examine your skin. Dermatoscopy is a specialised technique of examining skin growths for patterns that suggest whether these are cancerous or not. In experienced hands, a dermatoscope has been shown to increase the rates of detecting skin cancers, especially at an earlier stage.

• Assessment of previous treatment sites: The surgeon will carefully examine the treated areas for any signs of new growths or changes that may indicate recurrence.

For high-risk individuals, more frequent exams (every 3 to 6 months) may be recommended, especially in the first few years following treatment.

 

2. Self-skin exams

 

In addition to professional exams, patients should perform regular self-exams at home. A recommended frequency for these self-skin examinations is once every few months, looking for any changes, including:

• New growths or moles.
• Existing moles that change in shape, colour, or size.
• Sores that do not heal.

When performing a self-skin exam, patients should be diligent about checking all areas of their body, including the scalp, the soles of their feet, and areas between fingers and toes. For hard-to-see areas like the back, enlisting the help of a partner, or using a full-length mirror plus a handheld mirror is useful.

 

• Know the ABCDEs of melanoma

 

A helpful mnemonic for non-medically trained people to see if a mole warrants further attention by their dermatologist is the ABCDE rule:

• Asymmetry: One half of the mole does not match the other.
• Border: The edges are irregular, blurred, or jagged.
• Colour: The mole has multiple colours or uneven colour distribution.
• Diameter: The mole is larger than 6 millimetres (about the size of a pencil eraser), or Different in appearance compared to other moles in the body
• Evolving: The mole is changing in size, shape, or colour.

 

• Keep a skin journal: Document any new or changing lesions, including their location, size, and appearance. Share this information with your skin cancer surgeon during follow-up appointments.

 

3. Follow-up appointments

 

Patients should adhere to the follow-up schedule set by their healthcare provider. For individuals who have undergone Mohs surgery, the typical follow-up timeline is:

• 1 to 3 months after surgery: The first follow-up appointment is usually within a few months to check the site of surgery and to monitor for any signs of recurrence.
• 6 months to 1 year after surgery: Subsequent follow-ups may be scheduled every 6 months to 1 year, depending on the individual’s risk factors and the type of skin cancer treated.

For melanoma patients or those at high risk of recurrence, more frequent visits may be necessary, and additional diagnostic tests, like blood tests or imaging, may be performed.

 

4. Sun protection and lifestyle adjustments

 

Sun protection is critical in preventing both the recurrence of skin cancer and the development of new skin cancers. Patients should:

• Use sunscreen: Apply broad-spectrum sunscreen with SPF 30 or higher every day, even on cloudy days. Reapply every two hours, especially if sweating or swimming.
• Wear protective clothing: Use hats, sunglasses, and long-sleeved clothing to protect the skin from UV radiation.
• Avoid tanning beds: Tanning beds expose the skin to harmful UV radiation, increasing the risk of developing skin cancer.
• Seek shade: Stay in the shade, particularly between 10 a.m. and 4 p.m. when the sun’s rays are strongest.

In addition to sun protection, maintaining a healthy lifestyle by avoiding smoking and eating a diet rich in antioxidants can help boost the immune system and protect the skin.

 

Role of a skin cancer or dermatologic surgeon in Singapore

 

Skin cancer surgeons or dermatologic surgeons in Singapore are highly skilled professionals specialising in the diagnosis and treatment of skin cancer. With advanced training in techniques such as Mohs micrographic surgery, these surgeons offer a comprehensive approach to skin cancer care.

In Singapore, the healthcare system is renowned for its precision and advanced technologies in diagnosing and treating skin cancer. A well-qualified skin cancer surgeon can provide thorough consultations, precision surgery, and vigilant follow-up care to ensure the best possible outcomes for patients.

 

Choosing a skin cancer surgeon or dermatologic surgeon in Singapore

 

Selecting the right skin cancer surgeon is crucial for effective treatment and follow-up care. Here are some factors to consider when choosing a surgeon in Singapore:

1. Experience and expertise: Look for a surgeon with extensive experience in treating skin cancer, particularly the type you have been diagnosed with. Surgeons who specialise in Mohs micrographic surgery are often the best choice for complex cases.

2. Specialist certification: Ensure the surgeon is accredited by the Specialist Accreditation Board in dermatology or a related field and has received specialised training in skin cancer surgery.

3. Reputation and reviews: Research the surgeon’s reputation by reading patient reviews and testimonials. A well-regarded skin cancer surgeon in Singapore will have a track record of successful outcomes and satisfied patients.

4. Comprehensive care: Choose a surgeon who offers a full range of services, from diagnosis and treatment to follow-up care and patient education.

5. Accessibility: Consider the location and availability of the surgeon. Regular follow-up appointments are essential, so it’s important to choose a surgeon who is conveniently located and easy to reach.

 

Conclusion

 

The possibility of skin cancer recurrence underscores the importance of ongoing monitoring and follow-up care after treatment. Regular skin exams, both by healthcare providers and at home, along with lifestyle changes, such as sun protection, are key to minimising the risk of recurrence. Mohs micrographic surgery remains one of the most effective treatments for skin cancer, offering high cure rates and minimal risk of recurrence.

By collaborating closely with a skilled skin cancer surgeon in Singapore and adhering to a post-treatment plan that includes regular check-ups and vigilant self-care, patients can significantly reduce the chances of recurrence and enjoy better long-term health outcomes. For those seeking dermatology care for skin cancer recurrence, TSN Dermatology is dedicated to supporting patients through every step of their skin health journey.