Ask Dr. Mona: Explore treatment options for 'most common skin cancer'

“In hindsight, one of the biggest telltale signs it was cancerous was that after sun exposure in excess of 30 minutes, it would start to bleed slightly,” said Mike Hodge about a small bump on his neck.

At 27 years of age, Hodge’s innocuous looking lesion was soon diagnosed as basal cell carcinoma (BCC), the most common skin cancer and one that is found mostly in men. Basal cells are a type of cell found in the uppermost layer of the skin. Sunlight exposure is the most important risk factor, but fair skin, Northern European ancestry, childhood freckling and frequent past sunburns are important.

Hodge had MOHS surgery, where the cancer was removed one layer at a time until healthy skin was reached. He also had the topical immunologic cream, imiquimod, applied to his neck. Surgery is usually the treatment for this very slow-growing skin cancer that can, in very advanced cases, become ulcerated and infiltrate surrounding structures such as bone or facial sinuses. Untreated BCC tends to invade and spread across skin tissue and can grow very large to disfigurement.

And although surgery for skin cancer is well-known, immunologic treatment like imiquimod cream is less familiar to many. It can be applied to actinic keratoses (precancerous skin lesions) and some very early basal cell cancers. It causes the immune system to react and destroy the lesion. It’s typically applied at least a few times a week for several weeks, although schedules can vary. Like other topical gels, it can cause severe skin reactions in some people. It can also cause flu-like symptoms.

Here’s a resource that details the advantages of MOHS surgery: https://www.mohscollege.org/about-mohs-surgery.

Hodge is grateful to the person that told him his lesion didn’t look normal. “If he hadn't been as blunt as he was, I would have continued on for some time before seeking treatment.”

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Mona Khanna, M.D., is a triple board-certified physician, Emmy Award-winning journalist and humanitarian who proudly calls the Coachella Valley her year-round home.