Dr. Alai is an actively practicing medical and surgical dermatologist in south Orange County, California. She has been a professor of dermatology and family medicine at the University of California, Irvine since 2000. She is U.S. board-certified in dermatology, a 10-year-certified fellow of the American Academy of Dermatology, and Fellow of the American Society of Mohs Surgery.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
There is a very low chance that your skin cancer will recur after
Mohs surgery. Mohs cure rates have been reported as high as 96%-99%.
It is important to understand that no cancer treatment or surgery has a 100%
cure rate. A skin cancer may recur or a new cancer may arise in the same or
adjacent area even after Mohs or other surgery. Some skin cancers are more
aggressive than others and need additional treatment and closer follow-up. Skin
cancers frequently need additional follow-up and possible further treatment.
Although Mohs surgery tends to have the highest cure rate compared to other
treatments, Mohs may not be necessarily curative in advanced skin cancer (rare)
and may need one or more procedures, such as radiation or further surgery, to
fully treat the lesion. Follow-up appointments with your physician are very
important, especially in the first few years after Mohs surgery. Many patients
are seen every four to six months after their diagnosis of a skin cancer. Self skin
examinations monthly are good practice for patients with a history of skin
cancer. Any changing or new growth should be promptly checked by your physician.
More regular follow-up appointments may be needed for those with more aggressive
tumors or tumors in high-risk areas. Your physician will recommend the proper
follow-up for your specific condition.
How many "levels" of Mohs will I need?
On average, most patients may only need one or two levels before clearing the tumor
roots. Depending on the skin cancer type and location, a patient may need
anywhere from one to 10 or more levels of Mohs to clear a tumor.
There is no way to predict ahead of time how many levels your cancer will
require for cure. The number of Mohs levels needed to completely remove the skin
cancer depends on how big your cancer is and where the "roots" are. Mohs
surgeons always try to remove your cancer in as few levels as possible.
There is very little way to predict beforehand how large a skin cancer
is because often there are invisible portions "roots" that can be seen only with
the help of a microscope. Sometimes, more than one surgical procedure may be
required to remove very large or invasive tumors, cancers in small areas or
difficult areas, or to obtain the best medical and cosmetic result.
How are skin cancers treated?
There are many effective ways to treat skin cancers. Options
include local radiation (X-ray) treatments, curettage and desiccation "C&D"
(scrape and burn), cryosurgery (specialized deep freezing), photodynamic therapy
using Levulan and laser and or blue light, regular surgical excision, plastic-surgery treatment, interferon injections, laser removal and surgery, Mohs
surgery, and several prescription creams including Aldara (imiquimod) and Efudex
(flurouracil).
Skin cancer is the most common form of cancer
in humans. There are three main types of skin cancer; basal cell carcinoma and
squamous cell carcinoma (the nonmelanoma skin cancers), and melanoma.
Melanoma is a type of skin cancer which begins in skin cells called melanocytes and affects more than 53,600 people in the United States each year. These melanocytes can grow together to form benign moles which, after a change in size, shape, or color can be a sign of melanoma. Caused by sun exposure, early detection becomes extremely important to avoid a spread to other areas of the body. Diagnosis is confirmed through a biopsy of the abnormal skin and treatment depends on the extent and characteristics of the patient.
A keloid is a scar that doesn't know when to stop. When the cells keep on reproducing, the result is an overgrown (hypertrophic) scar or a keloid. A keloid looks shiny and is often dome-shaped, ranging in color from slightly pink to red. It feels hard and thick and is always raised above the surrounding skin.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Signs and symptoms of penile cancer include a lump on the penis and redness, irritation, or a sore on the penis. Risk of penis cancer is higher in uncircumcised men, due to a higher risk of HPV infection. Other risk factors include being over 60, having phimosis, having poor hygiene, using tobacco products, and having many sex partners. Prognosis and treatment depend upon the tumor's location and size, the stage of the cancer, and whether the cancer was recently diagnosed or if it recurred.
Scar formation is a natural part of the healing process after injury. The depth and size of the wound incision and the location of the injury impact the scar's characteristics, but your age, heredity and even sex or ethnicity will affect how your skin reacts.
Sunburn is caused by overexposure to UV radiation from the sun. UV rays can also damage the eyes. Repeated overexposure to UV rays also increases the risk for scarring, freckles, wrinkles, and dry skin. Symptoms of sunburn include painful, red, tender, and hot skin. The skin may blister, swell, and peel. Sun poisoning (severe sunburn) include nausea, fever, chills, rapid pulse, dizziness and more. Treatment for sunburn depends upon the severity. Sun protection and sunscreen for an individual's skin type is recommended to decrease the chance of sunburn.
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