“Tan is healthy”, “kids should be in the sun”, “tan is beautiful” . These phrases were very common during the 20th century.   Eastern European Jewish mothers found it very important for their kids to have pinkish cheeks.

But not only them. Sun was adored by the mass, in an era were leisure was gaining more time in people’s life.

Only in recent decades we witness the magnitude of sun damage.

According to the National Cancer Institute, every second person at the age of 65 will have skin cancer, and these figures are growing 5% annually.

Skin cancer is a large basket. It holds several types of tumors, most of them don’t endanger life, cause local damage to the skin, but some can be life threatening.

Basal Cell Carcinoma (BCC) is the most common, it can appear as a pearly nodule, or a wound the won’t heal, especially in sun exposed areas of the body. It almost never spreads to distant areas.

Squamous Cell Carcinoma (SCC) is less common, can look similar to the former, but has some ability to become more aggressive and metastasize.

Melanoma is even less common, but this tumor can endanger life. It mimics moles, causing unawareness and late diagnosis.

Awareness is the key word in dealing with skin cancer.

It starts with prevention.

Although people experience skin cancer years after exposure, it is important to protect ourselves, family and friends. Avoid sun exposure in mid-day, use shirts and hats, and sunscreen.

Once a new mole appears, an old one changed, don’t hesitate and get it examined by a dermatologist. Never neglect wounds that don’t heal.

Best follow-up is to have a yearly all body check-up by a dermatologist.

Treatment of skin cancer varies, according to the type of tumor, how deep it penetrated the skin, and it should be tailored personally.

Very superficial tumors can be treated with special chemotherapy creams, creams that enhance local immune activity, or specific exposure to special light beams.

Most tumors need surgery. In the case of Melanoma the surgery might involve removal of lymph nodes.

In BCC and SCC, the majority of skin cancers, getting the tumor out is usually sufficient.

And for that Mohs surgery is the best method.

Developed in the 1930’s, Mohs surgery enables the surgeon to make sure all the tumor is out.

It starts with local anesthesia, and excision of the lesion with minimal margins. while patients are in the waiting room with temporary bandage, the surgeon takes the tissue excised to the next door lab, a technician prepare slides, and the surgeon then looks under the microscope to see if there is any tumor left.

If there is no tumor seen on the slides, the wound can be closed. If there is still tumor left, the surgeon will excise more tissue just were it is needed.

At the end of the day, the tumor is out with the highest certainty as compared to “regular” excision, and with minimal sacrifice of surrounding healthy tissue.

Skin cancer in Israel, similar to America, Europe and Australia, is on the rise.

The combination of sunny climate and fair skin population is the key to the wide spread of the disease.

The immigration during the 1990’s of over a million former Soviet Union citizens, most of them of European fair skin origin, contributed to the rise in skin cancer numbers.

Mohs surgery in Israel is still limited. Only a handful of surgeons, some dermatologists, some plastic surgeons are specialists in the technique.

A Mohs surgeon should be qualified formally, and master the surgical and pathological aspects of the technique. In other words, have the surgical skill to remove the tumor, read the slides, and reconstruct the defect left with the best aesthetic and functional results.

I’m Dr. Ehud Miller, a Plastic Surgeon specializing in Mohs Surgery.

I have graduated the Med. School of Tel Aviv University, later specializing in Plastic Surgery at the Tel Aviv Sourasky Medical Center, and learning Mohs at Erasmus MC, in Rotterdam, Holland.

As the head of the Mohs unit at the Tel Aviv Medical Center, I have performed over 10,000 !!! Mohs surgeries.

I would be happy to answer any further questions, and when needed, escort you before, during and after surgery, for achieving the best clinical and aesthetic results.

And remember, sun protection and awareness can prevent surgery.

Keep eyes open on yourself and your closed ones.

I wish a Good health to you all

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