Professor Lyle Anson E. BestThoracic surgeon, surgeon.
Skin cancer is one of the most common oncological diseases, developing in approximately 40% of people who reach the age of 70. Skin cancer primarily occurs on exposed areas of the body: on the face (ears, forehead, nose, corners of the eyes, temples), torso, and limbs.
Types of Precancerous Skin Diseases
Precancerous skin diseases can be divided into two groups:
1. Diseases that become malignant in almost 100% of cases
- Pigmented xeroderma – a congenital chronic skin disease based on increased sensitivity to UV radiation.
- Bowen's disease. Currently considered as intraepidermal carcinoma in situ. The lesion is usually solitary, slowly growing, round or oval in shape, with a raised edge and scaly surface, sometimes with areas of ulceration. It is predominantly located on the upper limbs, torso, and perineum.
- Paget's disease – a rare form of intraductal breast cancer affecting the nipple areola. Scales, crusts, cracks, and erosions appear in the nipple area, accompanied by a tingling and itching sensation; over time, the nipple flattens.
- Keira erythroplasia – carcinoma in situ of the glans penis, essentially synonymous with Bowen's disease. It has a high tendency to transform into squamous cell carcinoma.
2. Diseases that become malignant in 10-15% of cases
- Keratoacanthoma
- Actinic keratosis and keratoma
- Trophic ulcers
- Late radiation ulcers
- Skin lesions in tuberculosis, syphilis, systemic lupus erythematosus
MOHS surgeries at Top Ichilov are performed by Dr. Ehud Miller, senior physician in the plastic surgery department at Ichilov Medical Center.
Types of Skin Cancer
The term skin cancer includes all malignant neoplasms of epidermal origin.
Basal cell carcinoma (basal cell carcinoma, skin carcinoid, corium carcinoma, cancroide) develops from the basal cells of the skin epithelium or glandular skin appendages.
- Dermal
- Cystic
- Reticular
- Pigmented
- Adenoid
- Keratinizing
- Trabecular
- Pagetoid
- Multicentric
- Nodular-ulcerative – the most common form. It appears as a dense, raised nodule of red-pink color with a shiny surface. Over time, the size of the nodule increases, and telangiectasias, ulcers, and crusts appear. The preferred location is the inner corner of the eye, eyelids, and nose. The tumor significantly destroys the underlying tissues but very rarely metastasizes.
Squamous cell carcinoma (squamous cell carcinoma). It is less common than basal cell carcinoma, has a greater ability for malignant growth, invading adjacent tissues and organs, and metastasizing to regional lymph nodes. It often appears as an ulcerated crater with rounded edges, developing in areas of frequent irritation – the red border of the lips, ulcerations on post-burn scars.
Melanoma (tumor of neuroectodermal origin, melanocytic). The most malignant type of skin tumors, rapidly metastasizing to regional lymph nodes and internal organs. It can develop primarily (on unchanged skin) or secondarily (in the area of a pigmented nevus). It has an uneven dark color with inclusions of gray, blue, white, and red, irregular edges, and sizes over 6 mm.
- Superficial spreading melanoma – the most common type, primarily develops from a nevus with frequent trauma. Characterized by slow growth over several years.
- Nodular melanoma – the second most common type, appears as a loose nodule on the skin with ulcerated areas. Characterized by rapid tumor growth.
- Malignant lentigo (Hutchinson's freckle). Most commonly develops in elderly individuals on the face.
- Peripheral lentigo. The danger lies in the predominant development of melanoma on the sole, where its growth and development are not always noticeable.
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Skin Cancer Treatment in Israel - Modern Therapy Methods
The choice of treatment method for skin cancer depends on the stage, histological structure of the tumor, its location, growth pattern, and the condition of the surrounding tissues.
1. Surgical excision is mainly used when the tumor is located on the torso and limbs, within 1-2 cm from the edge of the formation, which does not exclude the occurrence of tumor recurrence.
2. Radiation therapy is used for small tumors. The drawbacks include radiation damage to healthy tissues, a long treatment course, a lengthy rehabilitation period, and not very good results when the tumor is located in the corner of the eye, nose, or ear.
3. Laser therapy.
4. Cryotherapy using liquid nitrogen (this method is used for superficial infiltration of the skin by the tumor process).
5. Curettage and cauterization.
6. Local application of specially formulated creams (fluorouracil).
7. Drug therapy (used as part of combination treatment).
8. Mohs micrographic surgery (MOHS) – the most effective method for treating skin cancer. The surgical technology was developed and first described by Frederick Mohs in 1941, allowing for the precise and complete removal of the tumor under local anesthesia within 1-3 hours and avoiding recurrences. The method is quite expensive and labor-intensive, requiring the highest level of classification for the surgeon, histologist, and laboratory technicians. Before the surgery, a detailed map of the skin area where the malignant neoplasm is located is created. The surgeon removes the thinnest layers of skin, each of which is sequentially stained a specific color, has its own serial number marked on the map, and is sent for histology. Adjacent to the areas where cancer cells are found in histology, the next slice of skin is taken, stained again, and sent for histological examination – as a result, the tumor is completely removed, practically without affecting healthy tissues. Depending on the extent of the malignant process, various amounts of skin flaps may be removed. The recovery period depends on the individual characteristics of the patient. The main focus is on both the functional aspect – ensuring the complete restoration of the patient's ability to work (as much as possible) and the aesthetic side – minimizing the area of the postoperative scar. In most cases, reconstructive surgeries are performed immediately after the tumor removal surgery, and on the same day, the patient can be discharged home. In cases where comprehensive postoperative tissue reconstruction is necessary, reconstructive surgeries are performed the next day or a few days after the malignant tumor removal.
After any type of treatment for malignant skin tumors, it is necessary to avoid sun exposure, protect the skin from direct sunlight: wear long-sleeved clothing, headgear, and use sunscreen with a high level of UV protection. If you have long-healing wounds on your skin, "moles" that have started to grow rapidly or changed in shape or color – consult a doctor. Early detection of a malignant neoplasm will allow for a MOHS surgery to be performed in the shortest possible time and will preserve your health and life.
Advantages of Skin Cancer Treatment in Israel
Skin cancer treatment in Israel at the largest medical center has a number of undeniable advantages that make Israeli medicine a leader in this field – not only in the region but also worldwide.
The main advantages of treatment in Israel include:
- modern high-tech equipment, both therapeutic and diagnostic;
- world-renowned doctors, authoritative specialists recognized by the medical elite of all developed countries;
- unique surgical techniques that ensure not only victory over the disease but also excellent cosmetic results;
- minimal impact on unaffected tissues;
- the highest treatment effectiveness in the world;
- professional staff providing service at the highest level;
- comfortable conditions for staying in the clinic.
One of the most important advantages is also the reasonable prices at the clinic, which make skin cancer treatment in Israel accessible to a much larger number of patients than treatment in Europe and the USA.
It should also be noted that due to the specifics of the country, there is virtually no language barrier – a significant portion of doctors and staff speak Russian. Additionally, each patient receives a personal companion who speaks their native language and acts as a translator if necessary.
Skin Cancer Treatment in Israel: Treatment Prices
The peculiarity of the Israeli medical system is that there is no single price for treatment. Patients with the same diagnosis may receive different final bills; this depends on a multitude of factors: the disease itself, its stage and dynamics of development, the patient's age, comorbidities, the overall condition of the patient's body, and many others. Furthermore, when it comes to surgical interventions, the cost is influenced by the volume and complexity of the operation, the methods and instruments used, as well as the level of the surgeon's qualification – thus, an intervention performed by the leading specialist of the clinic will be priced higher than the work of an ordinary department physician.
At the same time, prices for skin cancer treatment in Israel remain relatively low. Maintaining a quality level that is among the best in the world, Israeli medicine retains its accessibility – on average, prices for treatment in Israel are 30% lower than in European clinics of similar level, and 50% lower than in the USA.
You can find out the approximate price level by contacting an international department consultant using the electronic form on the website or by phone. The final cost can only be provided by the treating physician after completing a full examination and approving the treatment plan.
- Melanoma
- Skin cancer