Skin Cancer Treatment without surgery: Cut-less Dermatology

According to the Skin Cancer Foundation, one person dies from skin cancer every hour in the United States — a good reason why everyone should schedule regular skin examinations. But you may ask, how do dermatologists know when a skin growth or mole needs to be removed?

In the past, every worrisome skin lesion required a biopsy, meaning a small piece of tissue was surgically removed and sent to a pathology laboratory. If the biopsy showed cancer, additional surgery was needed. Even today, surgical biopsy and removal continues to be the standard of care for skin cancer. Fortunately, we have newer techniques that enable us to not only catch skin cancers earlier but also to help us prevent unnecessary biopsies. Total body photography, digital dermoscopy mole monitoring as well as handheld dermoscopy lesion evaluation are some examples of this vital technology. Dr. Orit Markowitz speaks around the globe on these topics and each year directs the Mount Sinai Greater NY Dermoscopy course for dermatologists in the New York and New Jersey area who are trying to hone in on these new important diagnostic tools.

How we approach skin biopsies and cancer surgery is therefore changing for the better. There are even newer devices being developed each year and Dr. Markowitz is at the forefront. An example of the most recent laser tool is called Optical Coherence Tomography (OCT). Dr. Markowitz, a pioneer in OCT research, recognizes its potential to eliminate the need for surgery in many cases. Dr. Markowitz is the Director of Pigmented Lesions and Skin Cancer at Mount Sinai, and she is also the newly appointed President of the International Optical Coherence Tomography Society.

“An important component of OCT is the laser’s ability to take live black and white pictures of deeper skin layers. By combining this technology with other lasers, I am discovering successful ways to both diagnose and treat skin cancer bloodlessly,” said Dr. Markowitz. The earlier a skin cancer is caught, the better the prognosis and outcome. Dr. Markowitz, through the use of non-ablative lasers, has been able to successfully treat — without cutting — both early and even more advanced non-melanoma skin cancers. Non-melanoma skin cancers are not as deadly as melanoma but they are the most common type of cancer and frequently occur in cosmetically sensitive areas such as the face. The possibility of using noninvasive lasers to both diagnose and treat without cutting is very appealing.

Among the advantages of OCT are improved comfort, greater convenience and less scarring. Dr. Markowitz’s research has enabled Mount Sinai to become the country’s leading center for the development and use of OCT.

According to Dr. Markowitz, “I’ve also found OCT to be useful for benign skin growths, thus preventing the need for unnecessary biopsies.” She notes some examples: harmless moles, warts, hemangiomas, seborrheic and actinic keratoses and cysts. Other dermatological diseases that can be diagnosed with OCT include psoriasis, scabies, and blistering diseases.

Dr. Markowitz currently offers OCT and other noninvasive diagnostic techniques to patients at the Mount Sinai Doctors Faculty Practice.

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