Dermatology oncology
Dermatology oncology, also known as dermatologic oncology or cutaneous oncology, is a specialized field of medicine focused on the diagnosis and treatment of skin cancers. Dermatologic oncologists undergo extensive training, including a dermatology residency followed by a fellowship in oncology, to prepare for their roles. They treat various types of skin cancer, including basal cell carcinoma, squamous cell carcinoma, and melanoma, with the latter being particularly aggressive if not detected early. Treatment methods span from outpatient surgical procedures to more complex therapies, and dermatologic oncologists often collaborate with other cancer specialists when cancer has metastasized.
In addition to common skin cancers, dermatologic oncologists may address rarer forms such as Kaposi sarcoma and sebaceous gland carcinoma, providing a comprehensive approach to skin cancer care. Among their many responsibilities, they perform diagnostic procedures like biopsies and develop tailored treatment plans, often utilizing surgical techniques like Mohs micrographic surgery for optimal outcomes. The field is characterized by a multidisciplinary approach, where dermatologic oncologists work alongside various healthcare professionals, ensuring integrated care for patients facing skin cancer challenges.
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Subject Terms
Dermatology oncology
ALSO KNOWN AS: Dermatological oncology, dermatologic oncology, cutaneous oncology, oncodermatology, dermato-oncology
DEFINITION: Dermatologic oncology is the medical specialty dealing with the diagnosis and treatment of skin cancers. Dermatologic oncologists may provide services and treatment in an office or hospital setting. They receive special education after medical school in dermatology and additional training specific to oncology diagnosis, procedures, and surgeries. Often, dermatologic oncologists can treat skin cancers, but for cancers that have spread to the lymph nodes or other areas of the body, they will enlist the assistance of other specialized oncologists.
Subspecialties: Dermatologic oncologists may specialize in treating particular types of cancer, like advanced basal cell carcinoma, rarer skin cancer, or those that have significantly metastasized. Many specialize in a procedure, like hematopoietic stem cell transplantation, or study the genetics of skin cancer and related syndromes like Familial Atypical Mole-Melanoma Syndrome and BAP1 tumor predisposition syndrome. Others may have special training in a particular treatment or work in the development of treatments.
Cancers treated: Dermatologic oncologists diagnose and treat the three main types of skin cancersbasal cell carcinoma, squamous cell carcinoma, and melanoma. Basal cell carcinoma rarely spreads beyond the skin and is usually treated in the office on an outpatient basis. Squamous cell carcinoma also tends not to spread to other areas of the body, although it does have a somewhat higher incidence of doing so than basal cell carcinoma. It, too, can usually be treated in the office on an outpatient basis.
Melanomas are the most common cause of death from skin cancer. This type of skin cancer is very treatable if found early and is often successfully treated in the office on an outpatient basis. However, if diagnosed later, it can be aggressive and has a high incidence of spreading to the lymph nodes and other body parts. If melanoma has spread over a large portion of the skin or to other organs, dermatologic oncologists will work with other healthcare professionals, such as medical and surgical oncologists, radiologists, and chemotherapists, to treat cancer.
Dermatologic oncologists also treat rare forms of skin cancer, such as Kaposi sarcoma, which develops in the skin’s blood vessels, and sebaceous gland carcinoma, which originates in the skin’s oil glands.
Training and certification: Dermatologic oncologists must complete a residency in dermatology after completing medical school. Residencies are generally at least four years. After completion of the residency, doctors may take an American Board of Dermatology exam for board certification in general dermatology. The next step is usually a fellowship in dermatologic oncology. There is no specific board certification for dermatologic oncology.
Dermatologic oncologists learn to diagnose skin cancers and perform simple treatments in the office or on an outpatient basis, as well as more complex treatments. They usually receive training in working with other allied health professionals, such as medical and surgical oncologists, to deal with metastasized skin cancers. They are often trained to conduct clinical research.
Services and procedures performed: Dermatologic oncologists provide a wide variety of diagnostic and treatment procedures. They usually begin with a visual inspection of the area believed to be cancerous. This checkup may be occasioned by concern expressed by a patient or because of a referral from a primary physician. If the dermatologic oncologist believes cancer is a possibility, the area will be biopsied.
Biopsies generally fall into two categoriesexcisional and incisional. Excisional biopsies remove the entire lesion suspected of being cancerous as well as a small amount of healthy skin surrounding the lesion. The incisional is most frequently used when a lesion is very large and removal of the entire lesion is impractical. Biopsies are usually performed in the office or on an outpatient basis. The samples gathered are treated and examined under a microscope, often in the office by the dermatologic oncologist. However, the sample may be sent out to a dermatopathologist if the diagnosis is not clear or the doctor lacks the necessary facilities.
Once the lesion has been diagnosed as cancerous, the dermatologic oncologist creates a plan of treatment. The first step is to determine how deep the cancer has spread and if it has spread beyond the skin. If it has spread to the lymph nodes or other parts of the body, the dermatologic oncologist will work closely with other oncology professionals to provide treatment.
If the cancer is diagnosed early and has not spread, it can usually be treated through surgery. An is made around the lesion, and the lesion is removed. For basal cell carcinomas and squamous cell carcinomas that are still small, this is often all that is needed. melanomas may be removed in this way, but noncancerous skin around the lesion is usually removed as well to ensure that all the cancer has been removed. Small lesions can be removed using cryosurgery, a technique in which the lesion is frozen off with liquid nitrogen, or electrodesiccation and curettage, in which the lesion is burned off with an electrified needle.
Mohs micrographic surgery is another treatment option, often used for larger lesions. The dermatologic oncologist slowly removes small layers of tissue and examines them to determine if they are cancerous. If they are, another small layer of tissue is removed. This process continues until a noncancerous layer of tissue is found and removed. Another treatment option is photodynamic therapy, which treats malignant and non-malignant skin conditions, including cutaneous squamous cell carcinoma.
Related specialties and subspecialties: Many health professionals may work with dermatologic oncologists. Assistants help prepare patients, perform simple procedures, and do basic laboratory work. These assistants may play a key role in helping patients understand their diagnosis and communicating information about preoperative and postoperative care.
Dermatologic oncologists may send biopsies to a dermatopathologist, a dermatologist who has received additional training in the diagnosis of dermatologic diseases and conditions. A dermatopathologist will perform laboratory analysis on a submitted sample to determine if cancer is present and, if so, what type of cancer it is.
If cancer is diagnosed and is believed or found to have spread to lymph nodes or other areas of the body, many health professionals will join the dermatologic oncologist in helping develop and carry out a plan of treatment for the patient. The healthcare team will include specialists in the area to which the cancer has spread and will often involve a surgical or a medical oncologist, a radiologist, a chemotherapist, oncology nurses, and various other oncology experts. If the treatment for the cancer, or the cancer itself, is significantly disfiguring, a plastic surgeon may be involved.
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