Building Your Skin Cancer Team

Credit: VLADIMIR KONONOK/ISTOCK/GETTY IMAGES PLUS

Fortunately, most skin cancers can be treated in a dermatologist’s office. But sometimes your doctor may refer you to another specialist, or work in tandem with one or more. If the disease is diagnosed at a later stage, you may need additional medical professionals to support your treatment and recovery. Learn more about the benefits of a multidisciplinary team in our story on advanced basal cell carcinoma (BCC) and on our Merkel cell carcinoma patient support page. Here’s a list of potential players on your team.

Mohs Surgeon

A doctor — usually a dermatologist — with advanced training in Mohs surgery. They remove the tumor, serve as pathologist and also as reconstructive surgeon.

You may need one if your dermatologist is not trained to perform Mohs surgery and determines it is the best treatment option for your skin cancer.

Surgical Oncologist

A doctor trained to diagnose and surgically treat and remove cancerous tumors that have spread beyond the skin.

You may need one if your treatment requires surgery, such as a sentinel lymph node biopsy.

Plastic Surgeon

A doctor who reconstructs, restores and repairs body parts. A plastic surgeon may occasionally be called on to close a wound after surgery, particularly if it involves deeper tissue.

You may need one if removing your cancer requires reconstructive surgery, beyond what a dermatologist may be able to perform in an outpatient setting. Your dermatologist or Mohs surgeon may work with an oculoplastic surgeon, for example, if removing a skin cancer near the eye involves restoring eyelid movement.

Head and Neck Surgeon

Also called an otorhinolaryngologist, this doctor is trained in medicine and surgery to treat conditions (cancerous and noncancerous) of the deeper parts of the head and neck. This includes the ear, nose and throat, which is why this doctor is also called an ENT.

You may need one if your cancer has spread into deeper tissue, such as the saliva gland, muscle or bone.

Medical Oncologist

A doctor trained to diagnose and treat cancer patients, particularly those with more advanced stages of disease, using special medications that may be taken by mouth, injected or infused intravenously.

You may need one if your treatment requires immunotherapy, targeted therapy or chemotherapy, which is still used occasionally. Dermatologists can also prescribe some systemic therapies for advanced nonmelanoma skin cancers.

Radiation Oncologist

A doctor who is fully trained to use different types of radiation to destroy cancerous cells, while keeping your other cells healthy.

You may need one if your skin cancer is hard to manage surgically. Radiation is sometimes used on the elderly or those in poor health. Radiation can also be used as a combination therapy to help treat skin cancer that has spread to the lymph nodes or other organs.

Pharmacist

A medical professional trained to prepare and dispense medication, and counsel on their proper use and adverse effects. Pharmacy is a wide field, and there are specialists who specifically work with cancer patients.

You may need one if you are prescribed topical or oral medications to treat your skin cancer. Your pharmacist can check for drug interactions and advise on potential side effects from medications. Pharmacists can also recommend aids to help ease any pain or discomfort you may be experiencing.

Geneticist

A specialist who has studied how traits are passed down from parents to children through genes. Medical geneticists are doctors trained to diagnose and treat genetic disorders and counsel people and families at risk.

You may need one if the type of skin cancer you have tends to run in families or might make you susceptible to other cancers. A genetic risk assessment would reveal if your skin cancer has genes that can be inherited by other family members or increase your risk for other diseases, like pancreatic or colon cancer.

Behind-the-Scenes MVPs

After your dermatologist performs a biopsy on a suspicious lesion, the sample is sent to a lab to be examined by a pathologist. A pathologist is a doctor specially trained to study tissue under a microscope to diagnose diseases or determine the stage of a tumor. Dermatologists typically prefer to send tissue samples to board-certified dermatopathologists, who only examine skin tissue, looking for skin cancers as well as other skin conditions and diseases of the hair and nails. Pathologists also examine lymph node specimens and metastatic biopsies and may be called on to examine skin biopsies when a dermatopathologist is not available. Pathologists and patients typically don’t have much interaction, so it’s unlikely you’ll meet. (The exception is a Mohs surgeon, who is trained as both the surgeon and the pathologist to treat your skin cancer.) But the pathologist is an essential member of your skin cancer team. A high-quality pathology report makes all the difference when your team is working with you to determine the best course of treatment for you.

Your physician may refer you to a radiologist to determine if your cancer has spread. A radiologist is a doctor specially trained to order, perform and interpret imaging tests and procedures, including computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET) and ultrasound. There is an art to evaluating these test results, and the radiologist provides expert counsel to referring physicians.

What About a Cutaneous Oncologist?

Also called a dermato-oncologist, this is an evolving term used in the United States. These are dermatologists with a special interest and training in understanding the advanced use of systemic medications to treat skin cancer.

#SquadGoals: Keep Everyone on Your Skin Cancer Team Informed

Tell everyone on your health-care team about your skin cancer diagnosis and any proposed treatment. This includes your primary care physician, dentist, pharmacist and any other specialists who treat you and prescribe medications for you. That way they’ll know if your skin cancer diagnosis or treatment could impact any other conditions you might have.

Special thanks to John Strasswimmer, MD, PhD, for his guidance.