Fox Chase Opens New Facility Dedicated to Skin Cancer

At Fox Chase, Cliff Perlis, MD, MBe, practices Mohs surgery, which has the highest cure rate among skin cancer treatments.

Cliff Perlis, MD, MBe, is settling into his new office. On a clear day, the room glows with sunlight. But Perlis admits he's not one to spend much time in the sun. As a dermatology specialist at Fox Chase Cancer Center, he knows all too well the perils of too much sun exposure.

Perlis is the director of Mohs micrographic surgery and dermatologic surgery at Fox Chase. He primarily treats patients with non-melanoma skin cancers such as basal- and squamous-cell carcinomas, which are the most common and are on the rise.

In the newly renovated 4,500-square-foot facility at Fox Chase's 8 Huntingdon Pike medical offices, he practices Mohs surgery, a highly effective procedure to remove non-melanoma skin cancer layer by layer. First, Perlis acts as surgeon by removing a portion of the tumor and a thin margin of tissue. While the patient waits under local anesthetic, Perlis inspects the tissue under a microscope for tumor cells.

By closely examining the margins of the specimen, Perlis can map the precise location of additional tumor tissue. He then returns to the patient to remove this tissue, while preserving the healthy skin that surrounds it. The process is repeated during one patient visit until the entire tumor is removed.

Mohs has the highest cure rate compared to other skin cancer treatments. It ensures removal of the entire tumor with minimal scarring—especially important for sensitive areas such as the nose, lips and other head and neck areas.

Skin Cancer Facts

Each year, more than one million people in the United States develop non-melanoma cancers—basal- and squamous-cell carcinomas.

Years of exposure to the sun's ultraviolet (UV) rays is the most common culprit. UV radiation causes mutations in skin cells that can lead to cancer over time. As a result, patients tend to be 60 years of age and older, but developing these cancers at a young age is not out of the question.

Basal- and squamous-cell carcinomas have a high cure rate because they grow locally and typically do not spread, unless untreated. But they can be disfiguring if not caught early. A more serious skin cancer, melanoma, can invade the body and travel through the blood or lymphatic system.

Basal- and squamous-cell cancers are linked to cumulative sun exposure, while melanomas are linked to intermittent intense sun exposure. For example, vacationers who spend a few weeks each year exposed to large amounts of sunlight are at greater risk of developing melanoma.

While the sun is the primary cause of skin cancers, it is not the only cause. Other risk factors include chronic burns, irritation caused by chemicals such as petroleum and exposure to arsenic, which can be found in well water. People with weakened immune systems, including organ transplant recipients or HIV-positive individuals, are more susceptible to skin cancers.

"Typically, the body's immune system detects abnormal cell growth and programs cell death. But if the immune system is altered and this action does not take place, it can increase the risk of skin cancer," Perlis says.

Research on genetic links to skin cancer has helped specialists like Perlis understand skin cancer development and treatment. For example, individuals with xeroderma pigmentosum have extreme reactions to UV light and must avoid the sun. They frequently develop skin cancers because their skin lacks the ability to identify and repair defects caused by UV radiation.

"We can learn from these extreme cases because the defect is so obvious," says Perlis.

As part of an NCI-designated Comprehensive Cancer Center, Perlis is excited about translational research opportunities.

"Skin is a great model for studying cancer because it is so accessible," Perlis says. "It is a great way to study tumor stroma-connective tissue—and reactions to particular agents."

Also exciting are groundbreaking technologies under investigation for non-invasive diagnosis of skin cancer, including ultrasound, optical coherence tomography and confocal scanning laser microscopy. Perlis hopes Fox Chase will become a site to study confocal scanning laser microscopy, which uses a microscope to look beneath the skin's surface to identify cancer cells.

"That's why it is so great to practice at Fox Chase," Perlis says. "There are ample resources for clinical and research opportunities."