Virgin Island Skin Cancer Center

The Virgin Island Skin Care Center is the first all-inclusive skin cancer treatment and reconstruction center in the Virgin Islands.

We treat all types of skin cancer including:

• Basal cell carcinoma
• Squamous cell carcinoma
• Melanoma
• Many other cancerous and non-cancerous skin lesions

The non-cancerous skin lesions we treat include:

• Keloids
• Burn scars
• Lipomas
• Seborrheic keratosis
• Actinic keratosis
• Leukoplakia
• And many others

We now offer Moh’s type tumor removal at our new, state-of-the-art surgery center located in the Paragon Building behind SRMC. We also have on-site pathology capabilities to help rapidly diagnosis and make treatment decisions.

Our board-certified plastic surgeon can perform immediate reconstruction at the same time as tumor removal. We offer many non-surgical treatments and laser therapy.

Patients are seen in-person at our St. Thomas office location. Telemedicine appointments are also available on a daily basis for your convenience. Call us now for all your skin cancer needs!

Frequently Asked Questions

What is Skin Cancer? Do I Have it?

Skin cancer is the most common forms of cancer worldwide. It is a tumor of the skin with a chance for growth, local tissue destruction, and potential to spread to other parts of the body.

There are 3 main types of skin cancers:

• Basal cell carcinoma (BCCA)
• Squamous cell carcinoma (SCCA)
• Melanoma skin cancers of different varieties

Basal cell carcinoma and squamous cell carcinoma are the most common types of skin cancer. There are multiple types of basal cell skin cancers, but most types are very slow growing. The most aggressive type is morpheoform BCCA.

Basal cell carcinoma might appear as a pearly or waxy bump on the skin or as a flat, pink/red- or brown-colored lesion. Basal cell carcinoma can sometimes bleed. It typically grows very slowly.

Squamous cell carcinoma can appear as a firm, red nodule, or as a rough, scaly, and flat lesion that might itch, bleed, and become crusty. SCCA often arise from pre-cancerous skin lesions call Actinic Keratosis (AK). It is important to know the difference because an AK can sometimes be treated without surgery.

What is squamous cell carcinoma (SCCA)?

Squamous cell carcinoma (SCCA), is the second most common skin cancer. It comes from the outer layer of the skin, the epidermis. Usually, SCCA is found on the parts of skin that are most often exposed to the sun. This includes the hands, face, arms, legs, ears, and on the top of the head. However, it can occur in any part of the body. SCCA can also form in areas such as the mouth and on the genitals as a result of viral infections.

How common is squamous cell carcinoma (SCCA)?

Over 1 million people are diagnosed with SCCA in the US each year. There are more than 15,000 deaths each year in the US from SCCA, although most deaths are related to SCCA in the mouth or nose. SCCA on the skin results in about 3,000 US deaths per year.

SCCA is more common in men and in patients over the age of 50 but can be seen in younger patients with lots of sun exposure, as well.

What causes squamous cell carcinoma (SCC)?

Repeated exposure to ultraviolet light, either from the sun or from tanning beds, is the main cause of SCCA. Indoor tanning is linked to about 168,000 cases of SCCA in the US each year.

People with light skin, light hair (blond or red), and light eyes (blue, green, or gray) have a higher risk of skin cancer in general, as well as SCCA. However, darker skin patients such as African Americans are still at risk for SCCA.

Other risk factors include:

• Decreased immunity from things like:
  • Cancer of other organs
  • Chronic infections like AIDS
• Taking immunosuppressive medications, including chemotherapy or some biologic medications
• Having an organ transplant
• Having skin injuries such as burns, scars, ulcers, and skin areas that were previously exposed to chemicals
• Radiation injury to the skin
• Genetic skin disease called xeroderma pigmentosum
• Having long-lasting and repeated infections and inflammation of the skin or genital warts

What are the signs and symptoms of squamous cell carcinoma (SCCA)?

Some common signs and symptoms of SCCA include:

• A rough-feeling bump which will crust over and bleed that is higher than the skin around it but has a depression in the middle
• A sore that will not heal or a sore that heals and comes back repeatedly
• Skin that is flat, scaly, and red
• Actinic keratosis
• Actinic cheilitis, which develops mainly on the lower lip; causes tissue to become pale, dry, and cracked
• A precancerous condition called leukoplakia, in which white spots develop in the mouth, on the tongue, or gums

What increases the risk of cancer?

Sun exposure, having fair skin, light eyes, and light hair are the most common risk factors. People with darker skin are still able to get skin cancer, but the risk is substantially lower. People who are outside all the time in sunny climates are also at high risk due to repeated sun exposure. Anyone with a lowered immune system is also at risk.

Risk factors unique to melanoma include a history of severe sunburns and the presence of large and irregular moles. Patients with atypical moles that are left untreated are also at risk. Congenital nevi from birth also present a higher risk of melanoma than other moles or freckles.

What causes skin cancer?

The main cause of skin cancer is overexposure to sunlight, especially when it results in sunburn. The UV light damages DNA in the skin and causes it to become cancerous over time. Exposure to certain chemicals such as tar and coal can cause skin cancer for those with jobs that require frequent contact with these chemicals.

What are the signs of skin cancer?

The most common warning sign of skin cancer is a change on the skin, typically a new growth, or a change in an existing growth or mole. Another sign of skin cancer is skin areas that do not heal.

How is skin cancer treated?

Treatment depends upon the stage of the cancer. Some types of treatment include the following:

• Mohs type surgical resection uses a scalpel to remove the tumor and thin layer of surrounding tissue. It is well established that surgeons using Mohs type frozen section techniques provide the best chance for control of skin cancers. This method allows for confident reading of 99.9% of the tissue edges surrounding the tumor to ensure full removal of cancerous cells. However, at most hospitals, coordination of this technical tissue read with large cancer removal and reconstruction under anesthesia is not logistically possible. As a result, many larger cancers receive less reliable oncologic management. The Virgin Islands Skin Cancer Center has developed a coordinated approach which combines expert plastic and reconstructive surgeons with on-site pathologists at SRMC. This allows for the best tumor removal and simultaneous reconstruction under one anesthesia.
• Excisional surgery involves a surgeon removing the tumor and an extra margin of normal skin to be sure all cancer has been removed.
• Electrosurgery uses electricity to destroy the tumor and some surrounding area.
• Topical chemotherapy with 5-FU can be used to treat certain precancerous lesions.
• Radiation therapy is used for advanced disease and patients with health problems that prevent
  them from having surgery or the treatment of some cancers in sensitive areas. This type of care
  would be given by an outside radiation oncologist.
• If the cancer spreads beyond the skin to other organs or surrounding tissue, chemotherapy,
  targeted drug therapy, or immune therapy is often used. This would be coordinated with an
  outside medical oncologist.
• Large and/or recurrent skin cancers of the face and head present multiple challenges for
  patients and surgeons. First, removing the cancer with the best chance of permanent cure
  requires full surgical margin clearance and coordination of additional care (e.g., radiation
  therapy) as needed. Additionally, large skin and soft tissue defects created by removal of the
  tumor require complex and often multi-stage reconstruction to achieve an acceptable
  appearance.
• Immediate reconstruction is performed the same day by our board-certified plastic surgeon.
  The choice of reconstruction will vary based on a variety of factors, including location and size of
  the tumor, involvement of complex structures such as eyelids, lip, nose, ear, etc., patient health,
  tumor type, and other factors. Reconstructive options can vary from simple direct closure, to
  skin grafting, to local flaps, or even free tissue flaps in advanced cases.
• We have the ability to admit patients to Schneider Regional Medical Center or to transport
  patients to hospitals staffed by our doctors in Florida on an as needed bases if care is required
  that is not offered on the island.

What is melanoma?

Melanoma is not as common as basal cell or squamous cell carcinomas but is the most dangerous form of skin cancer. If left untreated or caught in a late stage, melanoma is more likely to spread to organs beyond the skin, making it difficult to treat and increasing the chances of death from skin cancer.

Melanoma means "black tumor.” The cells of the tumor produce melanin, the dark pigment that gives skin its color. Most melanomas are black or brown in color, but some are pink, red, purple, or skin colored.

Any area of the body can be affected by melanoma. Men are more prone to develop melanoma on the trunk. Women are more likely to have melanoma on the arms and legs. About 30% of melanomas begin in existing moles, but the rest arise in normal skin.

How common is melanoma?

Melanoma accounts for only about 1% of all skin cancers but causes the great majority of skin cancer- related deaths. It is one of the most common cancers in young people under 30, especially in young women. The incidence of melanoma has been dramatically increasing over the past 30 years.

What are the signs of melanoma?

Knowing how to spot melanoma is important because early detection allows for early treatment. Melanoma can appear as moles, scaly patches, open sores, or raised bumps.

Use the American Academy of Dermatology's "ABCDE" memory device to learn the warning signs that a spot on your skin may be melanoma:

• Asymmetry: One half does not match the other half.
• Border: The edges are not smooth.
• Color: The color is mottled and uneven, with shades of brown, black, gray, red, or white.
• Diameter: The spot is greater than the tip of a pencil eraser (6.0 mm).
• Evolving: The spot is new or changing in size, shape, or color.

Some melanomas do not fit the ABCDE rule, so tell your doctor about any sores that won't go away, unusual bumps or rashes, or changes in your skin or in any existing moles.

What causes melanoma?

Most experts agree that a major risk factor for melanoma is overexposure to sunlight, especially sunburns in youth. Ultraviolet (UV) radiation from tanning beds also increases the risk of melanoma and has been designated a carcinogen (cancer-causing) by the World Health Organization.

Although anyone can develop melanoma, an increased risk for developing the disease is seen in people with:

• A personal history of melanoma
• A family history of melanoma
• Fair skin, freckles, blond or red hair, and blue eyes
• A history of prolonged or excessive sun exposure, including blistering sunburns
• A history of tanning bed use
• Many moles, especially “atypical” moles
• A weakened immune system

Melanoma is more common in Caucasians but can occur in people of all skin types. Non-white individuals most often get melanoma on the palms, soles, and nails.

How is melanoma diagnosed?

If you have a mole or other spot that looks suspicious, your doctor may remove it and look at it under a microscope to see if it contains cancer cells. This is called a biopsy.

Once diagnosed, melanoma will be categorized based on several factors, such as how deeply it has spread and the appearance under a microscope. Tumor thickness is the most important characteristic in predicting outcomes.

Melanomas are grouped into the following stages:

• Stage 0 (Melanoma in situ): The melanoma is only in the top layer of skin (the epidermis).
• Stage I: Low-risk primary melanoma with no evidence of spread. This stage is generally curable with surgery.
• Stage II: There are features indicating higher risk of recurrence, but there is no evidence of spread.
• Stage III: The melanoma has spread to nearby lymph nodes or nearby skin.
• Stage IV: The melanoma has spread to more distant lymph nodes or skin or has spread to internal organs.

Some patients may need a biopsy of nearby lymph nodes to determine if the melanoma has spread. This is called sentinel lymph node biopsy. Other necessary tests may include a chest X-ray, a computedtomography (CT) scan, a magnetic resonance imaging (MRI) scan, a positron emission tomography (PET)scan, and blood work.

How is melanoma treated?

Treatment depends on the stage of the melanoma and health of the patient.

Surgery is generally the main treatment for melanoma. The procedure involves cutting out the cancer and some of the normal skin surrounding it. The amount of healthy skin removed will depend on the size and location of the skin cancer. Typically, surgical excision of melanoma can be performed under local anesthesia in the dermatologist's office.

In the early stages of melanoma, surgery has a high probability of being curative. More advanced cases may require other types of treatment in addition to or instead of surgery. Other treatment options may include lymphadenectomy (removal of surrounding lymph nodes), radiation therapy, immunotherapy (using the patient's immune system to attack the cancer cells), and chemotherapy.

What are benign skin growths?

Benign skin growths are non-cancerous bumps, spots, and lumps on the skin that come in a variety of shapes and sizes. Children may have freckles and moles that multiply or darken over time. As a person grows older and spends more time in the sun, their skin can change.Benign skin growths are non-cancerous bumps, spots, and lumps on the skin that come in a variety of shapes and sizes. Children may have freckles and moles that multiply or darken over time. As a person grows older and spends more time in the sun, their skin can change.

What are the different types of skin growths?

Dermatofibromas:

• Small, firm red or brown bumps caused by an accumulation of soft tissue cells under the skin, called fibroblasts. They often occur on the legs and may itch.
• Dermatofibromas can be surgically removed if they become painful or itchy.

Dermoid cyst:

• A benign tumor made up of hairs, sweat glands, and sebaceous glands, which are located in the middle layer of the skin. Some internal dermoid tumors may even contain cartilage, bone fragments, and even teeth.
• Dermoid cysts may be surgically removed for cosmetic reasons.

Freckles:

• Darkened, flat spots that typically appear only on sun-exposed areas of the skin. Freckles are common in people with blond or red hair.
• No treatment is necessary for freckles.

Keloids:

• Smooth, firm, raised fibrous growths on the skin that form in wound sites. Keloids are more common in African Americans.
• Keloids respond poorly to most treatment approaches. Injections of corticosteroid drugs may help to flatten the keloids. Other treatment options include surgery or silicone patches to further flatten the keloids.

Lipomas:

• Round or oval lumps under the skin caused by fatty deposits. Lipomas are more common in women and tend to appear on the forearms, torso, and back of the neck.
• Lipomas are generally harmless, but if the lipoma changes shape, your physician may perform a biopsy. Treatment may include removal by surgery if the lipoma bothers your child.

Moles (nevi):

• Small skin marks caused by pigment-producing cells in the skin. Moles can be flat or raised, smooth or rough, and some contain hair. Most moles are dark brown or black, but some are skin-colored or yellowish. Moles can change over time and often respond to hormonal changes.
• Most moles are benign, and no treatment is necessary. Some benign moles may develop into skin cancer (melanoma).