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Singer/songwriter Alisa Fineman

Alisa FeinmanThe cantorial soloist for Congregation Beth Israel in Carmel, is well known for lighting up a room with her music. So she was concerned, personally and professionally, when she was twice diagnosed with basal- cell carcinoma, a superficial skin cancer, on her face.

Fineman suspects the lesions that developed by her brow and below her right eye resulted from sun exposure during three college summers in the high elevations of the Rocky Mountains in Idaho, working as a fire lookout for the U.S. Forest Service. Or maybe it’s just genetics. It’s hard to know.

What she does know is that the two procedures she chose to treat the cancers were decidedly different in experience and outcome.

To remove the lesion in her eyebrow near the bridge of her nose, Fineman was advised to undergo Mohs surgery. In Mohs, a surgeon removes a very thin layer of skin and then checks the tissue under a microscope. If cancer cells are seen, the next layer is removed and examined. This is repeated until the skin samples are free of cancer cells. Mohs is considered one of the most effective treatments for superficial skin cancer, with a reported cure rate of 98 percent or better.

“It wasn’t until I took the bandage off the next morning that I realized the extent of the Mohs surgery,” Fineman says. “The surgeon did a fine job, but in retrospect, the best approach for me would have been to see a plastic surgeon. The surgery left quite a scar, a sizeable bump that has never gone away.”

After the emergence of a basal-cell carcinoma below her right eye, she talked with her dermatologist about her options. The doctor said she might be a candidate for radiation instead of surgery.

“I met with radiation oncologist Dr. Bradley Tamler, who did all kinds of things to see if I was a candidate — scraping the area to raise irregular cells, studying the outline of the cells under a black light, taking photographs,” says Fineman. “And he asked a lot of questions.”

Community Hospital, where Tamler practices, has been treating skin cancer and other skin conditions with what’s called superficial X-ray therapy for more than 15 years, longer than any provider in the area. The hospital uses a system developed by Gulmay Medical Inc. that treats just the top layer of tissue, where the cancer cells are found. Four different energy levels are available, enabling doctors to customize the depth of treatment for each patient. Radiation therapy can be an excellent option for small skin cancers when surgery might have an unsatisfactory cosmetic result without reconstruction.

After concluding that Fineman was a candidate for radiation therapy, Tamler worked with the hospital’s radiation treatment team to develop a plan for her. To eradicate the cancer cells, Fineman went to the Radiation Oncology department at Community Hospital for a series of 14 quick treatments in which radiation was carefully focused on a nickel-sized area of her face for less than a minute.

Side effects can include skin irritation.

Every day during her treatments, Fineman’s skin got redder, and every night she put ointment on it.

“Knowing I am in the public eye, Dr. Tamler was concerned about leaving the least scarring possible, and it has healed beautifully. One would have to look very closely to see there is a bit of an outline. No one notices it.”

Fineman never missed work, and didn’t need plastic surgery, a skin graft, or stitches.

“We want confidence we’re going to be cared for in the best way possible,” she says. “I was really pleased.”

Treating Skin Cancer

Mohs surgery has the best cure rate for basal cell carcinoma. It’s especially useful in treating tumors that are; large; have ill-defined edges; are in certain areas that can tolerate surgical removal; and those that have come back after other treatments.

Radiation therapyis often a good option for treating patients who might not be able to tolerate surgery and for treating tumors on the eyelids, nose, or ears – areas that can be hard to treat surgically. Potential advantages to superficial radiation may include:

  • No incisions
  • No anesthesia required
  • Minimal to no scarring
  • Virtually painless

To find out the most appropriate treatment for you, talk with your dermatologist or call Community Hospital’s Radiation Oncology department at (831) 625-4630.

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