As baby boomers age, the effects of excessive sun exposure are coming to roost. Skin cancer is the most common form of cancer, with more than 3.5 million skin cancers detected in two million people annually.

The majority of these cancers are known as basal cell and squamous cell carcinomas, otherwise known as well differentiated or non-melanoma skin cancers. These lesions are rarely fatal, but can lead to major disfigurement if left unchecked.

Treatment of these non-melanoma cancers has increased by 77 percent between 1992 and 2006, partly related to an increased awareness about skin cancer and partly because of an aging population.

One of the more common forms of treatment for non-melanoma skin cancers is a technique known as Mohs surgery, a procedure originally described by a surgeon known as Dr. Frederic E. Mohs in the 1930s. Mohs surgery is now considered a subspecialty of dermatology and is a tumor mapping, tissue sparing, frozen section technique that allows for the least amount of tissue removal with the highest cure rates. This allows for preservation of skin in aesthetically and/or functionally sensitive areas such as the lips, nose, eyelids and other areas. The Mohs technique is not widely used for melanomatous lesions.

An article published in the New York Times in January 2014 by Elizabeth Rosenthal raised a number of questions about Mohs surgery, its potential overutilization and the choices given to patients.

“Use of the surgery has skyrocketed in the United States — over 400 percent in a little over a decade — to the point that last summer Medicare put it at the top of its ‘potentially misvalued’ list of overused or overpriced procedures,” she said in the article.

Rosenthal goes on to cite specific patient examples, highlighting the cost of such procedures and their income potential for Mohs surgeons. The article then highlights income gaps between specialists and primary care doctors in the United States.

Dr. Brian Fabian, a Mohs College-trained dermatologist in Southwest Florida, said: “Mohs is a wonderful tool for preserving cosmetically sensitive areas on the face. Although it is generally used appropriately, there may be some abuse of the technique. …the increase in utilization is primarily related to an aging population.

“Although some of the facts and figures are factual, overall the article was a misrepresentation of the situation.”

Dr. Laertes Manuelidis, a Fort Myers dermatologist, agreed: “The article was somewhat one-sided — higher cure rates are in everyone’s best interest. Presentation of costs just paints a picture of demographic changes in this country.”

From my perspective as a facial plastic surgeon, Mohs surgery was the procedure that I recommended to both of my parents when they were faced with skin cancer. Few people would want to have sensitive areas on their face treated without the expertise of a specialist with the requisite training. Dermatologists trained in fellowships accredited by the Mohs College must spend an additional one to two years learning the intricacies of this form of therapy.

Although rising costs of health care are an omnipresent issue on the national agenda, most Americans want the best available techniques offered by the best trained doctors for the ailments they face. For now, sunscreen, hats, and a good relationship with a dermatologist remain a mainstay of Southwest Florida living.

— Stephen Prendiville, M.D., is a fellowship-trained facial plastic surgeon in Fort Myers who is certified by both the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology — Head and Neck Surgery. His office is located at 9407 Cypress Lake Dr., Suite A, in Fort Myers. 437-3900.