DEAR DR. DONOHUE: I am 62 and have lost my job and my health insurance. I have two skin cancers on my face. One is metastasizing. A clinic at one of the large hospitals in my city has agreed to treat me. The doctor biopsied the spot under my eye and said it was precancer. I had a previous basal cell skin cancer. Another biopsy from the jaw area was squamous cell cancer. He says it will take five minutes to remove it. Not by my cancer book; the book says it takes a skin graft. I guess since the clinic is free, no one cares. – D.K.

ANSWER: I know the hospital that sponsors your clinic. It’s one of the finest in this country. The hospital’s reputation is at stake if its doctors provide anyone with less than the best care. A doctor who starts treatment on a patient has an obligation to that patient to furnish care that meets the standards of good medicine, regardless of the patient’s payment. You are getting top-notch care.

Basal cell cancers arise from the lowermost skin layer, the base layer, hence the name. In the United States, 800,000 basal cell cancers occur yearly. They begin as small, waxy, pearly white or red bumps with a central depression that’s often covered with a crust. These cancers bleed easily. The cancer becomes an open sore that doesn’t heal. Basal cancers appear most often on the face, nose, scalp and ears. They almost never spread and almost never kill. Such cancers can be frozen, dried with an electric current, scraped off or removed by the Mohs’ technique. Mohs’ surgery is a time-consuming procedure in which thin slices of the cancer are removed and immediately examined microscopically. The removal continues until no slice shows cancer cells. Sometimes creams like Aladara are used to treat basal cell cancer.

Squamous cells are the topmost layer of skin cells. Squamous cell cancers have about one-quarter the incidence of basal cell cancers. They begin as hard, dull-red, slightly elevated lumps with a dome shape. They also become open, non-healing sores. Squamous cell cancers, if untreated, can spread. Rarely do they kill. They can be treated with scraping, drying by electric current, freezing and the Mohs’ technique.

You can trust your clinic doctor’s judgment. Why do you say that one cancer is metastasizing (spreading)? The doctor must not think so.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com