Treatment Options for Skin Cancer
Many methods are available for the treatment of skin cancer. Traditional therapies include surgery; cryosurgery, the application of extreme cold for the purpose of tissue destruction; radiotherapy; and electrodessication, the drying out and destruction of diseased tissue by an electrical current, accompanied by curettage (cleaning out). Other methodssuch as chemotherapy, immunotherapy, and vaccine therapyare useful for patients with specific clinical situations.
Basal Cell and Squamous Cell Carcinoma Treatment
Skin Cancer Surgery
Luckily, most basal cell and squamous cell carcinomas can be cured by surgical removal of the tumor. Many forms of surgery are available, depending upon the type and size of the tumor, its location on the body, and other factors. In general, the surgical treatments for basal cell and squamous cell carcinomas consist of the following:
- Simple ExcisionDuring this procedure, the cancer is excised, or cut away, along with a small amount of healthy surrounding skin known as the surgical margin. The resulting wound then is sewn up, and no further treatment is necessary. Surgical excision usually leaves a scar. Roughly 10 percent of small tumors will return, as will roughly 25 percent of larger tumors.
- Moh's SurgeryThis is a microscopically controlled form of excisional surgery. The physician begins by removing a layer of skin and mapping it in relation to the underlying site. The skin sample is checked under a microscope for the presence of cancer cells. Additional tissue is cut away from areas where tumor cells are found until all samples are free of cancer cells. Although this method is slow, it preserves the healthy tissue near a tumor and leads to better cosmetic results and better cure rates (about 96 percent) after surgery. This technique is especially useful for treating large tumors and tumors in hard-to-treat locations, such as the eyelids, ears, forehead, scalp, fingers, and genital regions.
- Laser SurgeryThis technique employs a beam of extremely focused light of various frequencies. When applied at close range, it is able to generate heat and vaporize targeted cancer cells. Laser surgery has been used successfully in some forms of basal cell carcinoma and for squamous carcinoma in situ (nonspreading, confined squamous cell carcinoma) that have not penetrated into the lower layers of the skin. Laser therapy does not destroy cancer cells within the deep layers of the skin.
- Electrodessication and CurettageDuring this procedure, the surgeon "cleans" the area by peeling away cancer cells with a slim instrument known as a curette. Next, an electrical needle is used to kill any remaining cancer cells by dessication (drying up). Electrodessication and curettage usually leaves a scar.
- CryosurgeryCryosurgery uses extremely cold temperatures to kill cancer cells. During this procedure, liquid nitrogen is applied to freeze the tumor tissue. After the cancer cells are killed and the tissue has thawed, the wound eventually heals within 3 to 4 weeks, although some blistering and crusting may take place. Following cryosurgery, scarring may occur, and the affected tissue may have less color. This method is not recommended for large tumors or for tumors on the eyelids, nose, ears, scalp or legs.
- Reconstructive SurgeryIf the skin cancer is very large, the edges of the surgical wound may not "stretch" to meet each other for suturing (surgical stitching). Such cases may require skin grafts (patches of skin removed from other areas of the body or from skin cultures) or other forms of reconstruction. This type of surgery will help to "close" defects, replace tissue, and renew the appearance of the skin where the tumor occurred.
- Lymph Node DissectionIn some individuals, the lymph node(s) near a cancer may appear enlarged, hard, or otherwise suspicious of metastasis (cancer spread). In such cases, the physician may want to perform a biopsy and/or surgical removal of the nearby lymph nodes.
Chemotherapy to Treat Skin Cancer
If surgery does not completely eliminate the basal cell or squamous cell carcinoma, other treatments are available, including chemotherapy.
- Topical chemotherapychemotherapy that is applied directly to the skin surfacemay be useful for some precancerous skin conditions (e.g., actinic keratosis) that have not penetrated the deep skin layers or spread to other organs. The chemotherapeutic drug 5-flurouracil (5-FU) is produced in cream form and may be used for this purpose. Topical chemotherapy does not affect organs other than the skin and therefore does not produce the side effects associated with systemic (whole-body) chemotherapy. The direct effects of topical chemotherapy include skin redness, irritation, and sun-sensitivity. Skin medications and physical protection from the sun can manage these effects after treatment.
- Photochemotherapytreatment with drugs that react to lightmay serve as a substitute for the surgical removal of some non-melanoma skin cancers. For example, Foscan (meta-tetrahydroxyphenylchlorin, "mTHPC") - a drug that is given intravenously (through a vein) - may be used with laser light therapy to kill skin cancer cells. Other photochemotherapy drugs include aminolevulinic acid and hypericin (drugs that are applied to the skin before light exposure), as well as psoralen, a drug that is given orally (by mouth) and used with ultraviolet A radiation ("PUVA" therapy). The cure rates for some chemotherapy treatments are very promising (in the 90 percent range), and cosmetic results may be better than those achieved with surgery.
- Systemic (whole-body) chemotherapy is a treatment alternative for basal cell or squamous cell carcinomas that have metastasized (spread) to the lymph nodes or to distant organs. Some of the drugs used for systemic chemotherapy include cisplatin, doxorubicin (Adriamycin®), mitomycin, and 5-fluorouracil (5-FU). These medications may slow the spread of cancer and provide some relief from symptoms, though systemic chemotherapy (alone or combined with other treatments) usually does not cure widespread, metastatic skin cancer.
Radiotherapy (Radiation Therapy) to Treat Skin Cancer
Radiotherapy is a good choice for the care of older patients and for individuals who have basal cell or squamous cell carcinomas in hard-to-treat areas such as the eyelids, nose, or ears. Radiotherapy also is more suitable for recurrent (returning) tumors and for large or deep tumors that might otherwise require extensive reconstructive surgery.
Biological Therapies to Treat Skin Cancer
Some researchers have reported tumor shrinkage and/or disappearance after injecting the lesion with interferon, a cytokine (protein) that activates the immune system. It increases the immune response and reduces tumor cell growth and reproduction in some individuals with skin cancer. Unfortunately, the interferon cure rates are not yet equivalent to those of other therapies. Interferon therapy may produce side effects such as fevers, shivers, muscle aches, bone pain, headaches, concentration difficulties, fatigue, nausea, vomiting, and general flu-like symptoms. These symptoms usually are temporary and improve after therapy is completed.
Prevention of Skin Cancer
The best way to prevent skin cancer is to avoid sunbathing and tanning salons. When you must have prolonged exposure to the sun, wear sunscreen. Make sure to check all skin lesions. If you detect any change in a mole or skin lesion, or if you are even mildly suspicious about the appearance of one, see your doctor promptly.