By Dr Ananya Mandal, MD
Skin cancer treatment depends on the type and stage of the disease. It also depends on the size and location of the tumor and the medical condition and personal choice of the patient.
The aim of treatment is to remove the cancer completely. If detected early, skin cancers can be cured completely. In some cases the skin cancer can be removed completely during the biopsy. In such cases, no more treatment is needed.
Treatment options for skin cancers include surgery, chemotherapy, photodynamic therapy, radiation therapy and biological therapy.
Team of specialists
A team of specialists help plan and execute treatment of skin cancers. This includes:-
dermatologists (skin specialists)
oncologist (cancer specialist)
reconstructive or plastic surgeon
The surgeon removes the cancerous growth and includes some normal tissue surrounding it. This reduces the chance that cancer cells will be left behind after surgery. The surgical method depends on the type of cancer, its size and location. Some of the types of surgery include excisional skin surgery, moh’s surgery, cryosurgery etc.
Excisional skin surgery
Excisional skin surgery is a common treatment to remove any type of skin cancer. Local anesthesia is used to numb the area before operation. The tumor is then removed with a scalpel. The margin of skin is also removed and is examined under the microscope for spread of the cancer. Affected lymph nodes around the cancer are also removed to detect spread of the cancer.
Mohs micrographic surgery
Mohs micrographic surgery is often used for basal cell and squamous cell skin cancers. This is also performed under local anesthesia. The surgeon shaves off thin layers of the tumor. Every layer is examined under a microscope. The operation continues until no cancer cells are seen under the microscope. Radiation therapy may be prescribed after this surgery to kill off the remaining cancer cells.
Electrodesiccation and curettage
Electrodesiccation and curettage is used to remove a small basal cell or squamous cell skin cancer. After locally anesthetising the area the cancer is removed with a sharp tool shaped like a spoon (called a curette). Then a needle like electrode is used to send an electric current into the treated area to control bleeding and kill any cancer cells that may be left. This is a faster and simpler technique. It may be performed up to three times to remove all the cancer cells.
Cryosurgery can be used in early-stage or a very thin basal cell or squamous cell skin cancer. The cancer cells are killed using liquid nitrogen directly to the skin growth to freeze and kill the cancer cells.
If a large area of skin is removed a skin reconstruction is used. Skin from another part of the body may be used to replace the skin that was removed. Usually skin from over the belly or thighs is used for reconstruction.
This therapy uses anti-cancer drugs to kill off the cancer cells. It is usually used after surgery. Some of the anti-cancer agents may be applied directly over the skin. These are used in very thin, early-stage basal cell or squamous cell skin cancer. This may also be used if there are several small skin cancers.
The creams are to be applied one or two times a day for several weeks. Some of the drugs used in the creams include Fluorouracil or 5-FU. This is used to treat early-stage basal cell and squamous cell cancers. Imiquimod is another agent that is used to treat early-stage basal cell cancer.
Chemotherapy agents may also be given as pills or as injections. People with melanoma may receive chemotherapy in this manner. Chemotherapy is associated with several side effects like:
loss of appetite
loss of hair
lowered blood cells leading to anemia
propensity to get infections etc.
This uses high energy beams of radiation to kill the residual cancer cells after surgery. Radiation therapy is not a common treatment for skin cancer. It is used after surgery for squamous cell carcinoma when the cancer has spread to other organs.
Photodynamic therapy is a method of treatment that uses a drug along with a special light source, such as a laser light, to kill cancer cells. PDT is helpful in very thin, early-stage basal cell or squamous cell skin cancer. The chemotherapeutic agent is either rubbed into the skin or injected intravenously before light is applied. The drug becomes active and destroys the cancer cells as the light is focussed on the lesion.
This is useful in some patients with advanced melanoma. Biological therapy for melanoma may improve the immune response of the body against the cancer cells. Drugs used for biological therapy include Interferon. Interferon can slow the growth of melanoma cells. Another drug is called Interleukin-2. It can help the body destroy cancer cells.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)