FOR SKIN CANCER
After the biopsy has been taken and pathology results are known, several treatment options are considered to definitively remove the skin cancer. Factors taken into consideration when recommending a certain treatment include the subtype, size, location, tumor depth, patient’s general health and cosmetic outcome.
- Mohs Micrographic Surgery: Mohs micrographic surgery is the most advanced, precise and effective treatment for most types of skin cancer. It is an outpatient surgical procedure, performed under local anesthesia, to remove skin cancer, one layer, or stage, at a time. The tissue is immediately processed onto slides and stained, then examined under the microscope, to ensure healthy, cancer-free tissue is reached around the periphery and the base of the removed specimen. This is a tissue-sparing procedure, allowing the surgeon to remove the cancer completely, without sacrificing healthy skin. Because the Mohs surgeon is specially trained as a skin cancer surgeon, pathologist and reconstructive surgeon and the cancer margins are evaluated microscopically, Mohs surgery has the highest success rate of all the treatments – up to 99%. This surgery is indicated for skin cancers which are large, aggressively growing, recurrent or on high risk areas such as the face, ears, scalp and hands.
- Excision: A scalpel is used to remove the visible skin cancer and at least 2-3 mm of normal appearing skin either as a circular or elliptical specimen. This tissue is then sent to a dermatopathologist who examines the specimen on slides, under the microscope, to verify the skin cancer is completely removed in the sections examined. Sutures may be used for reconstruction
- Electrodesiccation and Curettage: The clinically evident and palpable tumor is removed, or scraped, using a circular blade called a curette. This is followed by electrodesiccation with a heated electrode to further remove tumor cells and cauterize small bleeding vessels. Two to three cycles are performed to remove the entire tumor, leading to a shallow wound, similar to a rugburn, which is allowed to heal on its own, without sutures. When performed by an experienced clinician, this procedure provides a high cure rate for small, shallow basal cell carcinomas and squamous cell carcinomas, especially on the back, chest, arms and legs.
- Imiquimod Cream: Imiquimod cream (Aldaratm) is a topical immune response modifier which is applied directly to the skin cancer and surrounding skin by the patient five days per week for several weeks. It helps the body’s own immune system attack the abnormal cells, causing an inflammatory reaction and crusting, followed by healing as a smooth, depigmented patch. This provides a lower rate of cure than Mohs surgery, but is a great alternative for small, shallow skin cancers that are not located on the higher risk areas of the face and ears.
- Cryosurgery: Cryosurgery uses liquid nitrogen to “freeze” the affected lesion. It is impossible to determine the freeze temperature at the base of the skin cancer without a temperature probe, which limits its use and efficacy. Due to the lower cure rates for skin cancer, cryosurgery is usually reserved for surface scaling lesions called actinic keratoses, precursor lesions to squamous cell carcinoma.
- Oral Medications: Fortunately, advances are being made in dermatology through continual clinical trials, which provide us with new tools for treating skin cancer. A new medication, Erivedgetm (vismodegib), was recently FDA approved for the treatment of advanced basal cell carcinomas which are considered untreatable with surgery or radiation, have metastasized or recurred after surgery. This is a promising medication which is best utilized when all other treatment options have been exhausted.