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Treatment of Skin Cancer
Early detection and treatment of skin cancers will result in a cure in the majority of cases. Malignant Melanomas (MMs) require surgical excision and must always be sent for pathology testing (microscopic examination). They should not be 'burnt' or 'frozen'.
For BCCs and SCCs the type of tumour, site, size and stage of its development will influence the choice of treatment.
Your doctor or dermatologist can discuss the most appropriate options with you.
Curette and Cautery
This procedure is ideal for superficial BCCs. The tumour is scraped away from the underlying tissue with a surgical curette. The base is then cauterised to destroy any remaining tumour tissue and to stop bleeding. The wound heals to leave a flat, slightly depigmented scar and the cosmetic outcome is excellent most of the time. The cure rate is over 90% when the procedure is performed by a specialist dermatologist.
Surgical Excision
This technique, cutting out the tumour, can be used for many BCCs, SCCs and melanomas. This procedure may produce a more cosmetically acceptable linear scar when compared to the flat scar resulting from curette and cautery. Surgical excision also has a cure rate of over 90%.
Moh's Micrographic Surgery
This is a surgical technique for treating large, deep and recurrent skin cancers, as well as some skin cancers in difficult areas such as the corner of the eye. The tumour is surgically removed, processed and microscopically evaluated. Using careful mapping techniques, the dermatologist returns to the patient to remove any remaining tumour. The process is repeated until only normal cells remain. The cure rate is 98% but this procedure is performed on less than 1% of BCC cases. As with ordinary excision techniques, a skin graft or skin flap may be needed to close the larger wounds
Cryosurgery
Liquid nitrogen is sprayed onto the tumour to freeze it to -20º C to -40º C, the point where the tissue dies. This process may be continued in a series of freeze-thaw cycles until the tumour has been completely destroyed. Cryosurgery is generally limited to smaller tumours.
The cure rate is again better than 90%, and may give better cosmetic results than curette and cautery.
Although an apparently simple technique, cryosurgery requires a great deal of training and experience on the part of your dermatologist.
Radiation
High energy radiation is generally reserved for lesions not easily treated by surgery, curette excision or cryosurgery, especially those tumours in difficult areas of the face or in older patients. Cure rates are comparable to those of surgery and curette/cautery. Following healing of the radiation wound, the cosmetic result is excellent but there is some deterioration of the scar with time, and after 10 to 15 years a mottling at the treatment site often occurs.
Photodynamic Therapy (PDT)
PDT is a treatment option where a photosensitising cream is applied to the site of your skin cancer and then light is shone on that area. This light interacts with the cream and destroys the cancerous cells. This procedure may well need to be repeated some two to four weeks after the original procedure. Cure rates vary between 75% and 90% and the cosmetic outcome following this treatment is usually very good
Imiquimod
Imiquimod is a cream which stimulates the body’s own immune system to attack and destroy the skin cancer. This cream is usually applied by the patient five to seven times a week for a period of six weeks. Cure rates vary between 75% and 90% and usually there is an excellent cosmetic result.
Follow-up and Subsequent Management
This depends on the type of tumour and the nature of the treatment.
Your doctor will advise you, but if you have had one skin cancer you may get others, and regular review of your skin is advisable.
NEXT: How To check your own skin and your family's skin for skin cancer and melanoma.
Acknowledgement
This information is based on a publication of the Australasian College of Dermatologists.
Last Modified 1 October, 2004 Dr John R Sullivan / © 2004 Australasian College of Dermatologists
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