How do dermatologists treat skin cancer?

There are many treatments for skin cancer. Dr. Catherine Balestra will discuss treatment with you after considering the following:

• Type of skin cancer
• Where the skin cancer appears on the body
• Whether the skin cancer is aggressive
• Stage of the cancer (how deeply the skin cancer has grown and whether it has spread)
• Patient’s health

After considering the above, Dr. Balestra will recommend 1 or more of the following treatments for skin cancer.

Surgical treatment options:
When treating skin cancer, the goal is to remove all of the cancer. When the cancer has not spread, this is often possible. To remove skin cancer, the following surgical treatment may be used:

Excision:
To perform this, the dermatologist numbs the skin and then surgically cuts out the skin cancer and a small amount of normal-looking skin. This normal-looking skin is called a margin. There are different types of excision. Most excisions can be performed in a dermatologist’s office.

Mohs surgery:
Mohs surgery can only be performed by a dermatologist like Dr. Catherine Balestra who has completed additional extensive surgical training in Mohs surgery and has the title of Mohs surgeon.

Mohs surgery begins with Dr. Balestra removing the visible part of the skin cancer. Because cancer cells are not visible to the naked eye, she also needs to remove a small amount of normal appearing skin to check if it contains cancer cells.

This part of the surgery is performed one layer at a time. After removing a layer of skin, it is prepared so that Dr. Balestra can examine it under a microscope and look for cancer cells. If she sees cancer cells, Dr. Balestra removes another layer of skin. This layer-by-layer approach continues until the surgeon no longer finds cancer cells. In most cases, Mohs surgery can be completed within a day or less, often within 3 hours. The cure rate for skin cancer is extremely high when Mohs surgery is used.

Curettage and electrodessication:
This surgical procedure may be used to treat small basal cell and squamous cell skin cancers.

It involves scraping the tumor with a curette (a surgical instrument shaped like a long spoon) and then using an electric needle to gently cauterize (burn) the remaining cancer cells and some normal-looking tissue. This scraping and cauterizing process is typically repeated 3 times. The wound tends to heal without stitches.

Non-surgical treatment options:
Surgical treatment is not right for every case of skin cancer. Some patients cannot undergo surgery. Sometimes, surgery cannot remove all of the cancer, and more treatment is used to help get rid of the cancer. If the skin cancer is caught very early, surgery may not be necessary.

Immunotherapy:
This treatment uses the patient’s own immune system to fight the cancer. The patient applies a cream (generic name is imiquimod) to the skin as directed by the dermatologist.

Cryosurgery:
]The dermatologist freezes the skin cancer. Freezing destroys the treated area, causing the skin and cancer cells to slough off.

Chemotherapy applied to the skin:
The generic name for the medicine used in this treatment is 5-fluorouracil or 5-FU. The patient applies 5-FU to the skin cancer. It destroys the damaged skin cells. When the skin heals, new skin appears.

Chemotherapy:
If the cancer spreads beyond the skin, chemotherapy may kill the cancer cells. When a patient gets chemotherapy, the patient takes medicine. This medicine may be swallowed, injected (shots), or infused (given with an IV). The medicine travels throughout the body and kills the cancer cells. The medicine also destroys some normal cells. This can cause side effects, such as vomiting and hair loss. When chemotherapy stops, the side effects usually disappear.

Photodynamic therapy:
This treatment consists of 2 phases. First, a chemical is applied to the skin cancer. This chemical sits on the skin cancer for several hours. During the second phase, the skin cancer is exposed to a special light. This light destroys the cancer cells.

Radiation therapy:
Radiation may be used to treat older adults who have a large skin cancer, skin cancers that cover a large area, or a skin cancer that is difficult to surgically remove. Radiation therapy gradually destroys the cancer cells through repeat exposure to radiation. A patient may receive 15 to 30 treatments. This treatment is often only recommended for older adults. Many years after a person is exposed to radiation, new skin cancer can develop.

Surgical and Non-surgical treatment content quoted from the American Academy of Dermatology web site: http://www.aad.org/dermatology-a-to-z