50% of Americans who live to age 65 will be diagnosed with a skin cancer. The most common forms of skin cancer, basal cell carcinoma and squamous cell carcinoma, comprise over 90% of skin cancer diagnoses, but less than 5% of skin cancer related deaths. Most cases of skin cancer can be effectively treated if diagnosed and treated early. Thorough full body exams by your dermatologist can help catch and treat skin cancer early with very high cure rates. However, late diagnosis decreases the success rate of skin cancer treatments and can lead to more disfiguring outcomes. The form of treatment a dermatologist recommends depends on a number of factors, including the type of skin cancer, the size and location of the skin cancer, how far it has spread, and the overall health of the patient.
Mohs Micrographic Surgery
Mohs surgery is an in-office procedure, with a cure rate of 95-99%. It is the gold standard for treatment of high risk cancers, or those in cosmetically sensitive areas, such as the scalp, face, hands, and shins. A Mohs surgeon completes an extra year of training after dermatology residency in Mohs surgery, pathology, and reconstructive surgery. Mohs surgery is different than a typical excision, because it is tissue sparing. This means that the skin cancer is removed in stages with the small margins of normal skin around the cancer, until the cancer has been completely removed. The patient waits in between each stage while the surgeon examines each layer removed under a microscope, until the tissue examined under the microscope is cancer-free.
Electrodessication And Curettage
This treatment option is a good option for superficial cancers in low risk areas. It is done in the office, under local anesthesia. The cancer is scraped off the skin using a curette. An electrode is then used to burn the area, which stops the bleeding and destroys the remaining cancer cells. The procedure takes about 10-15 minutes, and the patient has a wound, similar to the biopsy site, that must be covered with Vaseline and a band-aid for about 1-2 weeks.
This involves the cancerous tissue being removed along with a margin of surrounding normal appearing skin. It is done in the office with local anesthesia, and the patient has stitches. The tissue is then sent to a lab to be examined under a microscope to ensure that all the cancer has been removed.
This treatment is usually chosen when a patient cannot undergo surgery, due to their age, health status or location of the tumor. Your dermatologist may also recommend it for large or high-risk cancers, to destroy cancerous tissue that is unable to be removed by surgery alone. This skin cancer treatment does not require any cutting or anesthesia. It is usually performed by a radiation oncologist. Radiation beams are directed at the site of the cancer. These beams destroy the cancerous tissue. This process requires multiple sessions, and the cure rates are not as high as other treatment options. There are short-term adverse effects, such as burning of the skin and change of skin pigmentation, and also long-term effects, such as increased risk of new skin cancers in the area exposed to radiation and delayed healing.
Photodynamic Therapy (a.k.a Blue Light)
Photodynamic therapy can be used to treat superficial skin cancers. The patient comes into the office, and a nurse or doctor applies a cream at the cancer site that makes cells sensitive to light. The cream is absorbed specifically in to cancerous and precancerous cells, as these are more active and absorb the medication more quickly. After 1-2 hours, the cream is activated by shining a blue light on the area. This kills the cancer cells and causes very little damage to the normal tissue surrounding it. Scarring is minimal, as there is no cutting. Because the cream makes the skin more sensitive to light, the area treated must not be exposed to any sunlight for 48 hours after the treatment.
Topical medications are FDA indicated for precancers and superficial skin cancers. There are 3 types of topical medication options – immunotherapy, chemotherapy, and ingenol mebutate. The patient applies the cream at home to the skin cancer for a few days or a few weeks, depending on the medication chosen by the dermatologist. Immunotherapy, such as Aldara, causes stimulation of the immune system. This stimulation helps the immune system kill the cancer cells. Chemotherapy, such as Efudex, destroys the cancer cells. This form of chemotherapy works externally and is applied to the skin only. Ingenol mebutate (Picato) is a newer form of topical medication for skin cancer treatment. It is only used for a few days compared to the others which are usually used for a few weeks. During the treatment with any topical option, the skin becomes inflamed, crusty and red for a couple weeks after the course is completed. After the scabs resolve, the underlying skin should be checked by your dermatologist to ensure the area is cancer-free.
If you would like more information regarding the various skin cancer treatment options, please contact Siperstein Dermatology Group.