Treatment

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Treatments for Precancers

Cryosurgery is usually limited to actinic keratoses and smaller, superficial tumors. The surgeon uses liquid nitrogen to freeze the abnormal tissue, which then sloughs off as the underlying skin heals.

Topical fluorouracil (also called 5-FU) -- which the patient applies at home in a cream or lotion -- can be useful for removal of actinic keratoses and has also been used for some very superficial squamous cell carcinomas. 5-FU is a selective treatment that targets damaged skin without touching surrounding normal tissues. This topical chemotherapy can be particularly effective in treating widespread actinic keratosis. The treatment lasts about three to six weeks, during which time the treated skin can be irritated and red. Because topical chemotherapy does not kill cells under the surface of the skin, close follow up is essential after therapy.

	Flash Player is required to view this video. CancerSmart Web Cast March 22, 2007 -- Drs. Hadley Claire King, Kishwer Nehal, and Jedd Wolchok present "The latest developments in the screening and treatment of skin cancer." Total Run time: 55 minutes

Treatments for Squamous Cell Carcinoma

The following are treatments administered for patients with squamous cell carcinoma:

• Curettage and Electrodesiccation

  The surgeon uses a semi-sharp instrument with spoon-shaped edge (called a curette) to scrape away tumor tissue. Then the area is treated with an electric needle to control bleeding and destroy any cancer cells that remain around the edge of the wound. The wound usually heals within a few weeks. Use of curettage and electrodesiccation for squamous cell carcinomas is usually reserved for very small, very superficial, nonaggressive tumors. Because curettage and electrodesiccation destroys tissue, the procedure provides no tumor sample for examination by a pathologist.

• Radiation Therapy

  Sometimes treatments with x-rays or high-energy particles are used to kill skin cancers. Radiation therapy can be useful for tumors that are very large or in areas that are difficult to reach surgically (such as the eyelid, tip of the nose, or the ear). Radiation therapy may also be used when surgery poses a high risk for complications, such as when a patient has multiple medical problems in addition to cancer. Radiation is sometimes used after surgery to destroy tumor cells that may have been missed, and may also be used as an adjunct to surgery for cancers that have a high risk for recurrence. Because radiation exposure is also a risk factor for skin cancer many years after treatment, radiation therapy is not often used in young patients.

• Standard Excision

  The tumor is cut from the skin along with a "safety margin" of normal skin, and the wound is often closed with sutures. Excision is most effective for primary tumors with well-defined borders, and can be performed virtually anywhere on the body. An advantage is that the surgeon can send tissue obtained by excision for microscopic evaluation by a pathologist, who will verify that the entire tumor has been removed along with a sufficient safety margin.

• Mohs' Surgery

  In this highly specialized technique, a trained Mohs' surgeon removes tumor tissue surgically layer by layer, mapping each layer and examining the tissue layer for tumor cells under a microscope before proceeding to the next layer. An exquisitely precise, complex, and time-consuming process, Mohs' surgery ensures that the entire tumor is removed and minimizes scarring by preserving as much normal skin as possible. Mohs' surgery has the highest cure rate of all therapies for squamous cell carcinomas, and is particularly effective for large tumors, tumors that have recurred after other treatments, and tumors in areas (such as the face) that require preservation of as much normal skin as possible.

Reconstruction after Surgery for Skin Cancer

Any form of surgery may leave a scar, some more noticeable than others. When removal of a basal cell carcinoma leaves a wound that is too large to close with simple sutures, skin grafts and other reconstructive procedures can help heal the skin and restore its appearance.