Treatment

	Skin Cancer: Latest Developments in the Prevention, Detection, and Treatment Runtime: 81 minutes

Squamous cell carcinomas that are small, superficial, have a well-defined edge, and have not been treated before are at low risk of spreading. There are numerous treatment options for low-risk squamous cell lesions and actinic keratoses. Many of these treatments, performed under a local anesthetic, destroy the lesion, but do not provide a skin sample for microscopic review.

Treatments for low-risk squamous cell carcinoma include:

• Surgery

  Surgery is an option for removing all types of squamous cell tumors. Surgical excision involves removing the tumor from the skin along with a "safety margin" (an extra amount) of normal skin to ensure that all cancer cells have been removed. The wound is then closed with sutures. Surgery is most effective for tumors with well-defined borders and can be performed virtually anywhere on the body. An advantage of surgery is that the tissue can be sent to a laboratory for microscopic evaluation by a pathologist, who will verify whether the entire tumor has been removed along with a sufficient safety margin.

• Curettage and electrodesiccation

  This is a highly effective treatment in which a surgeon uses a semi-sharp instrument with a spoon-shaped edge (called a curette) to scrape away cancerous tissue. The area is then treated with an electric needle to control bleeding and destroy any cancer cells that may remain around the edge of the wound. The wound usually heals within a few weeks. This procedure is sometimes performed to decrease the size of the tumor prior to Mohs surgery.

• Cryosurgery

  This treatment involves applying liquid nitrogen to freeze the abnormal tissue, which then sloughs off as the underlying skin heals.

• Laser Surgery

  Tumor tissue is vaporized with a highly focused beam of light. Because laser surgery only kills tumor cells on the surface of the skin, close follow-up is essential after therapy.

Other Treatment Options

• Photodynamic therapy

  This therapy is sometimes used to treat superficial tumors on the face and scalp. A strong light activates a photosensitizing chemical that is applied to the lesion, which destroys abnormal tissue while causing minimal damage to the surrounding skin.

• Topical chemotherapy with fluorouracil (also called 5-FU)

  Topical treatment targets damaged skin without touching surrounding normal tissues. Available in a cream or lotion, 5-FU is applied by the patient at home for about three to six weeks. The patient's skin may become irritated and red during treatment with 5-FU. Because topical chemotherapy does not kill cells under the surface of the skin, close follow-up is essential after therapy.

• Imiquimod, a topical lotion applied by the patient at home that causes local immune cells to attack abnormal tissue, may be used to treat actinic keratosis.

• Chemical peels also may be used to slough off actinic keratoses.

• Mohs Surgery

  For tumors with a high risk of recurrence, doctors at Memorial Sloan-Kettering offer a highly specialized technique called Mohs surgery. In this procedure, a surgeon removes tumor tissue surgically layer by layer, mapping and freezing each layer, and examining the tissue for tumor cells under a microscope before proceeding to the next layer. A 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, deep 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.

  Our doctors are evaluating a new, more efficient technique, called confocal reflectance microscopy, to rapidly image tissue removed during Mohs surgery. This technique may expedite the detection of remaining tumor cells without the need for complex frozen tissue processing.

Radiation Therapy

Radiation therapy with x-rays or high-energy particles can be useful for treating tumors in areas that are difficult to treat surgically, such as the eyelid, the tip of the nose, or the ear, or in patients who are at higher risk for surgical complications. Radiation is sometimes used after surgery to destroy tumor cells that may have been missed, or to treat tumors with a higher risk of recurrence. Radiation is usually delivered in small doses over a period of three to four weeks so as to avoid burning the skin. Radiation therapy is often reserved for older patients who cannot tolerate surgery.

Reconstruction After Surgery for Skin Cancer

Any form of surgery may leave a scar, some more noticeable than others. When removal of a squamous 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.