Hi everyone. Today, I would like to discuss how skin cancers are treated. It has been my experience that many people know little about treatment options beyond surgical excision. Hopefully this will shed some light on something I consider to be an important topic.
The treatment plan for skin cancer is determined by the type of tumor, the size and body site of the tumor, the depth of penetration into the skin, and the individual in which it occurs. Basal cell carcinoma and squamous cell carcinoma are the most common types of skin cancer and can be treated by one of several modalities. Most commonly, exision with a 4 mm margin of normal skin around the clinically visible tumor is performed. Excision with 4 mm margin results in 95% cure rate and the excised tumor is sent to a pathologist to ascertain that the margins are clear and tumor has been completely removed. Mohs micrographic surgery is reserved for tumors on the face or very large or recurrent tumors. However, many tumors do not penetrate very deeply into the skin and can be treated with a destructive modality known as “curettage and electrodessication.” In this method, the tumor is curetted with a very sharp instrument and then “burned” with electricity. No stitches are placed and no specimen is sent for pathology. This also has approximately a 90% cure rate when appropriately used for tumors that do not penetrate deeply. More recently, topical creams have been used to treat superficial forms of basal cell carcinoma and squamous cell carcinoma. 5-fluorouracil and imiquimod are two creams which have been shown to effectively clear superficial skin cancer when used daily for several months. While the cure rate is not as high as surgical excision, this remains a viable option for a patient who is not a good surgical candidate. Radiation is not commonly used but can be an effective treatment.
Melanoma is a very deadly form of skin cancer due to its high rate of metastasis. Melanoma is best treated with surgical excision with larger margins determined by the thickness of the tumor. The topical creams have been tried for melanoma in patients who cannot undergo surgery. The cure rates are much lower than those for surgical excision but may be an option for specific patients. Sentinel lymph node biopsy is often performed when a melanoma greater than 1 mm in depth is excised. In this procedure, the nearest lymph node to the cancer is removed and examined for metastatic melanoma. The rationale for this procedure is that this first lymph node would be the first region of metastasis and serves as a marker for metastatic potential of a tumor. Thus, a sentinel lymph node free of cancer indicates that the melanoma is not spreading and limited only to the skin. There are other chemotherapeutic options for advanced melanoma, but these treatments are not very effective overall.
Always speak with your dermatologist about the options available for you specific skin cancer.
Published On: August 11, 2006