Treatment Options
Many skin cancers that are detected early are able to be treated successfully with outpatient surgery. Sometimes nonsurgical procedures can be employed to treat precancerous lesions (called actinic keratoses) and very small nonmelanoma skin cancer that has not spread.
Topical chemotherapy creams may be used to shrink skin cancers on cosmetically sensitive areas before they are surgically removed. Skin cancer treatments can be used singly or in combination. The type of skin cancer, its size and location will guide treatment. Dr. Higgins will discuss your treatment options and tailor a plan that will best meet your needs.
Non-surgical options for localized skin cancer
- Cryosurgery – Cryotherapy is the use of liquid nitrogen to freeze and destroy abnormal cells while leaving the surrounding skin undamaged. It is used for precancerous lesions like actinic keratoses. It is an office procedure and may require several treatments. The treated area will turn red, swell, blister and a scab will form and fall off within 7-10 days. The treatment will likely not leave a scar, but the treated area may be a lighter color than the surrounding skin.
- Photodynamic Therapy (PDT) – Photodynamic therapy is a two-step, in-office treatment. A special photosensitizing (light-activated) topical medication is applied to the skin. This cream is preferentially absorbed by sun damaged skin cells. Then, a special light is applied that activates the cream to form oxygen which kills the sun damaged and precancerous cells. PDT can also be used to shrink or destroy tumors by damaging the tumor’s blood supply, and it can activate the immune system.
- Topical chemotherapy – Topical chemotherapy is the application of a cancer drug directly on the skin. The most common drug is 5-Fluorouracil (5-FU) which can treat actinic keratoses and small superficial basal and squamous cell carcinomas. The cream is applied several times a day for a few weeks. It will cause local redness and irritation and can cause side effects.
- Immune response modifiers – These are drugs that boost the immune system response against cancer and cause the cancer to shrink and disappear. It is used for actinic keratoses and some early basal cell cancers. It will cause local redness and irritation and can cause side effects. Imiquimod is the most commonly used drug.
- Chemical peels – A chemical called trichloroacetic acid (TCA) is applied to the skin to destroy sun damaged cells over a short period of time. This procedure is performed in the office, and it is only used to treat pre-cancerous actinic keratoses.
Surgical treatment options
- Surgical excision – small localized basal and squamous cell carcinomas can be removed with in-office surgery under local anesthesia. After the skin cancer is excised, small stitches will be placed to close the area for the best cosmetic result.
- Curettage and electrodessication. Curettage is the removal of cancer cells with a scraping instrument under local anesthesia. Electrodessication is the use of high-frequency electric current to destroy remaining cancer cells. This treatment method does not require stitches but takes a bit longer to heal.
- Mohs Micrographic surgery (Mohs) is a highly specialized surgical procedure where the individual layers of the tumor are removed one at a time and examined under a microscope. The procedure is done in stages, repeated layer by layer until there is no evidence of cancer cells. Mohs surgery requires specialized training and is used to spare as much normal tissue as possible to minimize scarring while providing a cure.
Other treatment options include radiation therapy, chemotherapy and retinoid therapy. These may be used singly or as an adjuvant treatment before or after surgery.
Basal Cell Carcinoma (BCC) Treatment Options
Localized BCC treatment options
- Excision
- Mohs
- Radiation therapy
- Curettage and electrodessication
- Topical Chemotherapy
- Topical Immunotherapy
Recurrent localized BCC treatment options include wide excision and Mohs surgery.
Metastasized BCC treatment options include targeted chemotherapy and sometimes surgical debulking or removal of tumors.
Squamous Cell Carcinoma (SCC) Treatment Options
Localized SCC treatment options
- Excision
- Mohs
- Radiation therapy
- Curettage and electrodessication – only for early stage, thin SCC (SCC in situ)
- Topical Chemotherapy – only for early stage, thin SCC (SCC in situ)
- Topical Immunotherapy – only for early stage, thin SCC (SCC in situ)
Recurrent Localized SCC treatment options include excision, Mohs and radiation therapy.
Metastasized SCC treatment options include surgical excision or debulking, chemotherapy, retinoid therapy, immunotherapy and possible enrollment in available clinical trials.
Melanoma Treatment Options
After melanoma has been diagnosed, tests will be done to determine the stage of the disease. Treatment options depend upon the stage of the disease. The stage is determined by the thickness of the tumor, whether it has spread to the lymph nodes or other parts of the body and other factors.
Generally, treatment options include:
- Surgery – Early, localized melanoma that has not spread to the regional lymph nodes may be treated with surgical excision alone.
- Chemotherapy
- Radiation Therapy
- Immunotherapy
- Targeted therapy is personalized cancer treatment designed to attack melanoma by inhibiting defective genes and molecules that play a role in the growth and spread of melanoma.
- Clinical trials
Dr. Heather Higgins has a toolbox of state-of-the-art options to treat your skin cancer, and the skills and experience to help you develop a treatment plan that best fits your needs.
