After a physician’s examination, a biopsy will be performed to confirm the diagnosis. This involves removing a piece of the affected tissue and examining it under a microscope. If tumor cells are present, treatment (usually surgery) is required. Fortunately, there are several effective ways to eradicate skin cancer. The choice of treatment is based on the type, size, location, and depth of penetration of the tumor, as well as the patient’s age and general state of health. Treatment can almost always be performed on an outpatient basis in a physician’s office or at a clinic. A local anesthetic is used during most procedures. Pain or discomfort is usually minimal with most techniques, and there is rarely much pain afterwards.
Curettage and Electrodesiccation
The growth is scraped off with a curette. This is an instrument used for scrapping the skin similar to a circular razor blade. The tumor site is desiccated (burned) with an electrocautery needle using an electrical current. When treating non-melanoma skin cancer the procedure is typically repeated a few times to help assure that all cancer cells are eliminated. Local anesthesia is required.
Along with the above procedure, this is one of the most common treatments for non-melanoma skin cancers. Using a scalpel, the physician removes the entire growth along with a surrounding border of apparently normal skin as a safety margin. The incision is closed, and the growth is sent to the laboratory to verify that all cancerous cells have been removed.
X-ray beams are directed at the tumor. Total destruction usually requires several treatments a week for a few weeks. This is ideal for tumors that are hard to manage surgically and for elderly patients who are in poor health.
Moh’s Micrographic Surgery
The physician removes the visible tumor with a curette or scalpel and then removes very thin layers of the remaining surrounding skin one layer at a time. Each layer is checked under a microscope, and the procedure is repeated until the last layer viewed is cancer-free. This technique has the highest cure rate and can save the greatest amount of healthy tissue. It is often used for tumors that have recurred or are in hard-to-treat places such as the head, neck, hands, and feet.
This is the most widely used treatment for individual actinic keratoses. It is especially useful when a limited number of lesions are present. Liquid nitrogen is applied to the growths with a cotton-tipped applicator or spray device. This freezes them without requiring any cutting or anesthesia. They subsequently blister becomes crusted and falls off. Some temporary redness and swelling can occur. In some patients, pigment may be lost.
The skin’s outer layer and variable amounts of deeper skin are removed using a carbon dioxide or erbium YAG laser. Lasers are effective for removing actinic cheilitis from the lips and actinic keratoses from the face and scalp. They give the physician good control over the depth of tissue removed, much like chemical peels. Lasers are also used as a secondary therapy when topical medications or other techniques are unsuccessful. However, local anesthesia may be required. The risks of scarring and pigment loss are slightly greater than with other techniques.
Photodynamic Therapy (PDT)
PDT can be especially useful for lesions on the face and scalp. Topical 5-aminolevulinic acid (5-ALA) is applied to the lesions at the physician’s office. As soon as an hour later, those medicated areas can be activated by a strong light. This treatment selectively destroys actinic keratoses and superfical non-melanoma skin cancers while causing minimal damage to surrounding normal tissue. Some redness and swelling can result from this newer therapy.
In addition to being used to treat actinic keratosis, Imaquimod and 5-Fluorouricil are approved for the treatment of superficial basal cell carcinomas. Imiquimod causes cells to produce interferon, a chemical that attacks cancerous and precancerous cells. 5-fluorouracil (5-FU) cream or solution, in concentrations from 0.5 to 5 percent, is the most widely used topical treatment for actinic keratoses. It works well on the face, ears, and neck. Some redness, swelling, and crusting may occur. An alternative treatment, a gel combining, hyaluronic acid and the anti-inflammatory drug diclofenac, also may prove effective.
This is used for the treatment of Actinic Keratoses. This method makes use of trichloroacetic acid (TCA) or a similar agent applied directly to the skin. The top skin layers slough off, usually replaced within seven days by new epidermis (the skin’s outermost layer). This technique requires local anesthesia and can cause temporary discoloration and irritation.