A skin biopsy is the definitive tool to diagnose skin cancer. Once you receive a diagnosis the choice of treatments will depend on the type of cancer, the size, location and depth of the tumor. Other considerations are your age, health, and the effect of the treatment on your appearance. Most treatments can be performed in an office or outpatient facility under local anesthesia.
Excisional Surgical not an excisional biopsy
The gold standard treatment is surgical excision for basal cell and squamous cell carcinoma and for some thin melanomas. Under local anesthesia, the tumor is cut out with a surgical knife along with a wide margin of normal skin. The wound is closed with stitches. There will be a scar. The excised tissue is examined at a lab to assure that all cancerous cells have been removed. If the lab reports that cancer cells still exist, a second procedure will be necessary. Cure rates are close to 97%.
Curettage and Electrodessication
For small superficial basal cell and squamous cell tumors, the growth is scrapped off and then burned with an electrocautery needle to kill any remaining cancer cells. It will leave a small whitish scar. This procedure may need to be repeated to assure all cancer cells are removed.
Mohs surgery is recommended for the removal of melanomas and for BCC and SCC tumors and reduces the risk of recurrence. Mohs surgery is microscopic surgery recommended when:
- there is a significant risk the cancer can spread or reoccur
- it is difficult to determine the extent of the cancer
- when the tumor is an area where excision can cause disfiguration, and
- when the goal is to save as much healthy skin as possible such as when the tumor is on the face, eyes, lips and nose.
Mohs surgery requires specialized training. The procedure involves the removal of thin layers of the tumor, which are examined under a microscope to see if any cancer cells remain. This is repeated until the sample is free of cancer cells. While Mohs surgery takes several hours, the result is the preservation of healthy skin and an almost invisible scar.
Lymph node dissection
Melanoma first spreads to nearby lymph nodes. Lymph node dissection is a surgical procedure to remove lymph nodes near a melanoma that are abnormal. Other melanoma treatments include Immunotherapy, targeted drug therapy, chemotherapy and radiation.
Localized treatments for BCC and SCC
Cryotherapy is freezing the tumor that is also commonly used for precancerous conditions like actinic keratosis and small and superficial tumors. The tumor is frozen, and the cancer cells are killed using with liquid nitrogen. Repeated freezing may be necessary. 20-50% of patients experience side effects including pain, blisters, and the potential for hypopigmentation and scarring. An additional disadvantage is the inability to assure that all cancerous tissues have been removed.
There are a variety of topical treatments including topical drugs and photodynamic therapy (PDT). Topical chemotherapy drugs are used to kill cancer cells.
PDT is best for treating precancerous lesions. A special drug is applied to the skin and collects in the tumor cells for several days making them sensitive to certain types of light. Then the light is applied to kill the cancer cells.
Topical therapies are reserved for low-risk superficial tumors that doesn’t extend deep into the skin. The advantages of PDT and topical drugs are that they do not cause scarring and can treat wide areas of superficial BCC.
A significant disadvantage of these topical treatments is the inability to assure that all cancerous tissues have been removed, because these treatments are limited in that they can reach deep in the skin. In addition, topical photodynamic therapy (PDT) causes pain during the procedure and inflammation including redness, erosions, pustules and crusts that last for 1-2 weeks.
When the tumor is not able to be removed surgically or the tumor is large or in an area difficult to reach, or the patient has other medical problems and cannot undergo surgery, radiation therapy may be recommended. Radiation therapy can cure small tumors. It may be combined with surgery to assure that all cancer cells have been killed.
When you have been diagnosed with skin cancer, you want a surgeon who will assure you receive the correct treatment for you. Dr. Sedrak is a board-certified, fellowship trained dermatologist and MOHs surgeon. At the Texas Skin Cancer Center with offices in Houston, Kingwood and Sugarland, Texas you will always receive private, respectful and compassionate care in a state-of-the-art facility. Contact Texas Skin Cancer Center to schedule a consultation today. Don’t wait. Early treatment can save you from disfigurement and suffering.