Treatment Options for Skin Cancer
By: Julie Neville, MD, FAAD and Paul Massey, MD, MPH, FAAD
Treatment options for your skin cancer depend on various factors such as the type and stage of the cancer, as well as your overall health. Some common treatments include:
Surgery: According to national and international guidelines, surgery is the recommended treatment for skin cancer for most patients. The surgeon removes the cancerous tissue along with a margin of healthy skin and this tissue is examined under a microscope to ensure all the cancer cells are removed. All surgical treatments result in scar formation, some of which can be minimized by surgical technique. Types of surgery for skin cancer include:
Mohs surgery (microscopically controlled surgery) – This technique involves removing thin layers of skin containing the cancer cells and then examining them under a microscope while the patient waits in the office. This allows for the surgeon to examine all the edges and achieve a high cure rate while minimizing the healthy skin that is removed. Sutures are often placed to aid in the healing process.
Excisional surgery - The cancer is surgically removed and the tissue is sent to a laboratory for examination with the pathology results available in a few days. The area will typically be closed using sutures.
Radiation therapy: Radiation therapy uses energy rays to kill cancer cells and is typically reserved for patients for whom surgery is not the best option. This treatment is non-invasive but does require many (sometimes daily) treatments over several weeks and results in radiation damage to the treated skin. Side effects such as weakness and fatigue may occur. There is also no microscopic examination of the tissue to ensure all the cancer is removed. Radiation treatments can actually increase risk of future skin cancer and make future surgery difficult in treated areas due to skin damage. It generally is also more expensive than all other treatments.
Curettage and electrodessication – The tumor is scraped off the skin using a sharp curette and the area burned with an electric needle to destroy any remaining cancer cells. No tissue is sent for microscopic examination, and the wound is left to heal on its own.
Topical medications: For select superficial skin cancer types, topical creams containing chemotherapy drugs or immune system modifiers may be used to treat the cancer. These creams are used over several weeks and create an expected temporary redness to the area treated. This option is non-invasive and no microscopic examination of the tissue is performed.
Oral medications: For selected advanced skin cancers, oral chemotherapy medications may be recommended. These medications may shrink or reduce the cancer but often do not result in a permanent cure. Side effects may also be significant, including hair loss, nausea, diarrhea and muscle cramps.
Your provider will select the option they feel would be best to treat your skin cancer, but please discuss it with them if you would like to review your treatment options.