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Skin Cancer: Treatment

Jessica Evert, MD, edited by Benjamin McDonald, MD

operating roomThere are multiple methods available for treating skin cancer. Your doctor will work to match a set of treatments to your individual needs, taking into account factors such as the degree to which your skin cancer has grown, whether your skin cancer has metastasized, and your general health.

Surgery is a primary method for treating skin cancers. There are different surgical approaches surgeons may choose based on the type of skin cancer you have:

Simple Excision. During simple excision a skin cancer tumor and a little adjacent healthy tissue is removed with a surgical knife. The incision is then sewn back together. Incisions are generally small, necessitating only local anesthetic be used. This procedure, which may leave a scar, is appropriate for treating both melanoma and non-melanoma forms of skin cancer.

Curettage with Electrodessication. During this procedure the tumor is scraped off using an instrument called a curette. After most of the tumor is scraped away the surrounding area is treated with an electrode (an electrically charged piece of metal) to kill any remaining cancer cells. The process may need to be repeated a few times, and often leaves a scar. It is most often used to treat small basal and squamous cell cancers.

Amputation. In some cases, if a melanoma skin tumor is on a finger or a toe, the doctor may call for surgical removal of that appendage. Amputations are no longer performed on whole arms or legs.

Cryosurgery. During cryosurgery cancerous cells are destroyed by freezing them with liquid nitrogen. This procedure may cause the skin in the treated area to blister and leave a scar. It often takes a few weeks for the wound to heal. Cryosurgery is used to treat small squamous and basal cell carcinomas.

Mohs Surgery. During this procedure the surgeon will remove a small layer of skin which he or she believes contains cancer cells. The sample is then checked immediately for cancer. If the doctor finds that the sample contains cancer then the doctor will remove another layer of skin and check the new sample for cancer. The process is repeated until the sample layer does not contain cancer. This process is slower than some of the other options but because it can save more healthy skin tissue than alternatives, it appeals to many patients.

Laser Surgery. During laser surgery the doctor aims a special laser beam at cancer cells to kill them. This surgery can only be used on skin cancers which are close to the surface of the skin. Laser surgery is a relatively new procedure.

Lymph Node Removal. During this procedure a surgeon will remove lymph nodes near the skin cancer to see if these nodes contain any cancer. Removed nodes are later examined under a microscope by a specialist to determine if they contain cancer. If the lymph nodes do contain cancer, then it is likely that the cancer has spread to other parts of the body.

Skin Grafting. During a skin graft, healthy skin sections are removed and used to cover over wounds created by prior skin cancer removals. Skin grafting procedures are useful in helping large surgical wounds that could not be stitched back together to heal properly. Skin grafts can also help reduce scarring and other appearance issues resulting from skin cancer surgery.

While each type of surgery is unique, they all share some common side effects. Light bleeding, pain, and tenderness around wounds and incisions are common. Your doctor can prescribe medication to ease any pain you may feel during the healing process.

A major side effect of most skin cancer surgeries is post-surgical scarring. Almost all of the skin cancer surgeries described above result in some form of scaring or other remnant of the procedure. To the extent you are concerned about scaring, talk to your doctor about the various pros and cons of different procedures to weight expected effectiveness against scaring risk. Be aware that though scarring may seem frightening, the procedures that cause these scars are designed to save your life.

Surgery is not appropriate as a treatment in all cases. General health concerns, and metastasized cancer scenarios can also compromise surgical treatment. Radiation therapy can be used as an adjunct to surgical treatments, or by itself when surgery is not appropriate. Radiation therapy involves the use of directional high energy radiation to kill cancer cells. While radiation alone can be used to cure small non-melanoma skin cancers, it generally can only slow down growth and symptom progression for more serious forms of skin cancer. Side effects of radiation therapy include irritation, redness and drying of the skin area.

Immunotherapy is a treatment that is commonly used with patients who have advanced melanoma. In immunotherapy patients are administered drugs that boost their immune response which in turn boosts their body's natural defenses against cancer. Though results of immunotherapy are typically modest, and do not often result in destruction of existing melanoma tumors, the effects do include slowing and shrinking of existing tumors which can result in symptom relief. Side effects of immunotherapy include fever, chills, fatigue, fluid retention, and achiness.