Surgery is the primary treatment for skin cancer, and chemotherapy, radiation therapy, and immunotherapy may be used in certain cases. Here are some of the procedures your doctor may recommend to treat skin cancer:
Your doctor will remove your tumor by removing progressively wider areas of skin around the skin cancer and examining them under a microscope for cancer cells. Your doctor will keep removing wider or deeper layers until no more cancer cells are present. This procedure allows your doctor to remove as little healthy skin as possible to minimize discomfort and scarring while still confirming that the entire lesion has been removed. This procedure is often used to remove skin cancers on the face.
Electrodessication & curettage
This procedure is sometimes called “scraping and burning.” Your doctor will use a surgical instrument called a curette to scrape the tumor from your skin. Your doctor will then deliver an electrical current to the tumor bed to stop any bleeding and kill any remaining cancer cells. Your doctor may then repeat this process anywhere from one to three times.
Your doctor will use an instrument to spray the tumor with liquid nitrogen in order to freeze and destroy it. Your doctor may repeat this process multiple times or combine it with other treatments to destroy all the cancer. This procedure is minimally invasive and allows your doctor to treat the cancer with little damage to healthy tissue.
Your doctor will use a narrow, intense beam of light to remove and/or destroy your tumor. Your doctor may remove the tumor layer-by-layer, depending on its depth. This is a very precise procedure that is easy to control without much damage to healthy tissue.
Your surgeon will use a surgical knife to remove the tumor and a margin of healthy skin around it. Small excisions are often closed with simple stitches, while larger excision sites, if they cannot be closed with simple stitches, may require closing by rotating in adjacent normal tissue, by skin grafting (taking either partial or full thickness skin from another part of the body), or left to heal on their own (delayed seconday intention healing). Your doctor will discuss all of these options with you, and if the repair is very large or complex, may enlist the assistance of a plastic surgeon.
External beam radiation therapy uses waves of high energy rays to target and kill cancer cells. In external beam radiation, a large machine delivers radiation to your tumor from outside the body. Your doctor may recommend radiation therapy to treat areas that are hard to perform surgery on, such as the eyelids, nose, and ears. Your doctor may also recommend radiation therapy after surgery in order to destroy any remaining cancer cells.
Chemotherapy is the use of drugs to target rapidly growing cells in an effort to destroy cancer cells. Chemotherapy medications may be given through the vein (intravenously) or by mouth (orally). Doctors commonly use chemotherapy to treat more advanced stages of skin cancer that have spread beyond the skin to other parts of the body. Your doctor may also recommend chemoprevention therapy, which is the use of certain drugs to prevent the development of cancer. The use of Vitamin B (such as B3 Nicotinamide) has been shown to have protective effects against damage caused by Ultraviolet sun exposure. Your doctor may suggest using Vitamin B to aid in chemopreventation therapy.
Immunotherapy stimulates the body’s immune system and helps it fight cancer cells. It stimulates the body’s natural defense system. Immunotherapy may be administered topically, applying a cream directly on to the tumor to stimulate the local skin’s immune system to destroy the cancer. This is an option for very superficial skin cancers. Immunotherapy may be used to treat advanced stage skin cancer. There are several immunotherapy drugs that either stimulate your entire immune system, or your immune system response to skin cancer cells.
The term targeted therapy means that the treatment primarily affects genetic vulnerabilities in cancer cells. Unlike conventional chemotherapy, targeted therapy does not attack all rapidly dividing cells in the body. Targeted therapy is intended to stop the growth of cancer cells by interfering with signals that cause the cancer to grow or continue to live. Targeted therapy does not work in all cases (primary resistance) or may work for some period and then stop working (acquired resistance).
Basal cell carcinomas often have genetic mutations in the hedgehog signaling pathway, which can cause the cancer to grow more aggressively. One form of targeted therapy, hedgehog pathway inhibitors, blocks these signals. Hedgehog pathway inhibitors may be recommended in patients with locally advanced basal cell carcinomas, basal cell carcinomas that have recurred after surgery or radiation therapy, metastatic basal cell carcinoma (very rare), or in patients who are not candidates for surgery or radiation therapy.
Photodynamic therapy is rarely used to treat skin cancer. Your doctor injects a drug into your bloodstream that collects in the cancer cells. Your doctor than aims a laser at the cells, which activates the drug and signals it to kill the cancer cells.
Clinical trials allow patients to try a new treatment before it is approved by the FDA for use by the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.