If caught in their early stages, all forms of skin cancer, including melanoma, respond well to treatment. Depending on the size, location and staging of a tumor, a number of different therapies may be recommended by your doctor. The prognosis for early stage basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) is very positive.
Surgical Excision. Surgical excision is the most common treatment for early stage basal cell or squamous cell carcinomas. Under local anesthetic, the tumor is surgically removed from the skin. If metastasis is not detected, surgical excision is often curative. Excision does leave a scar.
Mohs Surgery. Mohs surgery is a specialized form of surgical excision used if the physician is unsure of the depth or shape of the tumor beneath the skin. The procedure may also be used for large tumors, tumors that have returned after previous surgical removal or tumors that are in awkward locations for conventional surgery. A surgeon typically undergoes specialized training to perform Mohs surgery.
Instead of removing the entire tumor at once, the surgeon removes the cancer one layer at a time. The aim is to remove cancerous tissue while conserving as much of the healthy surrounding tissue as possible. After each level is removed, it is examined microscopically to determine whether further layers of tissue should be removed. This continues until the tumor is completely excised. Scarring depends primarily on the size and location of the tumor.
Electrodessication and Curettage. Both BCC and SCC may be treated by electrodessication and curettage (ED&C). Under local anesthetic, the cancer growth is “scooped” out using an instrument called a curette. The curette resembles a sharp spoon. Low-level electricity is used to kill cancer cells at the edges of the growth, and to control bleeding during the procedure. An ED&C leaves a flat white scar.
Radiation Therapy. Skin cancer responds well to radiation therapy, which uses a focused beam of radiation to kill cancer cells. Radiation therapy is often used to treat lesions on the ears, the eyelids and other areas where surgical removal would be impossible. Several weeks of treatment may be required to destroy all the cancer cells.
During the course of radiation therapy, rashes may develop, and the treated skin may become dry and appear red. After surgery, the area treated may be a different color from the rest of the skin. This color difference may become more pronounced with time.
Cryotherapy. Cryotherapy uses liquid nitrogen to freeze and kill pre-cancerous lesions and small tumors. As the lesion thaws, it separates from the body. More than one cryotherapy treatment may be necessary to completely remove the tumor.
The procedure does not usually cause any pain during the freezing. After the skin thaws, many people experience swelling and discomfort. A white scar remains after cryotherapy.
Topical Chemotherapy. Superficial forms of basal cell carcinoma may be treated with topical chemotherapy. Chemotherapy drugs destroy any fast-growing cells. A cream form of fluorouracil (5-FU) is applied to the lesion daily. By applying fluorouracil directly to the tumor, many side effects associated with chemotherapy can be avoided. However, the area treated will be severely inflamed for the course of the treatment.
Skin Grafting. Surgical removal of large skin cancer tumors may require a skin graft. A section of skin is removed from a healthy portion of the body, and used to seal the wound left after surgery.
Ongoing Research and Clinical Trials. Clinical trials are exploring other forms of skin cancer treatment. Photodynamic therapy, for instance, applies a chemical to the tumor that makes its cells sensitive to certain colors of laser light. When the cancer cells are exposed to laser light, the tumor begins to die.
Other clinical trials are investigating the use of retinoids, an artificial form of vitamin A, and interferon alpha, an immune system booster, to treat skin cancer metastasis. Retinoids are used to help stimulate the maturation of tumor cells into more “normal” looking cells. By stimulating the immune system, interferon alpha allows the body to better defend itself against further metastasis.
Paget’s Disease: Mastectomy Options. Paget’s disease requires specialized treatment. If the disease presents with breast cancer, or if Paget’s disease has spread into the breast, a modified radical mastectomy is performed. A mastectomy is the surgical removal of a breast.
In addition to the breast, a modified radical mastectomy removes lymph nodes from under the arm, the lining of the surrounding chest muscles and, occasionally, a portion of the chest muscles. Radiation therapy, chemotherapy or hormone therapy may be used in combination with mastectomy.
Clinical trials are examining the effectiveness of breast conservation techniques. If Paget’s disease has not spread beyond the area of the breast directly behind the nipple, the surgeon may remove only the nipple, the areola and breast tissue immediately under the nipple. Breast conservation techniques may be accompanied by radiation therapy to kill remaining cancer cells.