onceSkin cancer is the most common cancer in the United States. Basal Call Carcinoma (BCC), Squamous Cell Carcinoma (SCC) and Malignant Melanoma are the “big three” we see on an increasingly regular basis. BCC is by far the most common type ( approximately 80% of the cases) and has the best prognosis.
Treatments for skin cancer range from surgery to radiation to prescription topical creams and pills. Each skin cancer patient is encouraged to discuss all the options available for them, reviewing the success rates, the risks, the benefits, scar potential, etc.
Basic Treatment overview
Skin cancers can be excised (cut) with a standard rim of normal tissue with a high success rate. Typically, a routine skin cancer is excised with a 4mm rim of normal tissue and that piece of tissue is submitted to the lab for examination. At the lab, the tissue is examined to make sure the entire skin cancer has been removed but also to re-examine the tissue to make sure there are no other skin cancer types or unusual features.
Excising a skin cancer in an area where taking the smallest amount of skin but ensure complete removal is “margin control”. Moh’s technique and Frozen Section are two techniques of margin control. Moh’s is a technique pioneered by Dr. Moh’s many years ago whereby the dermatologist is both the surgeon and the pathologist checking the margins. Frozen section is a technique where the dermatologist or plastic surgeon is the surgeon and a pathologist or dermatopathologist acts as the pathologist to determine if the skin cancer has been completely removed. Both of these techniques have high cure rates with the goal of limiting how much tissue is removed. These techniques are typically used in the facial area, for large tumors, recurrent tumors, unusual/ aggressive tumors, etc. Once the skin cancer has been removed using margin control, then the area is repaired with sutures. Various repair techniques are used by the surgeon such as complex layered repair, flaps and grafts. The repair is individualized to the specific defect left from removing the skin cancer.
Radiation therapy has been utilized to treat skin cancer for decades. The success rates are very high and cosmetic results are usually fantastic. The down sides include numerous visits, lack of lab confirmation that the skin cancer is gone, pigment change and hair loss at the treatment site and if surgery is needed in the future, the radiation area makes surgery more difficult. There are different types of radiation. Radiation Oncologists are radiation experts and have elaborate, powerful machines available to treat skin cancers. SRT is a superficial type of radiation available for treatment of select non-melanoma skin cancers. The SRT machine is compact and delivers a much lower dose of radiation and is becoming more common place in dermatologist’s offices around the country. There are numerous advantages to radiation for treatment of non-melanoma skin cancers such as no cutting, no bleeding, no stitches, little to no pain, excellent cosmetic results, high cure rates approaching that of surgery and the convenience of having the procedure done in the office. Cost is comparable to surgery in many cases when using the SRT mode of radiation.
Pills- Erivedge (Vismodegib) is a prescription pill now available to treat advanced BCC. It’s a once a day pill and has been very impressive in it’s success rates. The pill is not for everyone with a BCC, but it has helped many patients with numerous BCC’s who don’t want or can’t have surgery.
Creams- There are numerous prescription creams available to treat certain superficial non-melanoma skin cancers. 5-fluorouracil and Imiquimod are the generic names and they can be used in many cases to treat skin cancers and also be used as adjuncts to improve success rates by treating the area of skin where the skin cancer was treated surgically.
Every patient and every skin cancer should be treated individually to do what is best for the patient. While surgery remains the most common form of treatment, radiation, prescription creams and pills afford other options in many cases. Patients should discuss all options available to them when deciding on what modality is best for them and their particular situation. Today we have an ever expanding array of treatment options so that the patient can be intimately involved in the decision making process.