Treatment of your Skin Cancer
Information on Diagnosis and Treatment Options
These are usually small white to skin-colored rough bumps on sun-exposed skin. They are considered the earliest form of squamous cell carcinoma. There is no way to determine which lesion will progress to be a full-fledged skin cancer; it is recommended that all these lesions be treated. Creams such as imiquimod or 5-flourouracil, liquid nitrogen, or curettage and desiccation are all options in the treatment of these common lesions.
Basal cell carcinoma
By far the most common type of skin cancer is basal cell carcinoma. These skin cancers arise from the base layer of cells in the skin. Basal cell carcinoma may come in many forms. It often begins as a small, pearly nodule. Fortunately, it is also the least dangerous kind--it tends to grow slowly and rarely spreads beyond its original site. Though basal cell carcinoma is seldom life threatening, if left untreated, it can grow deep beneath the skin and into the underlying tissue and bone, causing serious damage (particularly if it is located near the eye).
Squamous cell carcinoma
Squamous cell carcinoma is the next most common kind of skin cancer, frequently appearing on the lips, face, or ears, in areas of greatest sun-exposure. These cancers arise from the upper layers of cells in the skin. Squamous cell carcinoma may begin as a red, scaly patch, a group of crusted nodules, or a sore that will not heal, or has a bleed/heal/bleed cycle. It very rarely spreads to distant sites, including lymph nodes and internal organs. Squamous cell carcinoma can become life threatening if it is not treated.
Nevus with architectural disorder (formerly, dysplastic nevus)
These lesions have atypia (funny-looking cells) and are graded as mild, moderate or severe atypia. In the absence of a personal or family history of melanoma, mildly atypical lesions do not require excision, but those with severe atypia do. If I feel the clinical circumstances warrant it, complete excision may be recommended in spite of mild changes.
Atypical Melanocytic hyperplasia
These are lesions that have atypia (funny-looking cells) spreading throughout the epidermis, but fall short of being diagnosed as melanoma. They require complete excision.
Atypical Compound Nevus
An atypical compound nevus has atypia (funny-looking cells) of both epidermal and intradermal components, but is not yet considered melanoma. These lesions are unpredictable and can progress to melanoma. Complete removal is recommended.
A third form of skin cancer, melanoma, is the least common, but its incidence is increasing rapidly, especially in the Sunbelt states. These deadly skin cancers arise from the color cells in the skin. Melanoma is often asymmetrical, with blurred or ragged edges and mottled colors. It can be found on both sun-exposed and sun-protected skin, and can sometimes have no color at all. Melanoma is also the most dangerous type of skin cancer. If discovered early enough, it can be completely cured. If it is not treated quickly, however, melanoma may spread throughout the body and can be fatal.
Discussing your options
All of the treatments mentioned below, when chosen carefully and appropriately, have good cure rates. Even melanoma can be removed completely, especially if it is caught early, before it has had a chance to spread. However, all patients who have had a skin cancer should consider themselves at higher risk for more. Vigilance should always be maintained.
Imiquimod (Aldara, Zyclara, others) and 5 Fluorouracil (Efudex, Carac, Fluroplex, others) Topical Therapy
These creams are FDA-approved from the treatment of both actinic keratoses and thin, superficial skin cancers. When applied to the skin, they boost the immune system in the area and destroy the cancerous tissue. You will need to apply it 1-2 times a day for up to 8 weeks. The results of this treatment, when successful, are often cosmetically superior to surgery.
CURE RATE: ~85% COSMETIC RESULT: EXCELLENT
Curettage and desiccation
If the cancer is small, curettage and desiccation may be performed. In this procedure the cancer is scraped out, and an electric current is used to control bleeding and kill any remaining cancer cells. This leaves a circular white scar that is slightly larger than the original lesion.
CURE RATE: ~82% COSMETIC RESULT: CAN BE EXCELLENT IN CERTAIN BODY AREAS
Excision and closure
Most skin cancers are removed surgically. If the cancer is small, the procedure can be done quickly and easily, in the office, using local anesthesia. The procedure may be a simple excision closed with sutures, which usually leaves a thin, barely visible scar. For larger lesions, tissue advancement, movement or flaps may be required.
CURE RATE: ~95% COSMETIC RESULT: DEPENDS ON MANY VARIABLES
MOHS Micrographic Surgery
This is a special procedure performed only by specially trained dermatologic surgeons in which the cancer is shaved off one layer at a time. The tissue is examined immediately while you are in the office. This enables the surgeon to remove all of the cancerous tissue while leaving as much normal tissue in place as possible. It often requires a reconstructive procedure to repair the defect left after the cancer is removed. This option is appropriate for lesions in difficult-to-reconstruct areas, recurrent lesions, or those skin cancers where the borders are indistinct.
CURE RATE: ~96% COSMETIC RESULT: DEPENDS ON MANY FACTORS
This treatment uses very superficial x-rays to destroy the cancerous cells. It is appropriate for more mature patients, or those with aggressive or recurrent cancers.
CURE RATE: 90-95% COSMETIC RESULT: EXCELLENT
Other possible treatments for skin cancer include cryosurgery (freezing the cancer cells), injectable interferon.
A word about reconstruction
The different techniques used in treating skin cancers can be life saving, but they may leave a patient with less than pleasing cosmetic or functional results. Depending on the location and severity of the cancer, the consequences may range from a small but unsightly scar to permanent changes in facial structures such as your nose, ear, or lip.
Detecting a recurrence
After you've been treated for skin cancer, you should adhere to the regular follow-up visits recommended, to make sure the cancer hasn't recurred (come back).
Your physician, however, can't prevent a recurrence. It's up to you to reduce your risks by changing old habits and developing new ones. (These preventive measures apply to people who have not had skin cancer as well.)
- Avoid prolonged exposure to the sun, especially between 10 a.m. and 2 p.m. and during the summer months. Remember that ultraviolet rays pass right through water and clouds, and reflect off sand and snow.
- When you do go out for an extended period of time, wear protective clothing such as wide brimmed hats and long sleeves.
- On any exposed skin, use a sunscreen with an SPF (sun protection factor) of at least 15. Reapply it frequently, especially after you've been swimming or sweating.
- Consider taking HELIOCARE, a dietary supplement able to reduce or eliminate the harmful effects of exposure. It won't eliminate sunscreen, but help it do a better job. We recommend one capsule with breakfast per day. It is as close to Sunscreen in a Pill as we have today.
- Finally, examine your skin regularly; if you find anything suspicious, return for an evaluation as soon as possible. It is extremely important to have a full body skin examination at least once a year. If you haven't scheduled this potentially life saving visit, do it now.