Surgery to Remove Skin Cancer
Surgery to treat skin cancer may be done in one of several ways. Quite often, it’s done by the dermatologist who diagnosed it. The surgical method your doctor uses depends on the size and place of the growth and other factors. Some of the more common surgeries include:
- Wide-local excision (WLE) or excisional skin surgery - The surgeon removes the growth, as well as a border of skin around the growth, with a scalpel. This skin, which is the margin, is examined under a microscope to be certain that all the cancer cells have been removed. The size of the margin depends on the size of the growth. Some of the lymph nodes may also be removed.
- Mohs surgery (also called Mohs micrographic surgery) - A specially trained surgeon shaves away thin layers of the growth after the area is numbed. Each layer is immediately examined under a microscope. The surgeon continues to shave away tissue until no cancer cells can be seen under the microscope. In this way, the surgeon can remove all the cancer and only a small bit of healthy tissue.
- Curettage and electrodesiccation - This procedure begins with the doctor numbing the area to be treated. The cancer is then removed with a sharp tool shaped like a spoon. This tool is a curette. An electric current is sent into the treated area to control bleeding and kill any cancer cells that may be left. Electrodesiccation and curettage is usually a fast and simple procedure.
Photodynamic Therapy
Photodynamic therapy (PDT) is a treatment that uses a chemical in combination with a special light source, such as a laser light, to destroy cancer cells. This chemical is known as a photosensitizing agent, which is either applied as a cream or injected into the body. It stays inside the cancer cells for a longer time than in healthy cells. After several hours or days, the special light is focused on the cancerous growth. At this point, the chemical becomes active and destroys the nearby cancer cells.
PDT is used to treat surface-level cancer or cancer that is very close to the surface of the skin. It’s usually performed by the dermatologist in their office.
Topical Chemotherapy for Skin Cancer
Chemotherapy is a treatment that uses anticancer drugs to either kill or prevent the division of skin cancer cells. For some non-melanoma skin cancers the drug is applied directly to the skin, called topical chemotherapy. This treatment is typically used when the skin cancer is too large to be removed through surgery or when new cancers keep appearing.
Topical chemotherapy typically involves the application of a cream or lotion to the affected area one or two times a day for several weeks. Basal cell and squamous cell cancers that are present only in the top layer of the skin can be treated with a drug called fluorouracil (5-FU). Basal cell cancer located only in the top layer of the skin can also be treated with a drug called imiquimod, which stimulates the immune system.
Systemic chemotherapy, given through a vein or in pill form, is less common for non-melanoma skin cancer.
Radiation Therapy for Skin Cancer
Radiation therapy (also called radiotherapy) uses high-energy x-rays or other types of radiation to kill cancer cells.
Radiation therapy may be used for skin cancer in areas where surgery could be difficult or leave a bad scar, such as the eyelid, ear, top of the head, or nose. It’s also recommended for patients who:
- Had surgery, but the doctor feels there could still be cancer cells in the area
- Have a larger area to be treated
- Had non-melanoma skin cancer return in the same spot
- Don't want surgery or are not able to be given general anesthesia
There are two types of radiation therapy for skin cancer: external beam radiation therapy (EBRT) and brachytherapy.
- External beam radiation therapy delivers beams of radiation from a machine outside the body to the precise location where the cancer is located or to the surgery site. Treatments last a few minutes each session, with treatment given five days a week for several weeks.
- High dose-rate brachytherapy involves placing the radiation source on top of the skin cancer for short periods of time. HDR brachytherapy can be used for basal cell or squamous cell skin cancers. An applicator is filled with the radioactive material and then placed where it can deliver radiotherapy to the affected area. This can be repeated a couple times a week for several weeks to be sure the cancer cells are destroyed.
