Care & Treatment
Once your skin lesion has been identified and staged—and all the test results are in—your healthcare professional (dermatologist or oncologist) will discuss the appropriate treatment strategies with you. Most treatments are simple procedures performed in the healthcare provider’s office or in a clinic. Basal cell cancers are almost 100% curable. About 97% of melanomas, the most dangerous type of skin cancer, can be cured if diagnosed in the earliest stages.
Depending upon your particular tumor, treatments may include surgery, freezing (also known as cryotherapy), laser therapy, photodynamic therapy, chemotherapy, immunotherapy, and/or radiation therapy.
For small surface lesions and pre-cancerous actinic keratoses, the initial biopsy surgery may be all that is needed to completely remove the growth. This is likely to provide a complete cure. You may need a few stitches to close the incision.
More extensive surgery will be needed if your lesion is larger or goes deeper than the skin surface. Some normal tissue around the growth will also be removed to make sure no malignant (cancerous) cells are left behind.
In this procedure, your surgeon removes the growth in small sections, layer by layer, examining each removed section under a microscope in the operating room until all the malignant cells have been eliminated. This minimizes the amount of tissue that must be taken out. Mohs surgery is used for larger basal and squamous cell carcinomas, and for recurrences of the lesions.
Curettage and Electrodesiccation
During surface surgery for small basal cell carcinomas, the surgeon will repeatedly use a curet (a dull circular knife) to scrape away the growth and then an electrode to burn and seal the edges of the wound. This simple, quick technique is performed with local anesthetic, and is suitable for basal or squamous cell lesions.
Lymph Node Surgery
Your dermatologist or oncologist may wish to do a lymph node “dissection” to see whether any cancer cells have spread to the lymphatic circulation. A “sentinel” lymph node is tested to see if cancer cells have spread to the lymph system. This type of surgery requires general anesthesia in the hospital, during which you will be asleep for a short period of time.
Reconstructive Surgery and Skin Grafts
If a large lesion is removed, your doctor may not be able to secure the incision with just a few stitches. A skin graft may be recommended, which is when healthy skin is taken from another area of your body to cover the missing tissue. Other types of cosmetic surgery to reduce scarring and visual changes may also be appropriate.
A careful local application of liquid nitrogen will freeze and kill the surface layer of skin, removing actinic keratoses and small surface skin cancers. The frozen skin sheds off afterwards, but may leave skin sensitive for a few months afterward, and some scarring may occur.
For small surface lesions in early squamous or basal cell carcinomas, the precision of a laser may be the simplest way to burn off a malignant growth. This leaves little scarring or bleeding afterward.
Occasionally, if you develop a melanoma on a finger or toe, the best approach is to remove the affected part or, in some cases, the entire digit.
Special medications that make your skin cells sensitive to light are used in combination with laser techniques to destroy the surface layer of skin tissue, removing superficial skin cancers and actinic keratoses. The medications may be applied to the skin or injected into your body. You may need to stay out of direct sunlight for several weeks after this treatment.
Anti-cancer chemicals may be applied directly to the skin as a lotion, ointment, or cream. For example, imiquimod cream stimulates the immune cells to attack skin cancer cells and may be useful in early stages of melanoma. The creams and lotions are often irritating and may leave scars on the skin.
If a skin cancer has spread to other parts of your body—especially if you have melanoma—a chemotherapy drug may be given orally or through a vein (intravenously) every few weeks.
Immunotherapy or Biological Therapy
Substances that are able to stimulate your immune system to kill cancer cells include cytokines, interferon, and interleukin-2. They may make you feel ill, almost as if you have the flu. They may also be given along with other treatments in cases of melanoma.
Radiation (x-rays or injected radioactive particles) is sometimes used for skin cancer patients if there are reasons to avoid surgery. For example, some older people may not be able to tolerate an operation.
A newer technique called external beam radiation is a particular type of focused radiation. The treatments are painless and there is no need for anesthesia, but they may cause skin irritation, fatigue, and local hair loss.
Radiation may also be used in combination with other treatments.
Monoclonal Antibody Treatment
Monoclonal antibodies are able to target certain molecules in your body, shutting down the spread of cancers—especially melanoma—or boosting your own body’s immune response to the cancer cells.
Several recent breakthroughs (including the approval of the treatments ipilimumab and vemurafenib) have generated a great deal of excitement for treatment of melanoma, and two other drugs have been approved for patients with advanced melanoma. There may be serious side effects from monoclonal antibody treatment, so make sure to report any changes in your condition to your healthcare team.
After treatment, your healthcare provider will set up a schedule for check-ups. Make sure you go to all appointments. Keep track of your recovery so you can report on your progress.
Last Updated September 2020