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Skin Cancer Treatment
(August 2001)There are many treatments available today for skin cancer. The first step in the treatment process is to confirm the presence of skin cancer. To do this, a biopsy specimen is obtained from the suspected cancer site and the tissue is analyzed under the microscope. If skin cancer is present, the dermatologist will discuss the appropriate treatment options, discuss the risk, benefits and limitations of each form of treatment and make suggestions for treatment consistent with the nature of the tumor and the particular patient’s needs.
Methods
of Treatment
The most common forms of treatment for skin cancer include:
- Electrodesiccation and
curettage involves scraping away the malignant tissue with a sharp
surgical instrument called a curette. An electrosurgical device
may then be used to stop bleeding and cauterize a zone of normal
tissue; this procedure removes the cancerous tissue and minimizes the
chance of recurrence.
- Surgical excision
involves cutting into the skin with a surgical instrument, removing
the cancer, and then closing the wound.
- Radiation therapy can
also destroy cancerous tissue and is useful in certain types of skin
cancer, as well as in selected individuals for whom surgery is not
recommended.
- Cryosurgery involves the
use of an apparatus that sprays liquid nitrogen directly onto the
involved skin. This freezes the cancerous tissue and destroys
it. Wound healing usually occurs with minimal scarring.
- Topical chemotherapy
involves the application of chemicals such as 5-fluorouracil imiquimod
or tazarotene, which may help destroy pre-cancerous growths or
sometimes cancerous tissue.
Mohs'
Surgery
A recent advance in surgical excision of skin cancer is called Mohs’
surgery. This type of surgery is recognized as perhaps the most
effective method of treatment for advanced skin cancer and allows for
verification of complete removal of cancer before the wound is closed.
Dr. Kraffert performs this type of surgery in our office.
Mohs’ surgery is a term used for microscopically controlled surgical excision of skin cancer in which each bit of tissue is mapped and examined under the microscope to determine the site and extent of remaining malignant cells. This allows for repeated selective removal of cancerous tissue areas until the cancer is completely removed. While the procedure is time consuming, it yields a very high cure rate while allowing for maximal preservation of non-cancerous tissue. Mohs’ surgery is indicated for recurrent tumors, aggressive cancer variants, and tumors located in areas of high risk for recurrence, such as on and around the nose.
Mohs’ surgery was developed by Dr. Frederic Mohs approximately 40 years ago but has only recently become more widely available to patients for the treatment of skin cancer. Many refinements to his original technique have been added over the years. By using what has become known as the “fresh tissue technique”, skin samples removed during surgery are immediately processed and examined under the microscope for cancer. Working closely with a highly trained technician, the dermatologist can determine the precise location of any remaining cancerous tissue within the wound. This remaining cancerous tissue is then selectively removed and processed in the same fashion until the cancer is completely removed.
Reconstructive surgery (suture closures, skin flaps, or skin grafts) can usually be done on the same day as Mohs’ surgery. Since most skin cancers do not require Mohs’ surgery, your doctor will discuss the various treatment options available and recommend the one(s) most suitable for you.
Craig Kraffert, M.D.
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