When it comes to skin cancer, no one type of treatment is best. Your options depend on the type of skin cancer you have, the stage it's in, size and location of the tumour, and your health.
Seek out a board-certified dermatologist to help you decide how to treat your skin cancer, advises dermatologist Dr Anthony Rossi. “It is important to speak with a dermatologist who understands the type of skin cancer and the treatments available,” he says. “If you don’t know if a provider is an actual physician, ask.”
Depending on your situation, your doctor may advise to use one or a combination of the following treatments.
The main treatment for most types of skin cancers, especially if detected in the early stages, “removing skin cancer surgically with a margin of normal tissue can treat it efficiently and prevent it from returning or spreading,” Dr Rossi explains.
In this treatment, the surgeon will use anesthesia to prevent you from feeling pain. Then, in open surgery, the doc makes one large cut to remove the tumour and some peripheral healthy issue. In the case of minimally invasive surgery, the surgeon makes a few small cuts and inserts a tube with a camera called a laparoscope to project images of inside the body onto a monitor so the surgeon can see their work. Then the surgeon inserts tools through other small cuts to use to remove the tumour and some healthy tissue.
Mohs micrographic surgery
Considered the most effective technique for treating many basal and squamous cell carcinomas, this specialised surgery is used on early, non-metastatic skin cancer. “It helps to preserve as much normal, non-cancerous tissues and give complete tissue margin examination,” Dr Rossi explains, so the surgeon can be sure all of the cancer has been removed.
Typically used as an alternative to surgery for older patients and others who cannot undergo surgery, radiation therapy uses high-energy beams (often x-rays) to kill cancer cells. The beams may be delivered by a machine or by ingesting a solid or liquid form of radiation. “It can also be used in conjunction with surgery when the skin cancer is more advanced or has aggressive features that would make it prone to recurrence or spreading,” Dr Rossi adds.
FACT: More cases of skin cancer are diagnosed annually than all other cancers combined.
Chemotherapy for skin cancer comes in many forms-oral, intravenous, injection and topical. However they're delivered, these potent drugs destroy cancer cells or to stop or slow their growth. “Chemotherapy is utilised when the skin cancer has become metastatic or spread to distant organs of the body and is not amenable to surgery or radiation,” Dr Rossi explains. Chemo can also harm healthy cells, causing side effects such as hair loss.
Photodynamic therapy (PDT)
This nonsurgical treatment option approved for actinic keratosis utilises a medication that is a photosensitiser and then a light source that activates it, Rossi explains. “When activated, the reaction causes the destruction or death of the pre-cancerous and cancerous cells,” he says, adding that it can be used for early superficial skin cancers (mainly early basal and squamous cell, off label) when the patient does not wish to have surgery or is not a surgical candidate.
Also called immunotherapies, these are molecules or vaccines that promote the body's immune system to fight off the cancerous cells, Dr Rossi explains. These are usually reserved for advanced or metastatic skin cancers.
“These therapies target specific mutations, such as those found in melanoma, to prevent tumor growth or tumour progression. By targeting specific mutations or interfering with certain molecules, it can prevent cancer cell growth,” Dr Rossi says. These are most often used for metastatic cancers or advanced cancers.
Considered a topical form of chemotherapy, creams such as 5-fluorouracil (5-FU), imiquimod, and ingenol mebutate can be used to treat actinic keratoses, and some can be used to treat early superficial basal and squamous cell skin cancers off-label. “5-FU inhibits tumour growth by interfering with cellular replication, while imiquimod tries to boost the local immune response to recognise the cancerous cells and destroy them,” Dr Rossi explains. “Ingenol mebutate is a substance found in the sap of the plant Euphorbia peplus and an inducer of cell death.”
Lasers that emit high-intensity light to shrink or destroy tumours or pre-cancerous growths have been used to treat skin cancers. However, this may not be appropriate for all skin tumors, so discuss the risks and benefits with your dermatologist, Rossi adds.
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