Skin Cancer Management

Surgical Management

Once a lesion has been diagnosed as a skin cancer, either through clinical examination or by a biopsy, many will require surgical treatment.

There are a number of surgical options for treating skin cancer. Factors that will determine which treatment option is best for you include the type, location and thickness of the skin cancer.

Surgical excision

Surgical excision is the most common form of skin cancer surgery. It involves cutting out the skin cancer with a surrounding margin of normal skin. The wound is the usually sutured together.

In some circumstances the surgical wound will be closed with a flap of skin or a skin graft.

Curettage

Curettage is a surgical procedure where the skin cancer cells are scraped off the skin using a surgical instrument called a curette. The wound is similar to a deep graze and does not require stitches.

Curettage is usually performed on thin BCCs and some SCCs.

Mohs micrographic surgery

Mohs micrographic surgery is a specialised type of dermatological surgery where the skin cancer is removed and immediately checked under the microscope before closing the wound.

If the skin cancer has not been completely removed the surgeon will excise more skin until the margins are clear. Only then will the wound be closed.

Non Surgical Management

For some types of early skin cancer your dermatologist may recommend non-surgical treatment. The main advantage of non-surgical treatments is they often offer a better cosmetic outcome and avoid the pain and discomfort of surgery.

There are a number of different non-surgical treatments for skin cancer and sun damage, each with their own advantages and disadvantages. Your Dermatologist will discuss these options in more detail at the time of your consultation.

Some skin cancers, such as melanomas and thicker SCCs can not be treated non-surgically.

Cryotherapy

Cryotherapy involves freezing the skin using a cold substance such as liquid nitrogen. This treatment is generally reserved for non-cancerous lesions such as solar keratosis and warts.

In some situations very early skin cancers may be treated with cryotherapy however this treatment should only be performed by experienced practitioners.

Imiquimod (Aldara)

Aldara is a cream that is designed to stimulate the body’s own immune system in the skin to destroy cancer cells. It is usually applied for a 6 week period and induces a brisk inflammatory reaction.

Aldara may be used for superficial BCCs, precancerous lesions and sun spots. It has a high rate of cure and excellent cosmetic results.

Ingenol membutate (Picato)

Picato (ingenol) works by causing the death of certain cells in the body. Picato gel is used to treat actinic keratosis (a condition caused by too much sun exposure).

Photodynamic Therapy (PDT)

Photodynamic therapy involves applying a special cream to the tumour and then exposing it to bright light to create a photochemical reaction that selectively destroys cancer cells.

For skin cancer, PDT is usually performed on two occasions separated by one or two weeks. Like aldara, PDT may be used for superficial BCCs, precancerous lesions and sun spots. It also has a high rate of cure and excellent cosmetic results.

Laser

1927 Fraxel can be used for skin resurfacing and in that way ablating solar keratosis over an entire field. After numerous passes with the laser the skin heals with renewed skin layers.

Radiotherapy

Radiation therapy is a treatment that uses high-energy rays to destroy cancer cells. Radiation therapy may be used instead of surgery for skin cancer in places that are hard to treat or for patients who are too frail for surgery.

Radiotherapy may be used for BCCs and some SCCs. Sometimes radiation therapy may be recommended after surgery to help prevent the skin cancer from coming back.

In carefully selected patients, radiotherapy can be an excellent non-surgical treatment option.

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