Treatment Options for Basal and Squamous Cell Carcinoma

Depending on the type. size, and location of the skin cancer, a variety of treatment options are available. Most cure rates for these options are 95% or better. If you suspect you have a skin cancer, see your dermatologist. A simple biopsy is usually done to confirm the diagnosis. It may appear that the site has healed after the biopsy but further treatment is needed to remove any skin cancer still present below the surface. 

Common Skin Cancer Treatments

When detected early, most skin cancers respond to common treatment procedures including:

Destruction

This includes treatments where the cancerous tumor and its extensions are scraped from the area (curettage) and an additional layer of skin is then destroyed by an electrical current (electrodessication) or cryosurgery (liquid nitrogen) to provide a margin of safety.   When liquid nitrogen is sprayed on diseased tissue and the surrounding area, the tissue freezes and thaws. The intracellular ice crystals that form at this temperature kill the tumor cells.  The dead tissue then sloughs off, allowing the wound to heal. 

Curettage and cryosurgery are most successful in the removal of superficial skin cancers.  The raw area of skin takes approximately 2 weeks to heal with regular wound care.  A flat white scar may result after healing, so it is not recommended for skin cancers on the face. Since tissue is not available for pathological examination of the margins, there is a higher risk of recurrence (5-10%).

Topical immunotherapy therapy

Small superficial basal cell carcinomas can be treated effectively using a topical cream called imiquimod (Aldara™). The cream is applied 3-5 times per week for 6 weeks and stimulates your immune system to clear the skin cancer. Significant local irritation including redness, itching, oozing and crusting commonly occurs. This reaction may take several weeks to clear after treatment is complete. Cosmetic results are usually very good after the irritation has resolved. Cure rates are in the range of 80-90%.

Standard surgical excision

A treatment involving excision of diseased tissue along with a margin of normal skin to include any extensions of the tumor.  Following surgery, a specimen is sent to a laboratory where a pathologist examines the removed tissue by making vertical slices, similar to slices of bread.  Depending upon the extent of the cancer found, subsequent surgeries followed by separate laboratory analysis may be required.  However, only a sample of the removed tissue is evaluated.  If cancer cells are present in unexamined sections, they may be missed and the cancer may recur. Cure rate is approximately 95-97%.

Mohs Micrographic Surgery

A specialized type of excisional surgery where the surgeon removes the tissue and analyzes it under the microscope at the time of surgery. Very narrow layers of tissue are removed with each step and checked for cancer until all tumor cells are removed. Mohs micrographic surgery offers the best cure rate (>99%) of any skin cancer treatment and spares surrounding healthy tissue. After the skin cancer is removed it can be repaired immediately to restore the appearance of your skin.  .The precise nature of Mohs micrographic surgery requires more time than conventional surgical excision, so the technique is usually reserved for skin cancers that have already recurred with other methods, that are likely to recur due to large size, location, or microscopic appearance or those located in cosmetically delicate areas such as the head, neck, hands or feet.

Radiation therapy

A method that involves destroying cancer cells by exposure to beams of ionizing radiation.  The radiation oncologist chooses the specific type of radiation needed to reach the exact depth of the tumor and still provide a margin for safety.  Treatment usually requires 3 visits per week for 6-8 weeks. Redness and tenderness are common side effects during treatment. Because some color and texture changes may result, radiation therapy as a primary treatment is usually reserved for patients who are unable to undergo surgery. It may also be used following surgery for particularly aggressive types of tumors that are at risk for spread to nerves or lymph nodes.

Treatment Issues

The best treatment option for your skin cancer can be determined after examination and discussion with your dermatologist. Not all options are appropriate for all skin cancers. While destructive therapies may be good choices for skin cancers  the body they may leave a noticeable scar that is not acceptable on the head or neck. Skin cancers that are located on cosmetically delicate areas on the head and neck are frequently treated by Mohs micrographic surgery.  In these cases, Mohs surgery is often recommended because of the highest cure rate and ability to spare normal healthy tissue.