Skin Cancer Treatment

The most common non-melanoma skin cancers — basal cell carcinoma and squamous cell carcinoma — may be treated in several ways. 

Mohs micrographic surgery

Mohs surgery removes thin layers of skin until only cancer-free tissue remains. The procedure is designed to conserve healthy tissue and minimize scarring — especially for tumors on or near the nose, eyes, ears, forehead or scalp. Most tumors require one to three Mohs layers for complete removal of skin cancer cells. Mohs micrographic surgery provides the best cure rate for basal cell carcinomas, according to the American Cancer Society. It also can be performed for squamous cell carcinomas with good cure rates.

Reconstructive procedures following skin cancer treatment

When cancer is removed from the skin, the affected area may require reconstructive surgery. For example, if skin cancer affected the nose, removal of the cancer may cause a defect that can only be repaired through reconstructive surgery. The type of procedure that will be most beneficial depends on the part of the body affected by skin cancer. Scripps plastic surgeons work closely with Mohs surgeons to repair and reconstruct affected areas, Insurance usually covers both procedures.

Cryosurgery

Cryosurgery (also called cryotherapy) uses liquid nitrogen applied directly to the treatment area to destroy external tumors through extreme cold temperatures.

Photodynamic therapy (PDT)

Photodynamic therapy (PDT) uses a specialized light source in combination with a drug that’s applied to the skin cancer over several hours or days. The drug is activated by the light source and kills the cancer cells. It’s most often used for precancerous growths, such as actinic keratosis, but may also be used in conjunction with skin cancer surgery.

Topical chemotherapy

Topical chemotherapy applies a chemotherapy drug directly to the skin cancer via a cream or ointment. Topical chemotherapy is usually used for very early skin cancers or precancerous artinic keratoses.

Laser surgery

Laser surgery uses of a beam of laser light to eliminate cancer cells. Laser surgery is most commonly an option for very early and superficial basal cell carcinomas and squamous cell carcinomas.

Excision surgery

Excision surgery removes a tumor and an area of tissue surrounding it (referred to as a “safety margin”). Following the surgery, a pathologist examines a sample of the safety margin tissue for cancer cells to make sure they’re no longer present.

Electrodesiccation and curettage

Electrodesiccation and curettage is most frequently used for small basal cell carcinomas that do not require an excision. The physician scrapes away the tumor down to its base using a sharp curette. Then electrodesiccation is performed to seal the wound through the use of a high-frequency electric current. This is a widely used treatment modality.

Immune response modifiers

Immune response modifiers are drugs that boost the body’s ability to fight cancer. In certain cases, an immune response modifier called interferon can be injected directly into a tumor. Other immune response modifiers may be taken by mouth for patients who are not candidates for surgery or radiation therapy.

Depending on the location and stage of the tumor, melanoma skin cancer treatment may include surgery, immunotherapy, radiation therapy or chemotherapy.

Melanoma surgery

Physicians perform two different types of procedures, depending on how far the melanoma has spread.

• For thin melanoma growths, local wide excisions are performed after a skin biopsy to ensure all cancer cells are gone. This procedure has proven successful in curing most thin melanoma growths. 
• For melanoma that has a higher risk of spread, a sentinel lymph node biopsy may be performed in addition to local wide incision. 

Immunotherapy

Immunotherapy uses drugs that boost the body’s ability to fight cancer.

• Ipilimumab is a drug administered intravenously for melanomas that have spread to other parts of the body or cannot be successfully removed by surgery.
• Interferon-alfa and interleukin-2 (IL-2) can be injected or given intravenously with the aim of shrinking advanced melanoma.
• Interferon-alfa may also be administered as an additional therapy for patients with thicker melanomas, which often have cancer cells that have spread to other parts of the body. The goal is to keep the cells from spreading and growing.
• BCG (bacille calmette-guerin) may be used to help treat later-stage melanomas and is injected directly into the tumors.
• Imiquimod cream may be used for very early stage melanoma in situ in sensitive areas of the face that could be scarred by surgery.

Targeted therapy for melanoma

Targeted therapy for melanoma uses drugs that target specific proteins or receptors on tumors.

• Vemurafenib and dabrafenib attack a mutated gene known as BRAF protein that instructs melanoma cells to grow and quickly divide. About 50% of melanomas have the BRAF protein gene.
• Trametinib attacks the MEK protein, which is related to the BRAF protein. The drug may be combined with dabrafenib.

Chemotherapy

While chemotherapy is not as effective for melanoma as it is for other types of cancer, it may be recommended to help lessen symptoms or extend the life of patients who have late-stage melanoma. Chemotherapy can be combined with other immunotherapy drugs.

Radiation therapy

Radiation therapy is not a common treatment for a melanoma tumor that started on the skin, but it may be used on nearby lymph node areas after surgery to try to prevent the cancer from coming back. Radiation therapy may also be used to treat recurring melanoma, in either the skin or lymph nodes if the cancer can’t be completely removed by surgery.

Some skin cancer treatment plans may involve clinical trials. Talk with your physician about whether a clinical trial is right for you.

For a list of clinical trials that are currently enrolling patients, see our current list of clinical trials.

Your Scripps cancer team will develop a customized treatment plan outlining the treatments and therapies we recommend for your care. Before you begin treatment, you and your physician will review your plan together and discuss any questions or concerns you may have.

Your skin cancer treatment plan generally includes:

• Family and medical history
• A summary of your cancer diagnosis and staging information
• Diagnostic testing completed (e.g., imaging, biopsy, lab tests)
• Plans for surgery, radiation, chemotherapy and/or other treatments
• Potential side effects of treatments
• Contact information for your cancer care team members

Along with helping you understand your course of treatment and encouraging discussion between you and your physician, your plan helps your team coordinate your care. You also can share your treatment plan with other providers who may be involved in your medical care.

Your skin cancer care team includes health and medical professionals from a wide range of specialties. Scripps will customize your team to ensure you have the expertise and support you need. Your team may include:

• Dermatologists
• Mohs surgeons
• Surgical oncologists
• Radiation oncologists
• Medical oncologists
• Registered nurses
• Nurse navigators
• Dietitians
• Oncology social workers

Visit your cancer care team for more on our multidisciplinary approach to treatment.