- Type of skin cancer
- Where the skin cancer appears on the body
- Whether the skin cancer is aggressive
- Stage of the cancer (how deeply the skin cancer has grown and whether it has spread)
- Patient’s health
After considering the above, Dr. Bradley will choose one or more of the following treatments for skin cancer.
- Excision: To perform this, Dr. Bradley numbs the skin and then surgically cuts out the skin cancer and a small amount of normal-looking skin. This normal-looking skin is called a margin. There are different types of excision. Most excisions can be performed in Dr. Bradley’s office.
- Mohs surgery: Mohs surgery begins with Dr. Bradley removing the visible part of the skin cancer. Because cancer cells are not visible to the naked eye, Dr. Bradley also removes some skin that looks normal but may contain cancer cells. This part of the surgery is performed one layer at a time. After removing a layer of skin, it is prepared so that she can examine it under a microscope and look for cancer cells. If Dr. Bradley sees cancer cells, she removes another layer of skin. This layer-by-layer approach continues until she no longer finds cancer cells. In most cases, Mohs surgery can be completed within a day or less. The cure rate for skin cancer is high when Mohs surgery is used.
- Curettage and electrodesiccation: This surgical procedure may be used to treat small basal cell and squamous cell skin cancers. It involves scraping the tumor with a curette (a surgical instrument shaped like a long spoon) and then using an electric needle to gently cauterize (burn) the remaining cancer cells and some normal-looking tissue. This scraping and cauterizing process is typically repeated 3 times. The wound tends to heal without stitches. Sometimes, curettage is used alone.
- Other treatments: Surgical treatment is not right for every case of skin cancer. Some patients cannot undergo surgery. Sometimes, surgery cannot remove all of the cancer, and more treatment is used to help get rid of the cancer. If the skin cancer is caught very early, surgery may not be necessary.
Mohs Micrographic Surgery
Mohs micrographic surgery is the most effective and advanced treatment for skin cancer today. It offers the highest potential for cure – even if the skin cancer has been previously treated by another method. Mohs surgery treats skin cancer through a highly specialized and precise technique that removes the cancer in stages, one tissue layer at a time.
The Mohs procedure involves surgically removing skin cancer layer by layer and examining the tissue under a microscope until healthy, cancer-free tissue around the tumor is reached (called clear margins). Because the Mohs College surgeon is specially trained as a cancer surgeon, pathologist, and reconstructive surgeon, Mohs surgery has the highest success rate of all treatments for skin cancer – up to 99%.
There are three steps to the procedure:
A local anesthetic completely numbs the skin and the visible cancer is removed. This procedure only takes a few minutes, and then the patient rests comfortably with a light dressing applied to the area. A detailed diagram of the removed specimen, called a Mohs map, is drawn. The specimen is carefully divided and color-coded to distinguish top from bottom and left from right. A technician freezes the tissue and removes very thin slices from the entire edge and undersurface. These slices are placed on microscope slides and stained for examination under the microscope. Dr. Bradley carefully studies these slides under the microscope and examines the entire surgical margin of the removed tissue. This means the compete undersurface and edge of the specimen are examined and all microscopic roots of the cancer are identified and pinpointed on the Mohs map.
If cancer is found at the tissue margins of the microscopic slides, she then uses the Mohs map as a guide for removal of additional tissue from the patient only where cancer is present. Because there is no guesswork involved in deciding where to remove additional tissue, only tissue around the roots and extension of the cancer is removed. Therefore, this technique leaves the smallest possible surgical defect or final scar.
For certain medical conditions, you may require pre-operative and post-operative antibiotics. Often, you will know this because your primary physician may have discussed this with you on previous occasions. If you are needing these medications, please let us know during your initial visit.
- It is advisable to bathe or shower and wash your hair the evening before or the day of the surgery, especially since you will need to keep the wound dry after the procedure.
- You will also be spending considerable time in the office. Plan on eating a light meal before surgery and remember to bring reading materials to occupy your time while waiting for the results of the post-surgical tissue examination. If the tissue needs to be removed and examined in multiple stages, you may be staying through the lunch hour. Pack a few snacks and a lunch in case you get hungry.
- After the skin cancer is removed, we will plan to repair the surgical wound to best preserve function and aesthetic appearance. This reconstructive portion of the procedure may take between 45 to 60 minutes.
- It is a good idea to bring someone with you to drive or accompany you home.
Other treatments for skin cancer are:
- Immunotherapy: This treatment uses the patient’s own immune system to fight the cancer. The patient applies a cream (generic name is imiquimod) to the skin as directed by Dr. Bradley.
- Cryosurgery: Dr. Bradley freezes the skin cancer. Freezing destroys the treated area, causing the skin and cancer cells to slough off.
- Chemotherapy applied to the skin: The generic name for the medicine used in this treatment is 5-fluorouracil or 5-FU. The patient applies 5-FU to the skin cancer. It destroys the damaged skin cells. When the skin heals, new skin appears.
- Photodynamic therapy: This treatment consists of 2 phases. First, a chemical is applied to the skin cancer. This chemical sits on the skin cancer for several hours. During the second phase, the skin cancer is exposed to a special light. This light destroys the cancer cells.
- Radiation therapy: Radiation may be used to treat older adults who have a large skin cancer, skin cancers that cover a large area, or a skin cancer that is difficult to surgically remove. Radiation therapy gradually destroys the cancer cells through repeat exposure to radiation. A patient may receive 15 to 30 treatments. This treatment is often only recommended for older adults. Many years after a person is exposed to radiation, new skin cancer can develop.
What outcome can someone with skin cancer expect?
If it is caught early and properly treated, skin cancer can be cured. Even melanoma, which can be deadly, has a cure rate of almost 100% when treated early.
Even if you get a clean bill of health, you need to continue to see Dr. Bradley. Once a person gets skin cancer, the risk of getting another skin cancer is higher. Sometimes skin cancer returns. Dr. Bradley will tell you how often you should return for checkups.
Without early treatment, the outcome is not as favorable. Skin cancer can grow deeply. Removing the cancer can mean removing muscle and even bone. Reconstructive surgery may be needed after the surgery to remove the skin cancer. And skin cancer can spread.