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Skin Cancer Treatment

Skin cancer is a disease in which malignant (cancer) cells form in the tissues of the skin.  Skin cancer begins in the epidermis, which is made up of three kinds of cells:

• Squamous cells: Thin, flat cells that form the top layer of the epidermis.

• Basal cells: Round cells under the squamous cells.

•Melanocytes: Cells that make melanin and are found in the lower part of the epidermis. Melanin is the pigment that gives skin its natural color. 

Sunlight exposure, skin color, and other genetic factors can increase the risk of basal cell carcinoma and squamous cell carcinoma.  Skin cancer can occur anywhere on the body, but it is most common in skin that is often exposed to sunlight, such as the face, neck, and hands.

If caught early, most squamous cell carcinomas are curable and cause minimal damage. However, the larger and deeper a tumor grows, the more dangerous and potentially disfiguring it may become, and the more extensive the treatment must be.

If left untreated, SCCs may spread (metastasize) to local lymph nodes, distant tissues and organs and can become life-threatening. Therefore, any suspicious growth should be seen by a physician without delay. The doctor takes a tissue sample (biopsy), which is examined under a microscope to arrive at a diagnosis. If tumor cells are present, the physician uses the biopsy results and other factors to determine which treatment is right for you.

Fortunately, there are several effective ways to eradicate squamous cell carcinoma. The physician chooses the treatment based on the tumor’s type, size, location and depth of penetration, as well as the patient’s age and general health.

The patient can almost always receive treatment on an outpatient basis in a physician’s office or at a clinic. Most surgical procedures call for a local anesthetic, and pain or discomfort is usually minimal during and after the procedure.

Standard Treatment Options Available for Skin Cancer Patients at practices across the globe: 

  • Mohs Surgery: The gold standard for treating many SCCs (as well as many basal cell carcinomas and some melanomas). This includes those in cosmetically and functionally important areas around the eyes, nose, lips, ears, scalp, fingers, toes or genitals. Mohs is also recommended for skin cancers that are large, aggressive or growing rapidly, that have indistinct edges or that have recurred after previous treatment. The procedure is done in stages, all in one visit, while the patient waits between each stage. After removing a layer of tissue, the surgeon sections, color-codes and maps the tissue, then examines it under a microscope in an on-site lab. If any cancer cells remain, the surgeon knows the exact area where they are and removes another layer of tissue from that precise location, while sparing as much healthy tissue as possible. The doctor repeats this process until the margins are clear and no cancer cells remain. The wound may be left open to heal or the surgeon may close it with stitches. This depends on its size and location. In some cases, a wound may need reconstruction with a skin flap, where neighboring tissue is moved into the wound, or possibly a graft of skin taken from another, ideally inconspicuous, part of the body. This technique examines 100 percent of the tumor margins and leaves the smallest scar possible. The cure rate is up to 99 percent for a skin cancer that hasn’t been treated before, and up to 94 percent for a skin cancer that has recurred after previous treatment.
  • Excisional Surgery: can be used for squamous cell carcinomas as well as basal cell carcinomas and melanomas. For tumors discovered at an early stage that have not spread beyond the tumor margin, excisional surgery is frequently the only treatment required.  The physician uses a scalpel to remove, or excise, the entire cancerous tumor along with a surrounding border of presumably normal skin as a safety margin. The physician bandages the wound or closes the skin with stitches and sends the tissue specimen to a lab to verify that all cancerous cells have been removed. If the lab finds evidence of skin cancer beyond the safety margin, the patient may need to return for another surgery. 
  • Electrosurgery: This technique is usually reserved for small squamous cell carcinoma lesions. Using local anesthesia, the physician scrapes off part or all of the lesion with a curette (an instrument with a sharp, ring-shaped tip), then burns the tumor site with an electrocautery needle to stop the bleeding and kill any remaining cancer cells. The physician typically repeats this procedure a few times (often at the same session), scraping and burning a deeper layer of tissue each time to help ensure that no tumor cells remain. The technique can produce cure rates approaching those of surgical excision for superficially invasive squamous cell carcinomas without high-risk characteristics. However, it is not recommended for any invasive or aggressive SCCs, those in high-risk or difficult sites, such as the eyelids, genitalia, lips and ears, or any other sites (especially those around the face) that would be left with cosmetically undesirable results, since the procedure leaves a sizable, hypopigmented scar. 
  • Cryosurgery: This procedure is used for superficial SCCs. The physician destroys the tumor tissue by freezing it with liquid nitrogen, using a cotton-tipped applicator or spray device. Later, the lesion and surrounding frozen skin may blister or become crusted and fall off, usually within weeks. There is no cutting or bleeding, and no anesthesia is required, though the patient may experience some mild stinging. The physician may repeat the procedure several times at the same session to help ensure destruction of all malignant cells. Redness, swelling, blistering and crusting can occur following treatment, and in dark-skinned patients, some pigment may be lost. Inexpensive and easy to administer, cryosurgery may be the treatment of choice for patients with bleeding disorders or intolerance to anesthesia. However, it has a lower overall cure rate than the surgical methods. Depending on the physician’s expertise, the five-year cure rate can be quite high with selected, superficial squamous cell carcinoma; but cryosurgery is not often used today for invasive SCC because it may miss deeper portions of the tumor and because scar tissue at the cryotherapy site might obscure a recurrence.
  • Laser Therapy: Not yet approved for SCC but is sometimes used for superficial SCCs, above all when other techniques have been unsuccessful. It gives the physician good control over the depth of tissue removed. The physician uses a beam of light of a specific wavelength to destroy certain superficial SCCs, without causing bleeding. The physician may remove the skin’s outer layer and/or variable amounts of deeper skin, so local anesthesia may be needed. The risks of scarring and pigment loss are slightly greater than with other techniques. Some lasers (such as CO2 lasers) vaporize (ablate) the skin cancer, while others (nonablative lasers) convert the beam of light to heat, which destroys the tumor. 
  • Radiation Therapy: The physician uses low-energy X-ray beams to destroy the tumor, with no need for cutting or anesthesia. Destruction of the tumor may require several treatments over a few weeks or daily treatment for a month. Average cure rates are about 90 percent, since the technique does not provide precise control in identifying and removing residual cancer cells at the margins of the tumor. 
  • Photodynamic Therapy:  DT may be used for some superficial SCCs on the face and scalp but is not recommended for invasive SCC. The physician applies a light-sensitizing topical agent to the lesion and the area surrounding it. The patient waits for an hour or more to let this absorb into the skin. The doctor then uses a strong blue or red light or laser to activate this medicated area. This selectively destroys the lesion while causing minimal damage to surrounding healthy tissue. Some redness, pain, peeling, flaking and swelling can result. After the procedure, patients must strictly avoid sunlight for at least 48 hours, as ultraviolet exposure will increase activation of the medication and may cause severe sunburns.
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