Treatment Planning

In treating skin cancer, the doctor's main goal is to remove or destroy the cancer completely with as small a scar as possible. To plan the best treatment for each patient, the doctor considers the location and size of the cancer, the risk of scarring, and the person's age, general health, and medical history.

It is sometimes helpful to have the advice of more than one doctor before starting treatment. It may take a week or two to arrange for a second opinion, but this short delay will not reduce the chance that treatment will be successful. There are a number of ways to find a doctor for a second opinion:

• The patient's doctor may be able to suggest a doctor, such as a dermatologist or a plastic surgeon, who has a special interest in skin cancer.
• Patients can get the names of doctors from local and national medical societies, a nearby hospital, or a medical school.
  
• The Directory of Medical Specialists lists doctors' names and gives their background. It is in most public libraries.

Treating Skin Cancer

Treatment for skin cancer usually involves some type of surgery. In some cases, doctors suggest radiation therapy or chemotherapy. Sometimes a combination of these methods is used.

Surgery

Many skin cancers can be cut from the skin quickly and easily. In fact, the cancer is sometimes completely removed at the time of the biopsy, and no further treatment is needed.

Curettage and Electrodesiccation

Doctors commonly use a type of surgery called curettage. After a local anesthetics numbs the area, the cancer is scooped out with a curette, an instrument with a sharp, spoon-shaped end. The area is also treated by electrodesiccation. An electric current from a special machine is used to control bleeding and kill any cancer cells remaining around the edge of the wound. Most patients develop a flat, white scar.

Mohs' Surgery

Mohs' technique is a special type of surgery used for skin cancer. Its purpose is to remove all of the cancerous tissue and as little of the healthy tissue as possible. It is especially helpful when the doctor is not sure of the shape and depth of the tumor. In addition, this method is used to remove large tumors, those in hard-to-treat places, and cancers that have recurred. The patient is given a local anesthetic, and the cancer is shaved off one thin layer at a time. Each layer is checked under a microscope until the entire tumor is removed. The degree of scarring depends on the location and size of the treated area. This method should be used only by doctors who are specially trained in this type of surgery.

Cryosurgery

Extreme cold may be used to treat precancerous skin conditions, such as actinic keratosis, as well as certain small skin cancers. In cryosurgery, liquid nitrogen is applied to the growth to freeze and kill the abnormal cells. After the area thaws, the dead tissue falls off. More than one freezing may be needed to remove the growth completely. Cryosurgery usually does not hurt, but patients may have pain and swelling after the area thaws. A white scar may form in the treated area.

Laser Therapy

Laser therapy uses a narrow beam of light to remove or destroy cancer cells. This approach is sometimes used for cancers that involve only the outer layer of skin.

Grafting

Sometimes, especially when a large cancer is removed, a skin graft is needed to close the wound and reduce the amount of scarring. For this procedure, the doctor takes a piece of healthy skin from another part of the body to replace the skin that was removed.

Radiation

Skin cancer responds well to radiation therapy (also called radiotherapy), which uses high-energy rays to damage cancer cells and stop them from growing. Doctors often use this treatment for cancers that occur in areas that are hard to treat with surgery. For example, radiation therapy might be used for cancers of the eyelid, the tip of the nose, or the ear. Several treatments may be needed to destroy all of the cancer cells. Radiation therapy may cause a rash or make the skin in the area dry or red. Changes in skin color and/or texture may develop after the treatment is over and may become more noticeable many years later.

Topical Chemotherapy

Topical chemotherapy" is the use of anticancer drugs in a cream or lotion applied to the skin. Actinic keratosis can be treated effectively with the anticancer drug fluorouracil (also called 5-FU). This treatment is also useful for cancers limited to the top layer of skin. The 5-FU is applied daily for several weeks. Intense inflammation is common during treatment, but scars usually do not occur.

Clinical Trials

In clinical trials (research studies with cancer patients), doctors are studying new treatments for skin cancer. For example, they are exploring photodynamic therapy, a treatment that destroys cancer cells with a combination of laser light and drugs that make the cells sensitive to light. Biological therapy (also called immunotherapy) is a form of treatment to improve the body's natural ability to fight cancer. Interferon and tumor necrosis factor are types of biological therapy under study for skin cancer.

Followup Care

Even though most skin cancers are cured, the disease can recur in the same place. Also, people who have been treated for skin cancer have a higher-than-average risk of developing a new cancer elsewhere on the skin. That's why it is so important for them to continue to examine themselves regularly, to visit their doctor for regular checkups, and to follow the doctor's instructions on how to reduce the risk of developing skin cancer again.

Questions To Ask the Doctor

Skin cancer has a better prognosis, or outcome, than most other types of cancer. Although skin cancer is the most common type of cancer in this country, it accounts for much less than 1 percent of all cancer deaths. It is cured in 85 to 95 percent of all cases. Still, any diagnosis of cancer can be frightening, and it's natural to have concerns about medical tests, treatments, and doctors' bills.

Patients have many important questions to ask about cancer, and their doctor is the best person to provide answers. Most people want to know exactly what kind of cancer they have, how it can be treated, and how successful the treatment is likely to be. The following are some other questions that patients might want to ask their doctor:

• What types of treatment are available?
  
• Are there any risks or side effects of treatment?
  
• Will there be a scar?
  
• Will I have to change my normal activities?
• How can I protect myself from getting skin cancer again?
• How often will I need a checkup?

Some patients become concerned that treatment may change their appearance, especially if the skin cancer is on their face. Patients should discuss this important concern with their doctor. And they may want to have a second opinion before treatment.

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