Physicians consider a number of different options, depending on the type of cancer, its location, and its severity. Since treatment generally includes surgically excising (removing) the tumor, doctors will also consider the risk of scarring. A patient’s age and general health are also important factors. Some experts, for instance, question the practice of aggressively screening and treating frail, elderly patients for basal cell carcinomas that aren’t causing uncomfortable symptoms. Their reasoning is that basal cell cancer is unlikely to be dangerous. And complications from treatment can occur, especially among older people with other health problems. RELATED: A Parent’s Guide to Skin Cancer in Kids In addition to a dermatologist, the following experts are involved in skin cancer care, according to SkinCancer.net: (1)
Dermatological oncologistMedical oncologistRadiation oncologistSurgical oncologistMohs surgeonPlastic surgeonRadiologistPathologistNurse practitioner (NP) or physician’s assistant (PA)
It is typically performed on an outpatient basis in a doctor’s office with local anesthesia. After numbing the tumor and the surrounding area skin, the doctor scrapes off the problematic area with a curette, an instrument with a sharp, ring-shaped tip, according to the Skin Cancer Foundation (SCF). (2) Next, the physician cauterizes the site of the tumor with a small device called an electrocautery needle, which stops the bleeding and destroys any stray cancer cells. No stitches (sutures) are required. The scrape-and-burn procedure may be repeated once or twice during the same office visit and can be used on multiple locations. This method generally leaves a small scar. RELATED: Overview of Libtayo, First New FDA-Approved Drug for Metastatic Cutaneous Squamous Cell Carcinoma (CSCC) When Surgery or Radiation Isn’t an Option While the patient waits, the sample is examined under a microscope to see if there are any cancer cells. The procedure is repeated, with the doctor removing one thin layer at a time, until a tissue sample is cancer-free. The process can take several hours. The Mohs technique is considered the gold standard for treating many squamous cell cancers, basal cell cancers, and some melanomas, says the SCF. (3) It has the highest cure rate and spares as much healthy skin surrounding the tumor as possible, leaving the smallest possible scar. As with other skin cancer surgeries, it is typically done on an outpatient basis in a doctor’s office with local anesthesia. But because it is so complex and time-consuming, skin cancer experts have devised guidelines for when it is the best option. It’s often used when there’s a high risk of recurrence, the extent of the cancer is hard to determine, or the cancer is in a part of the body where appearance or function are high priorities, such as near the eye, the middle of the face, the ears, or the fingers, notes the American Cancer Society (ACS). (4) RELATED: Can Genetics Determine Risk for Melanoma Progression? As with curettage and Mohs, excisional surgery is typically done in a physician’s office with local anesthesia. The doctor uses a scalpel to remove the entire tumor, plus a surrounding border of healthy skin as a safety margin. The physician closes the incision with sutures, then sends the tissue specimen to a laboratory to verify that the border of healthy skin removed (known as the margin) does not, in fact, contain any cancer cells. If the lab detects cancer cells in the sample, the patient may need to return to the doctor for additional excision. Sutures generally stay in place for a week or two until the area heals. For large tumors that require more extensive surgery, doctors might cover the area with a flap made from skin near the tumor, or from skin taken elsewhere in the body. Excisional surgery has improved significantly in the past decade, with surgeons able to remove much less tissue than they once did. The result: smaller incisions that heal more quickly and cause less scarring. The physician applies liquid nitrogen to the growth with a swab or as spray, repeating several times if necessary to freeze and kill cells. The lesion eventually blisters, crusts over, and falls off, notes the ACS. (5) Cryotherapy may be the right choice for patients who can’t have surgery because of bleeding disorders or an intolerance to local anesthetic. But it has a lower overall cure rate than surgical methods. This treatment can be a treatment for actinic keratoses. Doctors are also investigating its use for basal cell and superficial squamous cell cancers. Doctors may also use laser surgery, in which lesions are vaporized or destroyed with heat, to treat actinic keratoses. Other conditions that may prompt laser surgery include Bowen’s disease (a type of early squamous cell cancer) and very superficial basal cell cancers. (2,5) Some dermatologists may treat actinic keratosis as well as some very superficial basal and squamous cell cancers with a chemotherapy cream, which kills cancer cells when applied directly to the skin. The most commonly prescribed medication of this type is 5-fluorouracil (Efudex, Fluroplex, Carac). (5) Topical medication can also stimulate the immune system to attack actinic keratosis and some very early basal cell cancers. Zyclara (imiquimod) is a cream applied directly on the tumor that induces your immune system to attack the tumor. Immunotherapy harnesses the power of the body’s own immune system to fight cancer. There are different types of immunotherapy, including:
Checkpoint Inhibitors These drugs target different pathways that help the immune system recognize and kill cancer cells. Cytokines These help boost the immune system.Oncolytic Viruses These are modified viruses that infect and kill cancer cells.
There are currently seven immunotherapies approved by the U.S. Food and Drug Adminstration (FDA) for melanoma, including the following: (6)
Proleukin (aldesleukin), a cytokine treatmentIntron A (interferon alfa-2b), another cytokine treatmentYervoy (ipilimumab), a checkpoint inhibitorOpdivo (nivolumab), also a checkpoint inhibitorSylatron or PEG-Intron (peginterferon alfa-2b), a cytokine treatmentKeytruda (pembrolizumab), a checkpoint inhibitorImlygic (T-VEC), an oncolytic virus
RELATED: Biologics Used for Common Inflammatory Diseases Do Not Pose Notable Melanoma Risk, Study Finds For instance, about one-half of all melanomas have mutations (defects) in the BRAF gene that cause out-of-control cellular growth. Oral drugs that target this mutation are called BRAF inhibitors. These include Zelboraf (vemurafenib) and Taflinar (dabrafenib). BRAF inhibitors are often combined with medication that targets a protein called MEK. Two such drugs are Mekinist (trametinib) and Cotellic (cobimetinib). One popular alternative treatment, black salve, is marketed as being able to draw out skin cancer. But there’s no credible evidence that shows it’s an effective treatment. Some studies show black salve can actually damage the skin, according to the American Academy of Dermatology. (7) Other popular remedies that are promoted online include:
Vitamins and herbsBaking sodaApple cider vinegarTurmericEssential oilsEggplant extract
Dermatologists warn that some of these products can interact with cancer treatments. It’s important to talk to your doctor before trying any type of supplement or complementary approach. (7) Researchers are looking into whether certain foods, or nutrients in foods, may help protect against skin cancer. Studies in animals suggest that some substances in foods, such as soy and flaxseed, may help prevent the spread of melanoma in the body, according to St Luke’s Hospital in Chesterfield, Missouri. (8) Per the SCF, other vitamins and nutrients found in food that might protect against skin cancer include: (9)
Vitamins A, C, and EBeta-caroteneZincFolic acidOmega-3 fatty acidsLycopene Polyphenols
If you have skin cancer, you should always talk to your doctor before trying any new treatment or dramatically changing your diet. RELATED Can Essential Oils Work for Skin Cancer? Additional reporting by Julie Marks.
