SKIN CANCER – TREATMENT SPECIALIZATIONS

Cryotherapy, also known as cryosurgery, is a commonly used in-office procedure for the treatment of a variety of benign and malignant lesions. In one report, cryotherapy was the second most common in-office procedure after skin excision. The mechanism of destruction in cryotherapy is necrosis, which results from the freezing and thawing of cells. Cryotherapy can be employed to destroy a variety of benign skin growths, such as warts, pre-cancerous lesions (such as actinic keratosis), and malignant lesions (such as Basal Cell and Squamous Cell Carcinomas). The goal of cryotherapy is to freeze and destroy targeted skin growths while preserving the surrounding skin from injury.

Electrodesiccation and curettage is a combination skin cancer treatment that involves scraping the abnormal cells with a curette and then “burning” or cauterizing the area with an electric current or liquid nitrogen to seal the blood vessels and remove all remaining cancer cells. This process may be repeated several times to ensure complete removal.

Curettage may be performed alone or in conjunction with other treatments. When performed together, electrodesiccation and curettage are most effective for primary lesions and are sometimes used for recurrent lesions as well.

Excision refers to the removal of a lesion by cutting through the skin down to the underlying fat and in most cases repairing the wound with sutures (stitches). Many types of lesions are removed by excision, including moles, cysts, lipomas, and skin cancers. When repaired, excisional wounds are usually sutured in a straight line, oriented to follow the normal wrinkle lines of the skin. Most wounds are closed with a layer of dissolving stitches below the skin in addition to a layer of surface sutures, which are removed one to two weeks after surgery. Depending on the location and size of the wound, it is often recommended that patients use a non-stretch skin colored tape to support the incisions for two weeks or more following suture removal until the wounds have sufficient strength to minimize the risk of a spread scar. Excisional wounds mature below the surface of the skin for approximately six months following surgery, by which time they have usually reached their final appearance.

Dr. Green always has two goals in mind while treating you and your skin cancer. First, he wants to remove the cancerous tissue. Second, he wants to leave you with the most cosmetic appearing surgical site as possible.

The topical chemotherapeutic agent most widely used for cutaneous tumors is 5-fluorouracil (5-FU) which interferes with DNA synthesis in actively dividing cells causing tumor death. Some of the commonly used topical prescription medications in this category are Carac Cream, Effudex cream, Aldara, and Zyclara. Patients self-treat by applying the topical cream for several weeks, resulting in increasing erythema and superficial erosions at affected sites. These sites typically heal without scarring once the desired inflammatory endpoint is reached. Some patients can experience pruritus (itching) and irritation, and, therefore, require close follow-up during the course of treatment to monitor response to the medication.

Although topical 5-FU has been used to treat precancerous actinic keratosis lesions, which may progress to Squamous Cell Carcinoma, its usefulness in treating invasive Squamous Cell Carcinoma is hindered by the inadequate depth of penetration of the topical medication into the dermis. Topical 5-FU application has been limited to treating superficial Basal Cell Carcinoma or Squamous Cell Carcinoma, because of the potential for persistent, deeper-invasive tumors to remain following treatment, and even then its use is rare.