Treatments
Diagnosis
To identify skin cancer, your doctor will follow these steps:
1. Examination of the Skin
Your doctor will carefully inspect any skin changes, assessing their size, shape, color, and texture. This visual evaluation helps determine whether the changes are likely to be cancerous or benign. Some skin abnormalities may resemble cancer but require additional testing to confirm the diagnosis. For instance, harmless moles, rashes, or skin conditions like psoriasis may mimic early cancerous signs.
2. Skin Biopsy for Laboratory Testing
If a suspicious lesion is identified, your doctor will remove a small section—or, in some cases, the entire lesion—for a biopsy. This sample is sent to a laboratory for a detailed microscopic examination. A biopsy not only confirms the presence of skin cancer but also determines the specific type (e.g., basal cell carcinoma, squamous cell carcinoma, or melanoma) and guides the treatment approach. Biopsy methods include shave biopsy, punch biopsy, or excisional biopsy, depending on the lesion’s characteristics
Determining the Extent of Skin Cancer
Once skin cancer is diagnosed, additional testing may be necessary to determine how far the cancer has progressed, known as its stage. Staging provides critical information to guide treatment decisions:
1. Biopsy as a Standalone Test
For superficial cancers, such as basal cell carcinoma, staging might not require additional tests. A biopsy that removes the entire growth often suffices, as these cancers rarely spread.
2. Advanced Staging Tests
For aggressive types of skin cancer, such as melanoma, squamous cell carcinoma, or Merkel cell carcinoma, further tests may be recommended:
– Imaging Tests: CT scans, MRIs, or ultrasounds might be used to assess nearby lymph nodes or organs for signs of cancer spread.
– Sentinel Lymph Node Biopsy: This involves removing and examining the nearest lymph node to the cancerous lesion for cancer cells. The sentinel lymph node is the first node where cancer is likely to spread.
3. Staging System
Skin cancer is classified into stages from I to IV using the Roman numeral system:
– Stage I: The cancer is small and confined to its original site.
– Stage II and III: The cancer has grown larger or spread to nearby tissues.
– Stage IV: The cancer has advanced significantly and spread to distant areas of the body.
Understanding the cancer’s stage is essential in tailoring the most effective treatment plan.
Treatment
Treatment for skin cancer depends on various factors, including the cancer’s size, depth, type, and location. Options range from minimally invasive procedures to more complex interventions:
1. Small, Surface-Level Cancers
In many cases, small cancers limited to the top layer of the skin can be completely removed during the initial biopsy, requiring no further treatment.
2. Additional Treatment Options
For larger or more invasive cancers, the following options may be used:
Cryosurgery (Freezing)
Liquid nitrogen is applied to destroy abnormal tissue by freezing it. This method is often used for precancerous lesions (actinic keratoses) or early-stage cancers. Once thawed, the dead tissue naturally sloughs off.
Excisional Surgery
The doctor removes the cancerous lesion along with a margin of surrounding healthy skin. For more invasive cases, a wide excision may be performed to ensure complete removal of cancer cells.
Mohs Surgery
A highly precise technique where cancerous tissue is removed in thin layers and examined
under a microscope. Layers are removed until no abnormal cells remain. This is especially
useful for sensitive areas like the face, where preserving as much healthy tissue as possible is important.
Curettage and Electrodesiccation or Cryotherapy
After removing most of the growth, the doctor scrapes away remaining cancer cells with a curette (a circular blade) and destroys residual cancer cells with an electric needle. Alternatively, liquid nitrogen can freeze the treated area. This method is suitable for basal or
thin squamous cell cancers.
Radiation Therapy
High-energy X-rays or other forms of radiation are used to destroy cancer cells. This approach is often reserved for cases where surgery isn’t an option, such as in patients with underlying health conditions or inaccessible tumor locations.
Chemotherapy
Chemotherapy may involve topical creams for surface-level cancers or systemic drugs for cancers that have spread. Systemic chemotherapy circulates throughout the body to target cancer cells in multiple locations.
Photodynamic Therapy (PDT)
PDT uses a combination of drugs that make cancer cells sensitive to light, followed by laser treatment. This method targets and destroys cancer cells without damaging surrounding healthy tissue.
Biological Therapy
This treatment boosts the body’s immune system to fight cancer cells. It involves using immune-activating drugs, such as immune checkpoint inhibitors, to enhance the natural immune response against cancer