Skin Cancer Treatment Options

In almost all cases, basal cell and squamous cell skin cancers and even melanoma can be successfully treated if they are diagnosed and treated early.

There are several skin cancer treatment options for non-melanoma (basal and squamous cell carcinomas) and melanoma. When detected early, the skin cancer tumor is relatively thin so simple surgery excision is the standard treatment. After the skin is numbed, the tumor is cut out, along with a small amount of normal skin at the edges. Excision may be performed in the outpatient or inpatient setting depending on the extent of the cancer.

For small superficial and nodular skin cancer growth, topical cream such as the imiquimod and flourouracil cream may be prescribed. These treatments usually don't leave any scars, but they can cause considerable pain and swelling as they work.

Small basal cell and squamous cell skin cancers which are primary or not recurrent may be treated with curettage and electrodesiccation. A curette is used to scrape off the growth and then a mild electric current is used to kill of any remaining abnormal cells.

Another surgery excision called the 'Mohs micrographic surgery' may also be used. Mohs technique is used to remove the cancer without harming the healthy tissue surrounding it. The cancer is removed in layers and examined after each layer is removed. The process is repeated until the tissue shows no signs of cancer.

Cryosurgery (figure on the left), another skin cancer treatment options, uses extremely cold temperatures to destroy diseased or abnormal tissue. Liquid nitrogen or argon gas is simply applied to the abnormal cells directly using either a swab or spraying device. This form of treatment is quick with usually few, if any, side effects. The procedure deadens the skin which falls off later by itself. Cryosurgery is usually an outpatient treatment for skin cancers at its early stage.

Depending on the size of the affected area, the type of suspected cancer, and its location on your body, the doctor will do a skin biopsy and/or a lymph node biopsy to determine whether cancer has spread and to what extend from the skin. This can help the doctor decide which skin cancer treatment options to use. A stage 3 melanoma means the cancer has spread to the nearby lymph nodes and stage 4, to other organs of the body.

Once it looks like the skin cancer has spread to nearby lymph nodes and/or beyond, the prognosis is not good. A stage 3 melanoma is very unlikely to be cured by surgery alone. After surgery, it may look as if all the cancer has been removed, some of these cells may remain. Adjuvant (after-surgery) treatment is recommended by the doctor to lessen the chance of a recurrent. The standard procedure after the surgery is to in cooperate immunotherapy or chemotherapy or a combination (biochemotherapy) as skin cancer treatment options.

Immunotherapy helps a person's immune system to better attack the cancer. Currently interleukin and interferon are used to destroy melanoma cancer cells. They are chemicals produced by the immune system but are mass produced in a lab. These are injected into your bodies to inhibit the cancer cells. Because high doses must be used, they can produce side effects.

The other skin cancer treatment options chemotherapy is the use of one or a combination of drugs to kill cancer cells by interfering with the DNA (genes) of fast growing cells like cancer cells. The drugs are usually given by intro venous infusion. It can be given orally in pill form or direct infusion to the bloodstream. Once the drugs enter the bloodstream, they spread to every part of the body. Unlike Immunotherapy, the drugs are less targeted and kill not only cancer cells but damage some normal cells as well. This causes side effects and the effects depend on the type of drugs given, the dosage, and the duration of the treatment.

Radiation therapy is the use of ionizing radiation (X-ray) to kill cancer cells and shrink tumors in a targeted area. This type of treatment cannot cure advanced skin cancer, but it can shrink the tumor. It is used as the only treatment option for those patients that are good candidates for surgery. Also, radiation therapy is used as a palliative therapy, for stage 4 melanoma to relieve the symptoms and improve the life quality of the patient, or as an adjuvant treatment to destroy the remaining cancerous cells. Finally, research is being done to test the effectiveness of chemoradiation, a combination of radiation therapy and chemotherapy.

The current standard skin cancer treatment options for stage 3 and 4 melanoma is rather limited with no new approved first-line medicines for the past 15 years. We are in desperate need of new treatment as the standard therapies don't significantly increase survival in most patients. Our hopes now for new advancement in the treatment of melanoma lie on clinical trials.

Clinical trials are research studies that are carefully done with patients to determine the effectiveness and safety of new drugs or new ways to treat cancer before they are approved by the FDA. The research studies go through 4 phase of clinical trials;

- first, to determine the safety of the drug in small groups of patients that have not responded to standard treatment,

- second phase is to closely watch for an effect on the cancer, side effects and dosage of the drug in larger groups,

- the third phase is to carefully examines the effectiveness of the drug by comparison between control groups and the groups getting the best standard treatment.

- once a drug has been approved by the FDA and is available for all patients, it is still studied in other clinical trials, referred to as phase 4 studies.

A clinical trial is only done when there is good reason to believe that the treatment, test, or procedure being studied may be better than the one used now. Treatments used in clinical trials are often found to have real benefits and may go on to become tomorrow's standard skin cancer treatment options.

Clinical trials are one way to get state-of-the art cancer care, but they may not be right for everyone ! If you would like to take part in a clinical trial, you should begin by asking your doctor if your clinic or hospital conducts clinical trials. There are requirements you must meet to take part in any clinical trial. Your doctors and nurses will explain the study to you in detail. They will go over the possible risks and benefits and give you a form to read and sign. They still need your informed consent even if you decided to join. It is very important that you find out the details, the pros and cons of the clinical trial and to ask a lot of questions before you join.

# Is there a clinical trial that I could take part in?
# What is the purpose of the study?
# What kinds of tests and treatments does the study involve?
# What does this treatment do? Has it been used before?
# Will I know which treatment I receive?
# What is likely to happen in my case with, or without, this new treatment?
# What are my other choices and their pros and cons?
# How could the study affect my daily life?
# What side effects can I expect from the study? Can the side effects be controlled?
# Will I have to stay in the hospital? If so, how often and for how long?
# Will the study cost me anything? Will any of the treatment be free?
# If I am harmed as a result of the research, what treatment would I be entitled to?
# What type of long-term follow-up care is part of the study?
# Has the treatment been used to treat other types of cancers?