Treatment - What is Skin Cancer? - Cancer Council Victoria

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Sunday 30 December, 2007

Reviewed by: Dr Alvin H Chong (MBBS, M. Med, FACD) Consultant Dermatologist, Skin & Cancer Foundation Victoria. Senior Lecturer in Dermatology, Dept. of Medicine (Dermatology), St Vincent's Hospital, University of Melbourne.

There are several ways to treat basal cell carcinoma and squamous cell carcinoma. In choosing the best treatment for you, your doctor will take into account a number of factors, including your age, general health, the type and size of the cancer, where it is on your body and what you want. The treatment choice will also depend on whether the cancer has spread anywhere else in your body, although this is unusual with common skin cancers.

If you have any questions about your treatment, don't hesitate to ask your doctor. It may help to make a list of questions (see the sample list at the end of this booklet) or take a close friend or relative with you.

Surgery

Most skin cancers can be simply cut out, along with a small area of normal skin from around the skin cancer. This is a simple operation that can usually be done in the doctor's rooms under local anaesthetic.

If the cancer is large or spreading, you may be admitted to hospital to have a larger amount of skin removed to make sure all the cancer cells are removed. You may have a general anaes-thetic. In most cases the wound is stitched together and heals as a straight scar.

Skin grafts or flaps

If a relatively large area of skin is removed, a skin graft may be required to cover the wound. For the graft, the surgeon will take a layer of skin from another part of your body and place it over the wound.

The other possibility is to do a ‘flap', where the surgeon will cover the wound using a flap of skin near the wound. It is left attached at one end to provide a blood supply. Most people, however, will be able to have the skin sewn up without a graft or flap.

After the operation

You may be uncomfortable for several days. If you have pain, your doctor will prescribe pain relievers for you.

If you had a skin graft, the area where the skin was grafted on may look unattractive immediately after the operation, but eventually it will heal and the redness will fade. There is a risk of infection, haematoma and scarring. Occasionally, the skin graft fails. If this happens, your doctor will advise you of the best next course of treatment.

Cryotherapy

Often people have some blistering and scabbing for one to two weeks after treatment. It can take up to 4 weeks for the area to heal, and it may leave a pale scar. Areas treated on the leg can take longer to heal.

Sometimes more than one treatment is needed to remove the cancer or keratosis completely.

Curettage and cautery

This procedure is also known as electrodesiccation and curettage. If you have only a small basal cell carcinoma, your doctor may simply scrape it off under local anaesthetic using a small instrument called a curette. The doctor may then use cautery to control any bleeding and to destroy any remaining cancer cells. Cautery involves using a needle to pass a very mild electric current into the area. This technique commonly leaves a pale scar.

The main advantage of this treatment is that it is simple. It can be done in a doctor's room, and you may be able to get back to normal activities very quickly.

Radiotherapy

Radiotherapy treats cancer by using radiation to destroy the cancer cells. It is given by machines that target intense beams of radiation onto the cancer.

Radiotherapy is not often used to treat early skin cancers, but it is valuable in situations where surgery could be difficult or disfiguring. It may also be used if a person is medically unfit for surgery. The main role for radiotherapy is to complement surgery in the treatment of locally advanced skin cancers and those that have spread to nearby lymph nodes. The treatment is often divided into several doses, given over 2 to 6 weeks depending on the severity of the problem. It is painless and only takes a few minutes for each treatment.

Side effects of radiotherapy

Skin in the treatment area may become red and sore after 2 or 3 weeks of treatment. From the start of your treatment, you will need to take care washing and avoid shaving the area or wearing clothing that can rub. Check with your doctor or nurse before using any talcum powders or lotions. Ask a member of your radiotherapy treatment team for a cream to ease any burning sensation. See coping with radiotherapy.

Chemotherapy cream

This cream is used for the treatment of cancer with anti-cancer drugs. The drugs work by destroying cancer cells.

If topical chemotherapy is used in skin cancer treatment, a cream containing a medication called 5-fluorouracil (Efudix) is applied directly to skin. This cream is mainly used for the treatment of solar keratoses. It is used every day, often for several weeks. The skin in the area may become red and inflamed, but this will only be temporary and there are usually no other side effects. The advantage of this treatment is that you can do it at home, there are no injections and usually there is no scar. However, it is only recommended for shallow cancers.

Immunotherapy

This involves stimulating the body's immune system to fight the skin cancer more vigorously. It is used to treat solar keratoses and some basal cell carcinomas.

A cream containing the drug imiquimod is applied to the cancer. It boosts the immune response in the area where it is applied. The treatment is taken for about 6 weeks. It causes reddening and sometimes scabbing of the affected skin, which may be present for up to 3 months. The skin settles down after treatment with little or no scarring.

Photodynamic therapy

This is another method of treating some basal cell carcinomas and solar keratoses. It involves the use of a chemical that is activated by a special light source.

The chemical is applied in a cream form to the lesion and left on for 3 to 4 hours. Abnormal cells absorb the cream during this time. After this, an intense light source is shone onto the area for a few minutes. The abnormal cells which have absorbed the cream are selectively destroyed by the light, while normal skin cells are not affected. The treated area will form scabs and then heal over the next one to two weeks, leaving little or no scarring.

Prognosis

More than 99% of people with basal cell carcinoma and squamous cell carcinoma are cured. The prognosis is good for most skin cancers that are found and treated early.

After your treatment for common skin cancer is complete, your doctor may want you to have regular check-ups for a time to make sure there is no cancer remaining and that treatment has been successful.

If you have had one skin cancer, you are at increased risk of developing another one. If you notice any changing or new spots, or are worried between appointments, it is a good idea to tell your doctor as soon as possible.

You will need to talk with your doctor about your own prognosis. Your medical history is unique, so you will need to discuss with someone who knows your medical history what you can expect and the treatment options that are best for you.

Do solar keratoses need treatment?

You may be advised to have a solar keratosis removed because your doctor feels it is at risk of becoming a squamous cell carcinoma. Or you may want to have one removed because of its appearance, or symptoms it is causing.

If you want a solar keratosis removed, the options are similar to those described above for common skin cancer: cryotherapy, cautery, chemotherapy cream , immunotherapy or photodynamic therapy.

A solar keratosis may respond to a simple moisturiser and keeping it out of the sun. Most are easily treated with freezing (cryotherapy). If your doctor is not sure whether the spot is a skin cancer or a solar keratosis, a piece may be cut out and sent to a laboratory for diagnosis (biopsy).

Protecting your skin

Whenever UV radiation levels reach 3* (moderate) and above, sun protection is required. At that level UV radiation is intense enough to damage the skin and eyes and contribute to the risk of skin cancer.

In Victoria from September to April, UV radiation levels are 3 and above for most of the day. Particular care should be taken between 10 am and 2 pm (11 am and 3 pm daylight saving time) when UV radiation levels reach their peak.

The SunSmart UV Alert is issued by the Bureau of Meteorology when the UV Index is forecast to reach 3 and above and tells you the time sun protection is needed for the day. It is reported in most daily newspapers and some television and radio weather forecasts across Australia. It is also on the Bureau of Meteorology website (www.bom.gov.au/weather/uv and SunSmart website www.sunsmart.com.au).

To protect against skin damage and skin cancer when the UV level is 3 and above, use a combination of 5 sun protection measures:

Slip on some sun-protective clothing-cover as much skin as possible.
Slop on SPF30+ sunscreen-make sure it is broad spectrum and water resistant. Put it on 20 minutes before you go outdoors and every 2 hours afterwards. Sunscreen should never be used to extend the time you spend in the sun.
Slap on a hat - one that protects your face, head, neck and ears.
Seek shade.
Slide on some sunglasses and make sure they meet Australian Standards.

From May to August, UV radiation levels in Victoria are usually low (below 3). Therefore, sun protection measures are not necessary during these months unless you are in alpine re-gions, or near highly reflective surfaces, such as snow or water.

* The Global Solar UV Index is a rating system adapted from the World Health Organization.
It ranges from: