Treatment Options for Skin Cancer

This section explains the different ways skin cancers can be removed. Once a skin cancer is diagnosed the doctors will sit down and discuss these options with you.

Many factors are critical in this decision and will have to be weighed. At this point, a final treatment plan will be formulated to best meet your medical needs.

  1. Curettage and desiccation: This involves scraping out the skin cancer with an instrument called a curette and using an electrical current to desiccate the area to further destroy any residual tumor and control any bleeding. It generally leaves a flat circular scar. It is the simplest way to treat skin cancer. It is used most often for small to mid-sized basal cell carcinomas or superficial squamous cell carcinomas.
  2. Excision: This involves cutting the skin cancer out with a scalpel. Generally the wound is then closed with sutures and results in a straight line scar usually 3-4 times longer than the tumor. The tumor is placed in formalin and sent to a pathologist to enjure that all the tumor has been removed. It is used for deeper or larger skin cancers. It is also sometimes used if the resultant scar would be more acceptable than that resulting from curettage.
  3. Plastic surgery: Plastic surgeons use the technique of excision and then closure with sutures. Plastic surgery is recommended for skin cancers that are large and may need rearrangement of the skin to close the wound. We may also recommend plastic surgery for tumors on the face where optimal scarring is desirable. Plastic surgeons do many procedures in the office under local anesthesia, but may recommend operating at a hospital or day surgery facility for more extensive tumors. Occasionally plastic surgeons will have a specimen checked rapidly by a pathologist during the procedure to ensure all tumor is removed before closing the wound. This is generally reserved when a complex closure is anticipated.
  4. Moh's surgery: This is a dermatological surgical technique of excising skin cancer. Generally when a dermatologist or plastic surgeon perform excisions they remove a margin of normal skin of approximately 3-4 mm with the tumor to ensure complete excision. The tumor is then fixed in formalin and sent to a pathology lab to check the margins to ensure that the cancer is completely removed. A Moh's surgeon takes out the tumor and then takes out a very narrow margin of skin around the tumor. The tissue is then processed right there and the surgeon evaluates the tissue to see if any tumor remains while the patient is there. If tumor is still present the surgeon takes out another narrow rim of tissue. The process is repeated until the entire cancer is removed with a minimal amount of normal skin removed. Then the defect is repaired either by the Moh's surgeon or a plastic surgeon depending on the size of the tumor defect. This procedure is often recommended for tumors in cosmetically sensitive areas such as the nose or ears, or for tumors that have recurred after previous treatment.
  5. Radiation therapy: When appropriate, this would involve seeing a radiation oncologist who directs multiple radiation treatments to a skin cancer. This is generally reserved for patients who cannot have surgery for other medical reasons or for those with such extensive cancer that surgery would be too disfiguring. It is also occasionally used as an adjunct to surgery for more aggressive skin cancers.