Surgery for Skin Cancer

Skin cancer is by far the most common cancer in the world. Although several risk factors exist, most skin cancers occur in older patients and are a result of ultraviolet light from years of exposure to sunlight or your local tanning bed.

Skin cancers can generally be classified into two main categories: melanoma and nonmelanoma. Melanoma is an unpredictable disease with a penchant for spreading throughout the body. Of the nonmelanoma skin cancers, basal cell and squamous cell carcinomas are the most common. These cancers rarely spread to other sites of the body, but do have a tendency to grow locally and thus still require treatment.

Fortunately, nonmelanoma skin cancers respond well to modern treatments, so the goal is not simply to cure the disease, but to do so with maximal preservation of function and cosmesis. Each patient is different and each tumor is different, therefore any treatment must be customized to account for individual factors. Surgery, including Moh’s surgery, may be the most effective and efficient means to address skin cancer, but depending on the location and size of the tumor, radiation therapy is often the better option.

Hopefully, if you’ve been treated for skin cancer, the option of radiation therapy (RT) was one of many that were discussed. RT tends to be an excellent treatment for patients age 60 or older with skin cancers involving the face (especially near the nose, check, lip, or eyelid) as it offers high cure rates as well as an excellent cosmetic outcome. RT may also be indicated in cases when the tumor appears particularly aggressive or is not completely removed after surgery, known as positive margins.

The downside to radiation therapy is convenience. The treatment involves daily (weekday), 30-minute, visits to the Tri-Cities Cancer Center for 3-6 weeks. Fortunately, the treatments themselves are short and painless. Numerous studies have been published on this approach and tumor control rates are consistently above 90% with very mild side effects, including skin dryness, peeling, and irritation when the treatment is performed by experienced radiation oncologists.

In the majority of cases, skin cancers are diagnosed by dermatologists who are trained to perform skin biopsies and surgical removal. Naturally, when a skin cancer
is found, and a skin surgeon is standing right in front of you, it’s easy to think surgery is what should be done, but patients should always be made aware of other treatment options. Thus, it is important for all patients who are diagnosed with skin cancer to have a second opinion with a radiation oncologist before they decide on the best treatment for them. A word of caution, radiation therapy should never be recommended, offered, or delivered outside of a radiation clinic at a cancer center and only be delivered by a trained radiation oncologist.

A precancerous form of squamous cell carcinoma, known as actinic keratosis, is also effectively treated with a non-surgical treatment known as photodynamic therapy (PDT). PDT is a very unique approach that was developed at the National Cancer Institute. This treatment involves injection of a photosensitizing agent which accumulates in abnormal cells. This agent is then activated with a certain wavelength of light that results in destroying these precancerous cells. Results from this treatment approach appear better than other current approaches including cryotherapy.

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