This is a local destructive method. Under local anesthesia, the tumor is curetted (scraped) and electrodessicated (burned). This leaves an open raw area like a scrape, which heals on its own with a scar that is about the size and shape of the tumor and is initially red but usually turns white.
This is a very simple procedure with an excellent cure rate for selected tumors. Since the tumor is removed in a fragmented fashion, there is no specimen going back to the lab to verify that it has been totally removed. The removal is based on the way the tissue handles and the doctor's clinical judgment. As with any removal method, there is a possibility that the tumor could recur, so the area needs to be monitored.
This treatment is particularly good for superficial tumors and lesions on the trunk and extremities. It can be used on facial lesions, particularly if they are small and the scar is of lesser concern. Lower legs may experience slower healing than other sites.
This tends to be a very cost effective method of treatment.
The tumor is excised or cut out, and the incision is stitched closed. This method can be performed by Dr. Elizabeth Spiers in the office with the patient under local anesthesia or can be done by another physician, such as a plastic surgeon.
Excision involves providing a specimen to the laboratory to ensure that the tumor has been completely removed. If the margins test positive for remaining cancer, then the procedure has to be repeated.
Risks include bleeding, infection, dehiscence (popping the sutures or fresh scar open), damage to underlying structures, and others. There is some limitation of activity possible, depending on the area treated, for as long as one month to minimize the risk of dehiscence. This procedure usually leaves a line scar, which can be camouflaged among existing lines/wrinkles on the face. On the back or other areas subject to tension, scars tend to spread.
Learn more about Dr. Spiers, her education, and her experience. As a practicing dermatologist and clinical associate professor, she values education to ensure her patients receive the treatments that will best benefit them.
This procedure is named for the doctor who developed it. It is done by a dermatologist with a more advanced surgical sub-specialization. In this technique, performed in the physician's office, the patient receives local anesthesia while portions of skin are removed for examination by frozen section. These portions of tissue are removed from the involved area and tested until the tumor has been completely removed. Then the physician will repair the area. Occasionally, the wound will be allowed to heal on its own. Skin grafts or flaps can be performed if needed for closure.
This procedure is especially good for large tumors, aggressive tumors, recurrent tumors, and tumors in important cosmetic areas, among others. It may not be appropriate treatment for some less aggressive tumors on the trunk or extremities. Depending on the number of stages needed to clear the tumor and then to complete the repair, it can involve a very long day in the doctor's office, making it difficult for some very elderly patients to handle. Mohs surgery has the highest cure rate for skin cancer treatment.
This medication is approved by the FDA for the treatment of actinic keratosis and superficial basal cell carcinoma. There are studies showing its effectiveness in squamous cell carcinoma in situ as well. It appears to work by releasing interferon from the cells in the skin where it is applied. It usually causes significant irritation at the application site. The medication is used for approximately six weeks. It is not appropriate for all tumors and appears to have somewhat lower cure rate than surgery. The advantage of this approach would be to minimize scarring. Occasionally, a post-treatment biopsy is advised to ensure that the medication has been effective. If the tumor has not cleared, surgery would then be required. This treatment is not advised for pregnant or nursing women.
Radiation therapy is occasionally used for large tumors in older patients who are not good surgical candidates. Generally multiple treatments over several weeks' time are required, and the process may be quite costly. It is not recommended for younger patients.
This is the first oral drug for the treatment of advanced basal cell carcinoma. It is approved for the treatment of basal cell carcinomas that have metastasized (a very rare occurrence), as well as for tumors that cannot be treated adequately with surgery or radiation. It is taken daily, and results can take months. Side effects may include muscle spasms, taste loss, nausea, and vomiting. In some cases, the severity of side effects can lead to discontinuation of treatment. It is a very expensive medication.
Learn more about skin cancer treatment options. Philadelphia-area patients can contact Dr. Elizabeth Spiers' office by phone (215) 230-4592.