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surgical treatments for skin cancer

Skin Cancer Removal & Treatment Options

So you have been for your skin check, and the doctor has found a lesion or more, of concern. What treatment options are they likely to recommend?

Skin cancer is treated in different ways and treatment depends on:

  • the type, size and location of the cancer
  • your general health
  • any medicines you are taking (which may affect the amount of bleeding and healing time)
  • whether the cancer has spread to other parts of your body.
  • whether the cancer can be treated by Dr Joshi under local anaesthetic or may be better treated with you asleep (referral) 
     

If the biopsy has removed all the cancer, you may not need any further treatment. Many of the treatments described in this section are suitable for sunspots (solar keratosis/ actinic keratosis)  as well as skin cancers.

Non Surgical Treatments for Skin Cancer

Cryotherapy/ Cryosurgery

Cryotherapy is a freezing technique used to remove sunspots (sometimes considered early SCCs) and some superficial BCCs.

The doctor sprays liquid nitrogen onto the sunspot or skin cancer and a small area of skin around it, causing a burning or stinging sensation lasting a few minutes.

The liquid nitrogen freezes and kills the abnormal skin cells and creates a wound, which will be sore and red for a few days and may weep or blister until a crust eventually forms on the wound and the dead tissue will fall off after 1–4 weeks, depending on the area treated.

New, healthy skin cells will grow and a scar may develop. Healing can take a few weeks, and the healed skin will probably look paler and whiter than the surrounding skin so for extensive areas, or on darker skin, it may leave you with pale patches of skin. 

Sometimes the procedure may need to repeated more than once if the abnormal cells are deeper than anticipated or treated with other options including excision (cutting out). 

Topical treatments

Some skin spots and cancers can be treated using creams or gels prescribed by a doctor that you apply directly on the skin.

These are called topical treatments.

They may contain immunotherapy or chemotherapy drugs as their active ingredient and are applied to clean, dry skin for 3-4 weeks every night till the areas blister and scab and then heal.

These usually heal without any scarring, but can be uncomfortable and are best done in winter. These are great for treatment on the face especially if there are many lesions of concern. 

Immunotherapy

Sunspots, superficial BCCs and some SCCs in situ (Bowen disease) can be treated using a cream called imiquimod.

This is a type of immunotherapy drug that causes the body's immune system to destroy the cancer cells.

Imiquimod will be applied daily for up to 6 weeks under the direction of your doctor and can cause scabbing and crusting, which may be uncomfortable.

The treated skin may become red and inflamed and may be tender to touch. Some people have a more serious reaction to imiquimod, but this is uncommon.

Chemotherapy

5-fluorouracil (5-FU)

This cream is used to treat superficial BCCs, sunspots and, sometimes, squamous cell carcinoma in situ (Bowen disease). It works best on the face and scalp.

While using the cream, you will be more sensitive to the sun and will need to stay out of the sun. The treated skin may become red, blister, peel and crack, and often feel uncomfortable. These effects will usually settle within a few weeks after treatment has finished.

Surgery

Surgery is the most common treatment for skin cancer. It is often referred to as “definitive treatment” ie the pathologist can confirm all the cancer is gone unlike with other treatments.

It is usually a quick and simple procedure that can be performed in clinic under local anaesthetic. More complex cases may be referred to be treated by a surgeon.

Your doctor injects a local anaesthetic to numb the affected area, then cuts out the skin cancer and some nearby normal-looking tissue (margin)  before closing the wound with stitches. A pathologist checks the margin to make sure the cancer has been completely removed.

The results will be available in about a week.

If cancer cells are found in the margin, further surgery may be required to minimise the chances of recurrence, though this is always a possibility.

Sutures are usually removed 7-14 days after the procedure, and it takes upto a year for the scar to mature and to flatten and go silvery white unless there are any complications. Rarely, small segments of the suture material may be retained within the scar but they rarely cause problems and can be easily removed by your doctor. 

Repairing the wound

For large skin cancers, a bigger area of skin needs to be removed, and the wound may covered with a skin flap or skin graft.

For a skin flap, nearby loose skin or fatty tissue is moved over the wound and stitched together. For a skin graft, a thin piece of skin from a similar appearing part of the body is stitched over the wound.

These procedures may be performed in the office by Dr Joshi but equally may sometimes be done as day surgery in hospital under a local or general anaesthetic.

We can organise referral to other specialists as needed for these or if you’d prefer. 

 

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