Health

Skin Cancer: Diagnosis & Treatment

Diagnosis & Treatment For Skin Cancer

Detection and Diagnosis

Detection

The cure rate for skin cancer could be 100 percent if all skin cancers were brought to a doctor’s attention before they had a chance to spread. Therefore, people should check themselves regularly for new growths or other changes in the skin. Any new, colored growths or any changes in growths that are already present should be reported to the doctor without delay. (See the How To Do a Skin Self-Exam section below for a simple guide on how to do a skin self-exam.)

Doctors should also look at the skin during routine physical exams. People who have already had skin cancer should be sure to have regular exams so that the doctor can check the skin—both the treated areas and other places where cancer may develop.

Diagnosis

Basal cell carcinoma and squamous cell carcinoma are generally diagnosed and treated in the same way. When an area of skin does not look normal, the doctor may remove all or part of the growth. This is called a biopsy. To check for cancer cells, the tissue is examined under a microscope by a pathologist or a dermatologist. A biopsy is the only sure way to tell if the problem is cancer.

Doctors generally divide skin cancer into two stages: local (affecting only the skin) or metastatic (spreading beyond the skin). Because skin cancer rarely spreads, a biopsy often is the only test needed to determine the stage. In cases where the growth is very large or has been present for a long time, the doctor will carefully check the lymph nodes in the area. In addition, the patient may need to have additional tests, such as special x-rays, to find out whether the cancer has spread to other parts of the body. Knowing the stage of a skin cancer helps the doctor plan the best treatment. 

Treatment Planning

In treating skin cancer, the doctor’s main goal is to remove or destroy the cancer completely with as small a scar as possible. To plan the best treatment for each patient, the doctor considers the location and size of the cancer, the risk of scarring, and the person’s age, general health, and medical history.

It is sometimes helpful to have the advice of more than one doctor before starting treatment. It may take a week or two to arrange for a second opinion, but this short delay will not reduce the chance that treatment will be successful. There are a number of ways to find a doctor for a second opinion:

• The patient’s doctor may be able to suggest a doctor, such as a dermatologist or a plastic surgeon, who has a special interest in skin cancer.

• The Cancer Information Service, at 1-800-4-CANCER, can tell callers about treatment facilities, including cancer centers and other programs that are supported by the National Cancer Institute.

• Patients can get the names of doctors from local and national medical societies, a nearby hospital, or a medical school.

• The Directory of Medical Specialists lists doctors’ names and gives their background. It is in most public libraries.

Treating Skin Cancer

Treatment for skin cancer usually involves some type of surgery. In some cases, doctors suggest radiation therapy or chemotherapy. Sometimes a combination of these methods is used.

Surgery

Many skin cancers can be cut from the skin quickly and easily. In fact, the cancer is sometimes completely removed at the time of the biopsy, and no further treatment is needed.

Curettage and Electrodesiccation

Doctors commonly use a type of surgery called curettage. After a local anesthetic numbs the area, the cancer is scooped out with a curette, an instrument with a sharp, spoon-shaped end. The area is also treated by electrodesiccation. An electric current from a special machine is used to control bleeding and kill any cancer cells remaining around the edge of the wound. Most patients develop a flat, white scar.

Mohs’ Surgery

Mohs’ technique is a special type of surgery used for skin cancer. Its purpose is to remove all of the cancerous tissue and as little of the healthy tissue as possible. It is especially helpful when the doctor is not sure of the shape and depth of the tumor. In addition, this method is used to remove large tumors, those in hard-to-treat places, and cancers that have recurred. The patient is given a local anesthetic, and the cancer is shaved off one thin layer at a time. Each layer is checked under a microscope until the entire tumor is removed. The degree of scarring depends on the location and size of the treated area. This method should be used only by doctors who are specially trained in this type of surgery.

Cryosurgery

Extreme cold may be used to treat precancerous skin conditions, such as actinic keratosis, as well as certain small skin cancers. In cryosurgery, liquid nitrogen is applied to the growth to freeze and kill the abnormal cells. After the area thaws, the dead tissue falls off. More than one freezing may be needed to remove the growth completely. Cryosurgery usually does not hurt, but patients may have pain and swelling after the area thaws. A white scar may form in the treated area.

Laser Therapy

Laser therapy uses a narrow beam of light to remove or destroy cancer cells. This approach is sometimes used for cancers that involve only the outer layer of skin.

Grafting

Sometimes, especially when a large cancer is removed, a skin graft is needed to close the wound and reduce the amount of scarring. For this procedure, the doctor takes a piece of healthy skin from another part of the body to replace the skin that was removed.

Radiation

Skin cancer responds well to radiation therapy (also called radiotherapy), which uses high-energy rays to damage cancer cells and stop them from growing. Doctors often use this treatment for cancers that occur in areas that are hard to treat with surgery. For example, radiation therapy might be used for cancers of the eyelid, the tip of the nose, or the ear. Several treatments may be needed to destroy all of the cancer cells. Radiation therapy may cause a rash or make the skin in the area dry or red. Changes in skin color and/or texture may develop after the treatment is over and may become more noticeable many years later.

Topical Chemotherapy

Topical chemotherapy is the use of anticancer drugs in a cream or lotion applied to the skin. Actinic keratosis can be treated effectively with the anticancer drug fluorouracil (also called 5-FU). This treatment is also useful for cancers limited to the top layer of skin. The 5-FU is applied daily for several weeks. Intense inflammation is common during treatment, but scars usually do not occur.

Clinical Trials

In clinical trials (research studies with cancer patients), doctors are studying new treatments for skin cancer. For example, they are exploring photodynamic therapy, a treatment that destroys cancer cells with a combination of laser light and drugs that make the cells sensitive to light. Biological therapy (also called immunotherapy) is a form of treatment to improve the body’s natural ability to fight cancer. Interferon and tumor necrosis factor are types of biological therapy under study for skin cancer.

Followup Care

Even though most skin cancers are cured, the disease can recur in the same place. Also, people who have been treated for skin cancer have a higher-than-average risk of developing a new cancer elsewhere on the skin. That’s why it is so important for them to continue to examine themselves regularly, to visit their doctor for regular checkups, and to follow the doctor’s instructions on how to reduce the risk of developing skin cancer again. 

Questions To Ask the Doctor

Skin cancer has a better prognosis, or outcome, than most other types of cancer. Although skin cancer is the most common type of cancer in this country, it accounts for much less than 1 percent of all cancer deaths. It is cured in 85 to 95 percent of all cases. Still, any diagnosis of cancer can be frightening, and it’s natural to have concerns about medical tests, treatments, and doctors’ bills.

Patients have many important questions to ask about cancer, and their doctor is the best person to provide answers. Most people want to know exactly what kind of cancer they have, how it can be treated, and how successful the treatment is likely to be. The following are some other questions that patients might want to ask their doctor:

• What types of treatment are available?
• Are there any risks or side effects of treatment?
• Will there be a scar?
• Will I have to change my normal activities?
• How can I protect myself from getting skin cancer again?
• How often will I need a checkup?

Some patients become concerned that treatment may change their appearance, especially if the skin cancer is on their face. Patients should discuss this important concern with their doctor. And they may want to have a second opinion before treatment. (See the Treatment Planning section.) 

Skin Cancer Research

Scientists at hospitals and research centers are studying the causes of skin cancer and looking for new ways to prevent the disease. They are also exploring ways to improve treatment.

When laboratory research shows that a new prevention or treatment method has promise, doctors use it with people in clinical trials. These trials are designed to answer scientific questions and to find out whether the new approach is both safe and effective. People who take part in clinical trials make an important contribution to medical science and may have the first chance to benefit from improved methods.

People interested in taking part in a trial should discuss this option with their doctor. Taking Part in Clinical Trials: What Cancer Patients Need To Know is a National Cancer Institute booklet that explains some of the possible benefits and risks of such studies.

One way to learn about clinical trials is through PDQ, a computerized resource developed by the National Cancer Institute. This resource contains information about cancer treatment and about clinical trials in progress all over the country. The Cancer Information Service can provide PDQ information to patients and the public. 

How To Do a Skin Self-Exam

You can improve your chances of finding skin cancer promptly by performing a simple skin self-exam regularly.

The best time to do this self-exam is after a shower or bath. You should check your skin in a well-lighted room using a full-length mirror and a hand-held mirror. It’s best to begin by learning where your birthmarks, moles, and blemishes are and what they usually look like. Check for anything new—a change in the size, texture, or color of a mole, or a sore that does not heal.

Check all areas, including the back, the scalp, between the buttocks, and the genital area.

1. Look at the front and back of your body in the mirror, then raise your arms and look at the left and right sides.

2. Bend your elbows and look carefully at your palms; forearms, including the undersides; and the upper arms.

3. Examine the back and front of your legs. Also look between your buttocks and around your genital area.

4. Sit and closely examine your feet, including the soles and the spaces between the toes.

5. Look at your face, neck, and scalp. You may want to use a comb or a blow dryer to move hair so that you can see better.

By checking your skin regularly, you will become familiar with what is normal. If you find anything unusual, see your doctor right away. Remember, the earlier skin cancer is found, the better the chance for cure.