Skin cancer is a prevalent condition, and patients often hear about Mohs micrographic surgery as a leading treatment option. While effective, it is not the only approach for treating skin cancers. Various non-surgical and surgical methods exist, offering suitable alternatives depending on the specific type, stage, and location of the cancer.
Understanding Mohs Micrographic Surgery
Mohs micrographic surgery is a specialized technique for removing skin cancer, characterized by its precision and high success rates. During the procedure, the surgeon removes thin layers of cancerous tissue one layer at a time. Each excised layer is immediately examined under a microscope in an on-site laboratory to check for remaining cancer cells. This real-time microscopic evaluation allows the surgeon to precisely identify and remove only the diseased tissue, preserving as much healthy skin as possible.
This process continues until no cancer cells are detected at the margins of the removed tissue. Mohs surgery is particularly effective for basal cell carcinoma and squamous cell carcinoma, especially when cancers are located in cosmetically sensitive areas like the face, ears, or hands, or in high-risk areas where recurrence is common. The technique boasts cure rates ranging from 97% to 99% for new cases of basal cell carcinoma and squamous cell carcinoma, and it minimizes scarring due to its tissue-sparing nature.
Non-Surgical Treatment Options
For certain skin cancers, non-surgical treatments offer effective alternatives to Mohs surgery, particularly for superficial lesions. These methods aim to destroy cancer cells without extensive tissue removal.
Topical Therapies
Topical therapies involve applying medicated creams directly to the affected skin. Imiquimod cream, marketed as Aldara or Zyclara, stimulates the body’s immune system to attack and eliminate cancer cells. It is applied five days a week for six weeks for superficial basal cell carcinoma, with cure rates up to 82%.
Another option is 5-fluorouracil, known as Efudex or Carac, a topical chemotherapy that destroys abnormal cells on or near the skin’s surface. This cream is applied twice daily for about four weeks and can achieve up to a 92% cure rate for superficial squamous cell carcinoma (Bowen’s disease). These creams are used for superficial basal cell carcinoma, squamous cell carcinoma in situ, and actinic keratoses.
Radiation Therapy
Radiation therapy uses high-energy rays to destroy cancer cells. This treatment is administered over several weeks, requiring multiple visits. It is chosen for patients who may not be suitable candidates for surgery, such as elderly individuals or those with other medical conditions that make surgery risky. Radiation can also be used for tumors in specific locations where surgical removal would be challenging or could lead to significant cosmetic impact.
Photodynamic Therapy (PDT)
Photodynamic therapy involves a two-step process: a photosensitizing agent is applied to the skin, then absorbed by abnormal cells. After a few hours, the treated area is exposed to a specific type of light, which activates the agent, destroying the targeted cancer cells. PDT is known for its favorable cosmetic outcomes, resulting in less scarring compared to other treatments. It is used for superficial basal cell carcinoma and squamous cell carcinoma, as well as precancerous lesions like actinic keratoses.
Other Surgical Approaches
Beyond Mohs surgery, several other surgical techniques are employed to remove skin cancers, each suited for different scenarios. These methods vary in their invasiveness and the amount of surrounding healthy tissue removed.
Surgical Excision
Surgical excision is a conventional method where the cancerous tumor is cut out along with a margin of healthy surrounding tissue. This margin ensures all cancer cells are removed. The excised tissue is sent to a lab for microscopic examination to confirm clear margins. This procedure is effective for various types of skin cancers, particularly those with clearly defined borders or in areas where a wider removal of tissue is acceptable.
Curettage and Electrodesiccation
Curettage and electrodesiccation is a two-part technique used for smaller, less aggressive basal cell and squamous cell carcinomas, as well as precancerous lesions. First, a curette, a spoon-shaped instrument, scrapes away the tumor. An electric needle then applies low-level heat to the treated area, destroying any remaining cancer cells and controlling bleeding. This process is repeated one or two times during the same visit to ensure thorough treatment. The wound heals within a few weeks, leaving a small, flat, round, white scar.
Cryosurgery
Cryosurgery involves using extreme cold, liquid nitrogen, to freeze and destroy skin cancer cells. This method is applied to superficial lesions, such as actinic keratoses and some small, low-risk basal cell carcinomas. The freezing process causes the cancer cells to rupture and die, and the treated lesion eventually scabs over and falls off. While less invasive, the cosmetic outcome can vary, and it is reserved for specific types of lesions.
Factors Influencing Treatment Choice
The selection of the most suitable skin cancer treatment is a personalized decision, guided by a range of factors. A dermatologist considers the specific characteristics of the skin cancer, including its type and subtype. Basal cell carcinoma and squamous cell carcinoma have different optimal treatments compared to melanoma.
The tumor’s size, exact location on the body, and its depth within the skin layers significantly influence the choice. For instance, cancers on the face or other cosmetically sensitive areas might lean towards tissue-sparing methods. The patient’s overall health, including any existing medical conditions or medications, also plays a role in determining suitability for different procedures. Cosmetic outcomes and the patient’s preferences regarding recovery time and appearance are also weighed in the decision-making process. Consulting with a qualified dermatologist provides a comprehensive assessment and a tailored recommendation for the most effective treatment plan.