Chemotherapy

Treatment depends on the

• type of skin cancer
• its stage and location and the
• individual's age and overall health

People with small basal cell carcinomas, for instance, may need only simple treatment. That's because basal cell cancers rarely spread to other parts of the body and seldom are fatal. Squamous cell carcinomas have a greater tendency to spread, and may require more treatment. Malignant melanoma may require complicated treatment because of its high risk for spreading.

Skin cancers are usually treated by a dermatologist, a doctor who specializes in skin diseases. Treatment often can be done in the doctor's office. Most require only a local anesthetic. The patient goes home after treatment, and can soon resume regular activities.

Some tiny skin cancers are completely removed and cured during the biopsy. No more treatment is needed. However, most require additional treatment to eliminate all of the cancer cells.

Three kinds of treatment are used for most skin cancers. They re:

• Surgery: Taking out or destroying the cancer.
• Chemotherapy: Giving drugs to kill the cancer cells.
• Radiation therapy: Using powerful energy from x-rays or other sources to destroy the cancer cells.

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Surgery

Surgery is the most common treatment. The doctor may use any of several surgical methods:

• Simple excision involves cutting out the tumor with a margin of surrounding normal skin to be sure it is completely removed.
• Cryosurgery (cryo = "cold") freezes and kills the cancer cells. It uses liquid nitrogen, which has a temperature of 196 degrees below zero centigrade. The extreme cold instantly kills the tumor, which falls off like a scab after the area thaws. Cryosurgery itself is painless. However, the treated area may become swollen and painful after it thaws. Cryosurgery is used mainly for small or superficial skin cancers, and to remove precancerous growths.
• Curettage and electrodessication combines two methods. In one, the doctor uses a curette, a sharp, spoon-shaped instrument, to scoop out the tumor. The area is then treated with electrodessication, applying electrical current produced by a special machine. It controls bleeding, and dehydrates and kills any cancer cells remaining near the edge of tumor area.
• Micrographic surgery (or Mohs surgery) attempts to remove all of the tumor and as little surrounding normal tissue as possible. The doctor removes one layer of tumor, and examines it with a microscope. If cancer cells are present he removes another layer, and examines that. The process continues until all cancer cells have been removed.
• Laser surgery uses the highly focused beam of light from a laser to destroy cancer cells. It is seldom used for cancers that have not grown beyond the outer layer of the skin.
  Modern ways of doing surgery reduce the amount of scar tissue that forms afterward. Nonetheless, skin cancer surgery will leave a visible scar. Its size usually depends on the size of the cancer and the amount of tissue removed during surgery.
• Cryosurgery for a small tumor usually leaves a faint, white scar that is barely visible.
• Treatment of large cancers may require a skin graft to close the defect. Grafting involves removing skin from another part of the body and moving it to the area where the cancer was removed. Scars often fade and become less visible with time.

Chemotherapy

Chemotherapy means treatment with anti-cancer drugs. The treatment for skin cancer often uses anti-cancer drugs in a lotion or cream applied to the skin. This localized, or topical, chemotherapy is for superficial tumors that have not advanced beyond the top layer of the skin. Topical chemotherapy usually does not produce nausea or other body-wide side effects. It does cause redness and inflammation in treated parts of the skin.

Systemic chemotherapy also may be given in a pill, injected into a muscle, or intravenous form through a needle in a vein. This body-wide, or systemic, chemotherapy can kill cancer cells that have spread outside the skin. It may cause nausea and other side effects in some individuals. Side effects are common, but can generally be controlled. This treatment is generally used only for metastic cancer.

Radiation Therapy

Radiation therapy, or radiotherapy, uses a special kind of energy carried by invisible rays or particles to kill cancer cells, or keep them from growing. X-rays are the kind of radiation often used to kill skin cancer. The amounts are much higher than those used in an ordinary mammogram or chest x-ray. This therapy often is used for cancers that occur in areas difficult to treat with surgery, especially in the very elderly, who may be unable to safely undergo surgery. These include cancers on the ears, eyelids, and tip of the nose.

Treatment is painless and does not make the body radioactive. Several treatments may be needed to kill all of the cancer cells.

Radiation therapy may cause:

• Rash, redness, or dryness in the area. Those changes are temporary and disappear.
• Other changes in skin texture or color may develop after radiation therapy. They may become more noticeable years later.

Other Treatments

Several other treatments may be used for skin cancer, including:

• Photodynamic therapy uses drugs that collect inside a tumor. The doctor then focuses a special light on the tumor. The light triggers a chemical reaction in the drug that destroys tumor cells, but does not harm surrounding normal tissue.
• Biological therapy tries to use the body's own natural defenses to attack and destroy cancer cells. It sometimes is called biological response modifier (BRM) therapy or immunotherapy. In one form of biological therapy, disease-fighting white blood cells are removed. The cells are grown in a laboratory and exposed to substances that boost their disease-fighting ability. The activated cells then are injected back into the body to attack the tumor. Biological therapy is used mainly for advanced forms of cancer that cannot be treated with other methods. It is available in clinical trials, studies conducted in medical centers to determine its safety and effectiveness.