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Skin Cancer

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Skin Cancer

Dedicated to Excellence in Patient Care & Education.

GENERAL

ACTINIC KERATOSIS

An actinic keratosis (AK) is a rough, dry, scaly patch or growth that forms on the skin. An AK forms when the skin is badly damaged by ultraviolet (UV) rays from the sun or indoor tanning.

Treatments

The physician scrapes or shaves off part or all of the lesion, then applies heat or a chemical agent to stop the bleeding and potentially kill any remaining AK cells.

The physician applies liquid nitrogen to the AK to freeze the tissue. Later, the lesion and surrounding frozen skin may blister or become crusted and fall off.

(PDT) is especially useful for widespread lesions on the face and scalp. The physician applies a light-sensitizing topical agent to the lesions, then uses a strong light to activate the topical agent, destroying the AKs while sparing healthy tissue.

Doctors may combine therapies for a period of time to treat AKs. Typically, treatment regimens combine cryosurgery with PDT or a topical agent like imiquimod, diclofenac, ingenol mebutate,  or 5-fluorouracil (5-FU). The topical medications and PDT may also be used alternately every three months, six months or year, as determined by the physician at follow-up skin examinations.

If you have numerous or widespread actinic keratoses, your doctor may prescribe a topical cream, gel or solution. These can treat visible and invisible lesions with a minimal risk of scarring. Doctors sometimes refer to this type of therapy as “field therapy,” since the topical treatments can cover a wide field of skin as opposed to targeting isolated lesions.

  • 5-fluorouracil (Carac®, Efudex®, Fluoroplex®): a form of topical chemotherapy.
  • Imiquimod (Aldara®, Zyclara®): A form of topical immunotherapy, it stimulates the immune system to produce interferon, a chemical that attacks cancerous and precancerous cells.
  • Ingenol mebutate (Picato®): A rapidly effective topical therapy derived from plants. An immunologic mechanism of action has been proposed.
GENERAL

BASAL CELL CARCINOMA

BCCs are abnormal, uncontrolled growths or lesions that arise in the skin’s basal cells, which line the deepest layer of the epidermis (the outermost layer of the skin). BCCs often look like open sores, red patches, pink growths, shiny bumps, or scars and are usually caused by a combination of cumulative and intense, occasional sun exposure. BCC almost never spreads (metastasizes) beyond the original tumor site. Only in exceedingly rare cases can it spread to other parts of the body and become life-threatening. It shouldn’t be taken lightly, though: it can be disfiguring if not treated promptly.

Treatments

A biopsy is a small sampling of the skin tissue. The area is numbed with local anesthetic and then a small piece of tissue is removed. Depending on the type of biopsy taken, sometimes sutures are required. Once proven by biopsy to be a Basal Cell Carcinoma, there are several treatment options, depending on the specific type of Basal Cell Carcinoma.

This technique is usually reserved for small lesions. The growth is scraped off with a curette, an instrument with a sharp, ring-shaped tip, then the tumor site is desiccated (burned) with an electrocautery needle. The procedure has cure rates generally above 95 percent.

Using a scalpel, the physician removes the entire growth along with a surrounding border of apparently normal skin as a safety margin. The skin around the surgical site is closed with stitches, and the tissue specimen is sent to the laboratory to verify that all cancerous cells have been removed. Cure rates are generally above 95 percent in most body areas, similar to those of curettage and electrodesiccation. A repeat excision may be necessary on a subsequent occasion if evidence of skin cancer is found in the specimen.

X-ray beams are directed through the skin at the tumor, with no need for cutting or anesthesia. Total destruction usually requires several treatments over a few weeks, or sometimes daily for one month. This is ideal for tumors hard to manage surgically and for elderly patients or others in poor health. Cure rates are around 90 percent.  Although radiation limits damage to adjacent tissue, it can involve long-term cosmetic problems and radiation risks.

PDT is FDA-approved for the treatment of superficial or nodular BCC, with cure rates ranging from 70 to 90 percent. A light-sensitizing agent, topical 5-aminolevulinic acid (5-ALA), is applied to the lesion in the physician’s office. Subsequently, the medicated area is activated by a strong blue light; theoretically, this will selectively destroy BCCs while causing minimal damage to surrounding normal tissue. Some redness, pain, and swelling can result. Patients must strictly avoid sunlight for at least 48 hours, or UV exposure may further activate the medication, causing severe sunburn.

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A physician trained in Mohs micrographic surgery removes a thin layer of tissue containing the tumor. While the patient waits, frozen sections of this excised layer are mapped in detail and examined under a microscope, generally in an on-site laboratory. If cancer is present in any area of the excised tissue, the procedure is repeated only on the body area where those cancer cells were identified (the tissue mapping allows the Mohs surgeon to pinpoint this area of the body), until the last excised layer viewed microscopically is cancer-free. This technique can save the greatest amount of healthy tissue and has the highest cure rate, 99 percent or better. It is often used for large tumors in cosmetically important areas, and those that have recurred, are poorly demarcated (hard to pinpoint), or are in critical areas.

  • Imiquimod: FDA-approved only for superficial BCCs, with cure rates generally between 80 and 90 percent. The cream is rubbed gently into the tumor five times a week for up to six weeks or longer. The first in a new class of drugs that work by stimulating the immune system, it causes the body to produce interferon, a chemical that attacks cancer.
  • 5-Fluorouracil (5-FU): a chemotherapy drug approved to treat internal cancers, also has been FDA-approved for superficial BCCs, with similar cure rates to imiquimod. The liquid or cream is gently rubbed into the tumor twice a day for three to six weeks. Side effects are variable, and some patients do not experience any discomfort, but redness, irritation, and inflammation usually occur.
GENERAL

SQUAMOUS CELL CARCINOMA

Squamous cell carcinoma (SCC), the second most common form of skin cancer, is an uncontrolled growth of abnormal cells arising from the squamous cells in the epidermis, the skin’s outermost layer. SCCs often look like scaly red patches, open sores, warts or elevated growths with a central depression; they may crust or bleed. Cumulative, long-term exposure to ultraviolet (UV) radiation from the sun over your lifetime causes most SCCs. Daily year-round sun exposure, intense exposure in the summer months or on sunny vacations and the UV produced by indoor tanning devices all add to the damage that can lead to SCC.

Treatments

A biopsy is a small sampling of the skin tissue. The area is numbed with local anesthetic and then a small piece of tissue is removed. Depending on the type of biopsy taken, sometimes sutures are required. Once proven by biopsy to be a Basal Cell Carcinoma, there are several treatment options, depending on the specific type of Basal Cell Carcinoma.

This technique is usually reserved for small lesions. The growth is scraped off with a curette, an instrument with a sharp, ring-shaped tip, then the tumor site is desiccated (burned) with an electrocautery needle. The procedure has cure rates generally above 95 percent.

Using a scalpel, the physician removes the entire growth along with a surrounding border of apparently normal skin as a safety margin. The skin around the surgical site is closed with stitches, and the tissue specimen is sent to the laboratory to verify that all cancerous cells have been removed. Cure rates are generally above 95 percent in most body areas, similar to those of curettage and electrodesiccation. A repeat excision may be necessary on a subsequent occasion if evidence of skin cancer is found in the specimen.

PDT is FDA-approved for the treatment of superficial or nodular BCC, with cure rates ranging from 70 to 90 percent. A light-sensitizing agent, topical 5-aminolevulinic acid (5-ALA), is applied to the lesion in the physician’s office. Subsequently, the medicated area is activated by a strong blue light; theoretically, this will selectively destroy BCCs while causing minimal damage to surrounding normal tissue. Some redness, pain, and swelling can result. Patients must strictly avoid sunlight for at least 48 hours, or UV exposure may further activate the medication, causing severe sunburn.

Learn More

A physician trained in Mohs micrographic surgery removes a thin layer of tissue containing the tumor. While the patient waits, frozen sections of this excised layer are mapped in detail and examined under a microscope, generally in an on-site laboratory. If cancer is present in any area of the excised tissue, the procedure is repeated only on the body area where those cancer cells were identified (the tissue mapping allows the Mohs surgeon to pinpoint this area of the body), until the last excised layer viewed microscopically is cancer-free. This technique can save the greatest amount of healthy tissue and has the highest cure rate, 99 percent or better. It is often used for large tumors in cosmetically important areas, and those that have recurred, are poorly demarcated (hard to pinpoint), or are in critical areas.

GENERAL

MELANOMA

The most dangerous form of skin cancer, these cancerous growths develop when damaged skin cells (most often caused by ultraviolet radiation from sunshine or tanning beds) triggers mutations that lead the skin cells to multiply rapidly and form malignant tumors. Melanomas often resemble moles; some develop from moles. The majority of melanomas are black or brown, but they can also be skin-colored, pink, red, purple, blue or white. Melanoma is caused mainly by intense, occasional UV exposure (frequently leading to sunburn), especially in those who are genetically predisposed to the disease.

Treatments

A biopsy is a small sampling of the skin tissue. The area is numbed with local anesthetic and then a small piece of tissue is removed. Depending on the type of biopsy taken, sometimes sutures are required. Once proven by biopsy to be a Basal Cell Carcinoma, there are several treatment options, depending on the specific type of Basal Cell Carcinoma.

Using a scalpel, the physician removes the entire growth along with a surrounding border of apparently normal skin as a safety margin. The skin around the surgical site is closed with stitches, and the tissue specimen is sent to the laboratory to verify that all cancerous cells have been removed. Cure rates are generally above 95 percent in most body areas, similar to those of curettage and electrodesiccation. A repeat excision may be necessary on a subsequent occasion if evidence of skin cancer is found in the specimen.

A physician trained in Mohs micrographic surgery removes a thin layer of tissue containing the tumor. While the patient waits, frozen sections of this excised layer are mapped in detail and examined under a microscope, generally in an on-site laboratory. If cancer is present in any area of the excised tissue, the procedure is repeated only on the body area where those cancer cells were identified (the tissue mapping allows the Mohs surgeon to pinpoint this area of the body), until the last excised layer viewed microscopically is cancer-free. This technique can save the greatest amount of healthy tissue and has the highest cure rate, 99 percent or better. It is often used for large tumors in cosmetically important areas, and those that have recurred, are poorly demarcated (hard to pinpoint), or are in critical areas.

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