SKIN CANCER TREATMENT
Skin cancer has developed when a certain cell that resides in the skin keeps on replicating uncontrollably. The cancerous cells may still contain certain functioning genes within them that hold them back from spreading to other body sites. Such cancerous cells grow just in the vicinity of their origin. That is the case for a number of skin tumors, such as basal cell carcinomas, and non-ulcerated squamous cell carcinomas. Basal cell carcinomas are the most common skin cancer in the U.S. The incidence of melanoma is still much higher than 100 years ago, but the number of new annual cases has plateaued.
TYPES OF SKIN CANCER
Cancers can arise from all the cell types that reside within the skin. You would be surprised to learn how many different cell types are housed in our skin.
- Basal Cell Carcinoma, and Squamous Cell Carcinoma are of keratinocyte origin. Keratinocytes make up the outer layer of the skin, and our hair follicles.
- Melanoma is the cancer of the pigment cells.
- A variety of immune cell cancers, such as T cell, B cell, and mast cells to name a few. These are much less common than basal cell carcinomas.
- Cancer of the sebaceous glands, which are the oil producing glands of the skin.
- Sweat gland cells can turn cancerous as well.
- The cells that are associated with the nerve fibers, and the cells of the nerve ending interface usually form benign tumors, such as neurofibromas.
SKIN CANCER TREATMENT OPTIONS
As expected, different types skin cancers, their location, aggressiveness, thickness, and the patient’s general health and preference lead to different treatment options:
- Procedural Options for Basal Cell and Squamous Cell Carcinomas:
- Liquid nitrogen- This the least invasive treatment modality. it is reserved for very superficial squamous cell carcinomas. It has a fairly high rate of recurrence of the skin cancer, unless the skin is so aggressively frozen that the treatment results in permanent whitening.
- Curettage and desiccation- Because basal cell carcinoma, and certain squamous cell carcinoma cells do not adhere to their peripheral normal cells as well as normal cells do to each other, a curette, which is a semi-sharp round razor, could physically scrape off the cancerous cells. Chance of recurrence is about 5%. This technique results in minimal scar.
- Mohs micrographic Surgery(MMS)- MMS has the lowest rate of recurrence, and leads to the most diligent preservation of the peripheral normal tissue. In this method, thin layers of where the cancer is located are scooped off. A technician cuts, and stains thin slices of the deep and peripheral margins of it. Dr. Silvers screens the stained thin layers under a microscope. If need be, more tissue is removed for examination from where the nests of cancerous cells are seen. When all the cancerous cells are removed, the wound can be closed, or be allowed to heal on its own.
- Cutting out the tumor with a few millimeters of normal peripheral skin, is the traditional way of removing skin cancers, It has a rate of recurrence of 3-10%. Representative cross sections of the removed tissue will be examined under a microscope. The entire peripheral and deep margin of the removed skin cannot be examined with this method.
- Non Surgical Skin Cancer Treatments:
Radiotherapy: Modern radiotherapy can focus the radiation rays on the tumor only, and results in minimal damage to the peripheral normal tissue. Even the skin that overlies a tumor is minimally damaged by the radiation rays. Local tissue alteration and possible future cancers that can be induced as the result of the radiation are some of the drawback. The chance of future cancers as sequela of radiation is quite low.
Topical Immunotherapy: Imiquimod is an immunomodulator that activates the immune cells that home in the skin to recognize the cancerous cells, and eradicate them. It is not recommended for basal cell carcinomas on the tip of the nose. It results in three weeks of wide local redness and crusting. The rate of recurrence is quite variable.
Erivedge (vismodegib) is an oral medicine that is FDA approved for advanced basal cell carcinoma, or patients who have numerous basal carcinomas. It shrinks and eradicates many of the tumors.