Treatment Options
There is no single best method to treat all skin cancers and precancerous lesions. Choice of method is dictated by the size of the lesion, its location, its type (often confirmed by biopsy), and whether it is a primary or recurrent lesion. Also considered is the patient’s age, health, occupation and preference for treatment method. Current treatments for BCC and AK include the following:
PDT
PDT is photodynamic therapy. It is a non-surgical procedure performed in the
doctor’s practice. PDT involves simple preparation of the lesions,
application of special light activated cream and exposure of the lesion to
a special red light. It is approved for the treatment of superficial or nodular
BCC, Bowen's disease and AK. Common side effects include mild to moderate redness and swelling
which often resolve rapidly. Due to the selective nature of PDT
treatment, healthy tissue is left unharmed 7-9,
12 and scarring is minimal.
Surgical excision
There are three types of surgical technique all of which allow confirmation of diagnosis and confirmation of complete removal of the cancerous lesion.
- Simple excision
This involves cutting the lesion out. The wound is stitched and some scarring is expected. It can be used to treat superficial, nodular and morpheaform BCC and SCC. - Excision with flaps or grafts
These are performed on larger lesions. It involves taking a layer of tissue from another part of the body (grafts) or creating a flap to repair a tissue defect. These are highly skilled procedures and cosmetic results vary. - Mohs’ micrographic Surgery
Mohs’ surgery is very precise. Thin layers of tissue are systemically excised and examined under the microscope for cancer cells until tumour has been completely removed. It is used on recurrent BCC or SCC and difficult lesions eg lesions on the nose, ear or around the eye. This procedure is most costly and time consuming
Cryotherapy
Involves the freezing of lesions and surrounding area with liquid nitrogen.
It is performed in the doctor's rooms. The freezing causes exposed tissue
to blister and die. Cryotherapy is commonly used to treat both superficial
BCC and AK. This treatment often results in loss of pigmentation (white mark)
and a depression in the skin where the lesion has been.
Curettage & cautery
The lesion is scooped out using a sharp instrument. Cautery burns the area to curb bleeding. Sutures are not required with these procedures. A scab will form which heals over a few weeks and will often result in a mark or scar. These methods can be used to treat superficial and nodular BCC, SCC and AK.
Topical chemical therapy
This involves the application of topical cream to lesions and surrounding normal skin daily or twice daily for periods ranging from 4 to 6 weeks. Increasing inflammation of the lesion occurs during this time, culminating in ulceration and the destruction of the diseased tissue. Treatment may be associated with pain, itchiness and discomfort. Depending on the type of topical chemical therapy, it may be used to treat either superficial BCC or AK. This treatment is carried out by the patient at home.
Radiotherapy
Previously X-ray treatment was sometimes used for the treatment of skin cancer but is less commonly used now.
