With early detection, treatment can be quick + effective.
Skin cancer is often separated into two groups: melanoma and non-melanoma skin cancers. That’s because non-melanoma skin cancers rarely spread beyond the skin, making them easier to treat. Melanoma, on the other hand, is more likely to spread to other parts of the body. Although it’s less common than other types of skin cancer, melanoma is more dangerous and harder to cure.
There are two main types of non-melanoma skin cancers: basal cell carcinoma and squamous cell carcinoma. These names refer to which layer of skin the cancer has formed:
- Basal cell carcinoma occurs in the basal layer (the lower part) of the epidermis. This is the most common type of skin cancer, accounting for about 80 percent of all skin cancers, according to the American Cancer Society.
- Squamous cell carcinoma occurs in the squamous layer (the upper part) of the epidermis. It is also very common, but less common than basal cell carcinoma.
“The most common treatment for the non-melanoma skin cancers are destructive modalities, whether that is surgery or a procedure known as electrodesiccation and curettage,” says Kira Minkis, MD, PhD, dermatologist at Weill Cornell Medicine.
Here are the most common treatments used for non-melanoma skin cancers:
Mohs micrographic surgery is a newer treatment for skin cancer where a thin layer of skin is removed and immediately evaluated under a microscope until the tissue is clear of cancer cells. It’s a skin-sparing surgery meant to reduce the amount of skin removed. “It’s an involved process. There [are] lots of steps involved and because of that, the duration of the procedure is lengthier than for a standard excision,” says Dr. Minkis.
A standard excision “is a procedure where a skin cancer is removed with a standard margin of normal skin around it and typically stitched up immediately afterwards,” says Dr. Minkis. The tissue is then sent to a pathologist, but it can take up to a week for the results. If cancer is found in the margins, an additional surgery may be needed.
Electrodesiccation and curettage is a procedure where the surface of the skin is scraped off, and then an electric needle is used to burn the base of the skin. This is only used for early-stage skin cancers that are only on the very surface of the skin.
Cryotherapy “is a procedure where liquid nitrogen is applied to the skin to freeze the surface of the skin,” says Dr. Minkis.
Topical therapy or cream therapy uses a topically applied cream to attack the skin cancer. These creams are either a topical chemotherapy or a topical immunomodulator.
“These surgeries and procedures are all outpatient procedures, which essentially means that the patient is treated in an office setting, not in a hospital,” says Dr. Minkis. They are “generally a one-day procedure. A patient comes and sees the treating physician, generally a dermatologist in the office. The procedure is performed and the patient can go home immediately afterwards.”
In some cases, doctors may recommend (or patients may choose to receive) radiation therapy. This is performed by a radiation oncologist. A machine is used to deliver external radiation to the area with the skin cancer growth in order to destroy the cancer cells. “It can involve as many as 35 visits in order to safely deliver the radiation,” says Dr. Minkis. Learn more about what radiation therapy is here.
“The great thing about non-melanoma skin cancers is they could be visualized and detected early,” says Dr. Minkis. “The treatments are very low risk and very efficient … so you don’t have to worry about the burden of the disease afterwards.”
Dr. Minkis is a dermatologist at Weill Cornell Medicine, an assistant professor of dermatology at Weill Cornell Medical College, Cornell University, and an assistant attending dermatologist at NewYork-Presbyterian Hospital.
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The non-melanoma skin cancers are oftentimes easier
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to treat than more advanced melanoma.
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Basal cell carcinoma is the most common type of skin cancer
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and the most common malignancy overall,
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and squamous cell carcinoma is
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the second most common type of skin cancer.
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The most common treatment for the non-melanoma skin cancer
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are destructive modalities, whether that is surgery
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or a procedure known as electrodesiccation and curettage.
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As far as surgeries go, the two most common type
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of surgical techniques for the non-melanoma skin cancers
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include a procedure known as Mohs micrographic surgery,
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or Mohs surgery, or a standard excision.
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Mohs is a procedure where skin cancer is removed
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and evaluated microscopically to ensure that the edges
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are clear of cancer, and if not,
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an additional layer can be performed until we get to the point
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where all the margins are clear.
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A standard excision is a procedure where skin cancer is removed
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with a standard margin of normal skin around it,
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and typically stitched up immediately afterwards.
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The main difference is you're not sparing as much tissue.
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You could potentially be taking more than necessary,
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and because you're not examining it at the time
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that you're stitching the patient, there is a possibility
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that you haven't fully removed everything
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and the patient might need another procedure afterwards
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to ensure that everything has been removed.
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Electrodesiccation and curettage is a procedure
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where the surface of the skin is scraped off,
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and the base of that scraping is then treated
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with an electric needle to burn the base.
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Topical therapy or cream therapy for skin cancers
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uses one of several different creams to destroy the skin cancer
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either by topical chemotherapy or a topical immunomodulator.
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These surgeries and procedures are all outpatient procedures,
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which essentially means that the patient is treated
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in an office setting, not in a hospital.
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Generally, it's a one-day procedure.
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The procedure is performed
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and the patient can go home immediately afterwards.
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Another option that might be offered to a patient
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to treat their skin cancer is radiation therapy.
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That is performed by a physician called the radiation oncologist,
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where radiation is delivered to the skin to destroy the skin cancer.
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Radiation can have a lot of toxicity to the skin and to organs,
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so it has to be delivered in a very precise method.
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As an alternative for somebody that does not want to undergo surgery
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of the skin, radiation can be discussed with their physician.
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The great thing about the non-melanoma skin cancers
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is they could be visualized and detected early.
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The treatments are very low risk.
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We've come a long way with various procedures
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so we could really target the therapy to remove the cancer.
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Patients could get back on their feet and back to normal
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almost immediately afterwards.
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Local treatments other than surgery for basal and squamous cell skin cancers. Atlanta, GA: American Cancer Society. (Accessed on February 27, 2020 at https://www.cancer.org/cancer/basal-and-squamous-cell-skin-cancer/treating/other-than-surgery.html.)
Skin cancer treatment (PDQR)-patient version. Bethesda, MD: National Cancer Institute. (Accessed on February 27, 2020 at https://www.cancer.gov/types/skin/patient/skin-treatment-pdq.)
Treating basal and squamous cell skin cancer. Atlanta, GA: American Cancer Society. (Accessed on February 27, 2020 at https://www.cancer.org/cancer/basal-and-squamous-cell-skin-cancer/treating.html.)
Treatment and prognosis of basal cell carcinoma at low risk of recurrence. Waltham, MA: UpToDate, 2020. (Accessed on February 27, 2020 at https://www.uptodate.com/contents/treatment-and-prognosis-of-basal-cell-carcinoma-at-low-risk-of-recurrence.)
Treatment and prognosis of low-risk cutaneous squamous cell carcinoma. Waltham, MA: UpToDate, 2020. (Accessed on February 27, 2020 at https://www.uptodate.com/contents/treatment-and-prognosis-of-low-risk-cutaneous-squamous-cell-carcinoma.)
What are basal and squamous cell skin cancers? Atlanta, GA: American Cancer Society. (Accessed on February 27, 2020 at https://www.cancer.org/cancer/basal-and-squamous-cell-skin-cancer/about/what-is-basal-and-squamous-cell.html.)