Current Skin Cancer Treatments Focus on Proven Surgical Approaches and New Non-Invasive Therapies

Main Category: Melanoma / Skin Cancer
Article Date: 03 May 2005 - 11:00 PDT

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The phrase "You have skin cancer" is one that will be heard by more than 1 million people this year, leaving most of them shocked and uncertain about their treatment or prognosis. Many skin cancers have high cure rates when detected early, therefore proper dermatologic treatment is essential in beating this potentially deadly condition.

Speaking today at the American Academy of Dermatology's (Academy) Melanoma/Skin Cancer Detection and Prevention Month news conference, dermatologist John A. Carucci, M.D., Ph.D., director of Mohs Micrographic and Dermatologic Surgery at Weill Medical College of Cornell University, New York, N.Y., discussed the most effective therapies for treating the mildest to the most severe forms of skin cancer.

"There are several factors that are considered when treating skin cancer, including its size and location, how the tumor appears under the microscope, and whether it is a new or recurring cancer," explained Dr. Carucci. "For melanoma, the most serious form of skin cancer, surgery is still standard practice whereas for non-melanoma skin cancers, such as basal cell carcinoma and squamous cell carcinoma, surgical removal remains the gold standard, however, other modalities may be appropriate in some instances."

Surgical Options

Dr. Carucci explained that for most melanomas and a large percentage of squamous cell and basal cell carcinomas, surgery remains the treatment method of choice due to its high success rate and proven track record over the years. The two most common surgical procedures used in treating melanoma and non-melanoma skin cancers are standard excisional surgery and Mohs micrographic surgery. Another option used to treat some small basal and squamous cell carcinomas, but not melanoma, is electrodesiccation and curettage (ED&C).

Excisional Surgery

With excisional surgery, the skin cancer is surgically removed along with a margin of normal appearing tissue surrounding the tumor. In general, the more invasive the skin cancer, the more tissue is removed. Following the procedure, the specimen is examined under a microscope to ensure that all of the skin cancer has been removed. In the case of a melanoma that is thin and has not spread beyond the original site, excisional surgery may be the only treatment required.

Mohs Micrographic Surgery

Mohs micrographic surgery is a specialized treatment performed by dermatologic surgeons expertly trained in this procedure. The goal is to completely remove the tumor while preserving as much surrounding normal tissue as possible, making it a preferred treatment for high risk or cosmetically sensitive areas such as the face, ears or hands. During Mohs surgery, the dermatologic surgeon removes the tumor along with a thin layer of normal appearing tissue. The removed tissue is then examined under a microscope while the patient waits in the office to determine if all of the cancer cells have been removed. "One benefit of Mohs micrographic surgery is that it allows the surgeon to approach wound repair knowing that the risk of recurrence of skin cancer has been minimized," said Dr. Carucci. This process of removing a thin layer of tissue and examining it under a microscope is repeated until cancer cells are no longer detected.

Electrodesiccation and Curettage (ED&C)

This surgical procedure, which is often used to treat small basal cell and squamous cell tumors, involves scraping off the surface of the skin cancer and gently burning or cauterizing the base of it with an electric needle. This scraping and cauterizing process is typically repeated several times to ensure all cancerous tissue is removed.

Topical Immunotherapy

Recently FDA-approved for the treatment of basal cell carcinomas and a very common early stage of skin cancer known as actinic keratoses (AKs), imiquimod is a topical alternative to surgery for some patients. Applied as a cream to the skin approximately once a day for 16 weeks, imiquimod works by breaking down the lesion and then regenerating healthy skin. Dr. Carucci explained that, in effect, imiquimod jumpstarts the body's immune system to fight the lesion.

"Clearly, patients would prefer a treatment that doesn't involve surgery as long as a non-invasive approach is effective for their type of skin cancer," said Dr. Carucci. He added that imiquimod is being used successfully to treat patients with extensive sun damage, such as multiple AKs that run together mixed with superficial (in-situ) squamous cell carcinomas.

Photodynamic Therapy (PDT)

Another non-invasive treatment currently being used to treat AKs and superficial basal cell and squamous cell carcinomas is photodynamic therapy (PDT). This therapy treats the tumor with a photosensitizing chemical in two phases. First, the photosensitizing chemical is applied and allowed to interact with the tumor for several hours. Next, the treated area is exposed to a light source that in turn activates the photosensitizing chemical and destroys the skin cancer -- causing little damage to surrounding normal skin.

Futuristic Treatments

Melanoma vaccines remain an area of active research interest, however, Dr. Carucci cautioned that a vaccine will not be administered to prevent melanoma in all patients as the name would suggest.

"The melanoma vaccine is not like a flu vaccine, which is administered to prevent someone from contracting the flu," said Dr. Carucci. "Unlike vaccines we are used to hearing about, it will not prevent you from getting melanoma. It is hoped that a melanoma vaccine might help the patient's immune system to attack the melanoma and prevent further spread."

"There has really been an explosion of new research in many areas of oncology that could one day help patients with all types of cancer," added Dr. Carucci. "By applying this knowledge to skin cancer, I'm hopeful that one day we can offer effective treatments to patients with the most advanced disease and save more lives. In the meantime, skin cancer patients should work closely with their dermatologists to find the treatment option that is right for them. Our greatest tools right now are prevention and early detection. Everyone should have a skin cancer screening examination performed by a dermatologist once a year."

For more information about skin cancer, visit the Academy's patient education Web site at http://www.skincarephysicians.com and select "SkinCancerNet."

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 14,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or http://www.aad.org.

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