Skin cancer: Treatment
Most skin cancers are successfully removed and/or treated using the following techniques:
Cryotherapy is when liquid nitrogen is used to produce extreme cold to distroy cancer cells on the skin with a spraying device.
Diathermy (electrocautery) is a safe procedure that is used by burning the cancerous tissue and sealing blood vessels, which helps to reduce or stop bleeding.
Serial curettage is a technique used where an area of skin cancer is scrapped and scooped out with a curette and then electrocauterised to distroy the cancer cells of a superficial area and low risk tumours. This procedure may need to be performed a few times and does leave scarring.
Simple excision/wide local excision
Simple excision/wide local excision is when the skin cancer is removed by cutting out the lesion and closing the area with sutures. An amount of surrounding tissue must also be removed to reduce the risk of leaving any cancer behind. The lesion is then sent to pathology for microscopic analysis to determine what type of cancer it is and if it has been adequately excised. There are standards that doctors follow to ensure the correct amount of healthy tissue is clear of cancer, depending what type of cancer it is.
Flap repair is a technique that is used to repair an area that has been excised and may be needed when there will be too much tension or puckering by simply bringing the skin together or for a better cosmetic outcome. They also heal very well because they have their own blood supply. Tissue is freed and rotated or moved from an adjacent area to cover the defect while still attached to the body at its base. The edges are then all neatly sutured together.
Full thickness skin graft (FTSG)
Full thickness skin graft (FTSG) is when a small amount of healthy skin containing all of the epidermis and dermis is cut out and is used to fill the area where the skin cancer has been removed and where the excised area is too large or tight to simply bring the skin together. The donor skin is secured to the new site with small sutures and is then covered with a special padded material that is sutured or stapled on. After 7-10 days the pad is removed and then it can be determined if the graft has taken successfully. If the graft has been unsuccessful, the area may need to be debrided and treated as an ulcer.
Split skin graft (SSG)
Split skin graft (SSG) is when a thin 'shave' of healthy skin is removed containing all of the epidermis and some of the dermis using a dermatome. This technique is used when a large defect area needs grafting due to removal of a large skin cancer. Depending on the thickness of the SSG, the donor site should re-epithelialize completely in 7 to 21 days. This procedure is usually performed in hospital under general anaesthetic.
Neurovascular Island Flap (NVI)
Neurovascular Island Flap (NVI) is an island flap that is incised and released that contains an artery, vein and sensory nerve. It is created using adjacent healthy tissue to repair the defect and distributes repair tension. These flaps are also very vascular, requiring surgical suction to evacuate the bleeding in order for the doctor to see so this procedure is only performed in hospital.
Imiquimod (Aldara) cream
Imiquimod (Aldara) cream, in some circumstances, may be used to treat superficial BCCs that are more than 1 cm from the eyes, ears, nose, lips or hairline. It will not be used on BCCs that have recurred, are invasive or nodular. The cream can cause a severe local reaction, in which case, treatment can cease until the area has settled, then the regime is to continue for up to a total of 6 weeks (including resting time). Excision is still the best method for treating BCCs because it has a higher cure rate and can be assessed to ensure that it has been completely removed.