Most skin cancers are detected and cured before they spread. Melanoma that has spread to other organs presents the greatest treatment challenge.
Standard treatments for localized basal cell and squamous cell carcinomas are safe and effective. Small tumors can be surgically excised, removed with a scraping tool (curette) and then cauterized, frozen with liquid nitrogen, or killed with low-dose radiation. Applying an ointment containing a chemotherapeutic agent called 5-fluorouracil -- or an immune response modifier called imiquimod -- to a superficial tumor for several weeks may also work. Larger localized tumors are removed surgically.
There is a wide range of treatment approaches, including excision, radiation therapy, cryosurgery, electrodesiccation and curettage, photodynamic or laser-beam light exposure, and topical therapies. Mohs micrographic surgery is a form of tumor excision that involves progressive radial sectioning and real-time examination of the resection margins until adequate uninvolved margins have been achieved, avoiding wider margins than needed. Each of these methods is useful in specific clinical situations...
In rare cases where basal cell or squamous cell carcinoma has begun to spread beyond the skin, tumors are removed surgically and patients are treated with chemotherapy and radiation. Sometimes disfiguring or metastatic (spreading) basal cell skin cancers that are not able to be treated by surgery or radiation are treated with a once a day pill called vismodegib (Everidge).
Melanoma tumors must be removed surgically, preferably before they spread beyond the skin into other organs. The surgeon removes the tumor fully, along with a safe margin of surrounding tissue. There is controversy whether removing nearby lymph nodes is valuable in certain cases. Neither radiation nor chemotherapy will cure advanced melanoma, but either treatment may slow the disease and relieve symptoms. Chemotherapy, sometimes in combination with immunotherapy -- using drugs like interferon -- is generally preferred. If melanoma spreads to the brain, radiation is used to slow the growth and control symptoms.
Immunotherapy is a relatively new field of cancer treatment that attempts to target and kill cancer cells by manipulating the body's immune system. Some of the most promising developments in the field of immunotherapy have sprung from efforts to cure advanced melanoma. Some researchers are treating advanced cases with vaccines, while others have used drugs such as interferon, interleukin-2, Keytruda (pembrolizumab), or Yervoy (ipilimumab) in an effort to stimulate immune cells into attacking melanoma cells more aggressively. Genetic manipulation of melanoma tumors may make them more vulnerable to attack by the immune system. Each of these experimental treatment approaches aims to immunize a patient's body against its own cancer -- something the body cannot do naturally.