Understanding Skin Cancer - Treatment

How Do I Know If It's Skin Cancer?

All potentially cancerous skin growths must be biopsied to confirm a cancer diagnosis. Depending on the suspected type of skin cancer, the biopsy techniques vary slightly but crucially.

Any potential melanoma requires a surgical biopsy, also called excisional biopsy, in which the entire growth is removed with a scalpel. A pathologist then studies the sample under a microscope to determine whether cancer cells are present.

If melanoma is diagnosed, other tests may be ordered to assess the degree of cancer spread (metastasis). They include:

• Imaging. Your doctor will order one or more tests to look for metastasis. They include CT scan, MRI, and chest X-ray.
• Other biopsies. Using a variety of techniques, your doctor may want to get tissue samples from other organs or lymph nodes

Skin growths that are most likely basal cell carcinoma, squamous cell carcinoma, or other forms of non-melanoma can be biopsied in various ways. Part or all of the growth can be taken with a scalpel, or a thin layer can be shaved off for examination under a microscope.

What Are the Treatments?

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 and cause few side effects. Small tumors can be surgically excised, removed with electric current, frozen with liquid nitrogen, or killed with low-dose radiation. Applying an ointment containing a chemotherapeutic agent called 5-fluorouracil to a superficial tumor for several weeks may also work. Larger localized tumors are removed surgically.

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, radiation, or immunotherapy. Some patients with advanced squamous cell carcinoma respond well to a combination of retinoic acid (a derivative of vitamin A) and interferon (a type of disease-fighting protein produced in laboratories for cancer immunotherapy). Retinoic acid also seems to inhibit cancer recurrence in patients who have had tumors removed.

Melanoma tumors must be removed surgically, preferably before they spread beyond the skin into other organs or glands. The surgeon removes the tumor fully, along with a safe margin of surrounding tissue and possibly nearby lymph nodes. 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 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 are using drugs such as interferon and interleukin-2 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.

People who have had skin cancer once are at risk for getting it again. Anyone who has been treated for skin cancer of any kind should have a checkup at least once a year. About 20% of skin cancer patients experience recurrence, usually within the first two years after diagnosis.