There are four main ways of treating skin cancer: excisional surgery (cutting the cancer out); electrodesiccation (destroying the cancer cells with heat); cryosurgery (freezing the cancer cells until they die); and radiation therapy.
The type of treatment chosen for basal cell or squamous cell cancer depends on how large the cancer is and where it is. If the sample taken for biopsy shows that cancer cells are present on the outer edges of the sample, we will go back into the area to remove any remaining cancer and a safety margin of cancer-free cells. For squamous cell cancers, which are more likely to spread, surgery may be followed by radiation in some cases.
For cases that are in the delicate areas of the face such as those around the nose, lips, ear or around the eyes, or for cases that have recurred after prior treatment, especially among people younger than 60, the use of microscopically controlled surgery (Mohs surgery) is indicated. In this procedure, a thin slice of the cancer is removed and the bottom layer is examined for cancer cells. This process is repeated until a cancer-free layer is reached, and is associated with close to 99% cure rates.
Less normal tissue is removed in this procedure and the patient is spared the risk of a larger procedure. Also this technique leads to a better cosmetic result after surgery because of its time sparing effect. Mohs micrographic surgery is also done in some cases of skin cancer outside of the face, such as on the legs or arms, or whenever a smaller scar is desired.
Mohs micrographic surgery is done in the office, under local anesthesia.
Dr. Touma has experience in treating over 4000 cases of skin cancer, and specializes in the cosmetic reconstruction of the skin after the precise removal of the skin cancer. In some cases, you may be referred to another physician for the reconstructive part of the procedure.
Surgery is the only way melanoma can be cured. Melanomas are usually larger and deeper than other forms of skin cancer and a larger safety margin is also removed.You may be referred to a surgical oncologist for a sentinel lymph mode biopsy, which will help determine the presence of cancer cells in the lymphatic drainage area. If the disease has already spread to nearby lymph nodes, these too will be removed. If melanoma has spread to more distant parts of the body, lymph nodes, skin, and underlying tissue there may also be removed. Although this cannot usually cure the cancer, in some cases, it could help relieve pain and lead to longer survival.
Chemotherapy treatment with anticancer drugs, has had only limited success in treating widespread melanoma. Because the standard methods of treating skin cancer have not been helpful for patients with later stage melanoma, these patients may be asked to consider experimental programs using new combinations of drugs and substances that can stimulate the body's immune system.