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Moles and Skin cancer - Treatment of skin cancer

  Treatment of skin cancer


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.

Basal Cell Carcinoma after Mohs surgery and skin graft.

  Follow-up care

    Even when a skin cancer has been completely removed and is considered cured, follow-up examinations are needed to see if the cancer has returned, or recurred. That is most likely to happen in the first two years after treatment. In addition, a person who has had one skin cancer may still be at risk of developing another. Persons cured of skin cancer should continue to examine their skin every 6 to 8 weeks, have follow-up examinations as advised, and avoid overexposure to the sun.

  Expected survival times


Nearly 99% of basal cell and squamous cell cancers that are detected early and treated promptly are cured.  For patients with melanoma and  early stage disease, the chances of cure are greater if the cancer has not invaded deep into the skin. For patients with early-stage melanomas that are small, thin, and limited to a single area, the 5-year survival rate is about 91%. Once melanoma has spread to nearby areas, the survival rate falls.

Squamous Cell Carcinoma after Mohs surgery and skin graft

  Hope for the future


The real hope for the future lies in prevention and early detection of skin cancers. Most skin cancers can be prevented by avoiding overexposure to the sun. Any unusual markings on the skin, especially any that change in size or color, should be checked by a doctor.

Scientists are now looking at ways of treating melanoma with substances that boost or reinforce the bodys own immune system. Of these substances melanoma vaccines and , interleukin-2 has had some success against melanoma. Ongoing studies will determine whether this treatment, perhaps combined with chemotherapy and other agents that act on the immune system, will improve survival rates for patients with melanoma.

Defect after Mohs surgery repaired with skin flap

  How to help guard against skin cancer

     Don't get too much sun. Try to avoid the sun when its rays are strongest-between 10 a.m. and 3 p.m. Those who cannot avoid being exposed to the sun should wear clothing to cover up as much of the skin as possible. A sunscreen with a sun protection factor (SPF) of at least 15 should be applied to the exposed areas. Do not use sunlamps or go to tanning salons or parlors. Any usual blemish, mole, or other marking on the skin, especially one that changes in size or color, should be checked by a doctor.

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