Dr. Norman Levine, MD, is a dermatologist in active practice in Tucson, Arizona. He has authored four books about skin health and dermatology therapy and contributed to hundreds of articles, several book chapters, and even a CD-ROM. Dr. Levine is a reviewer of dermatological cases for Physicians' Review Network.
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
There are several effective means of treating skin cancer. The choice of therapy depends on the location and size of the tumor, the microscopic characteristics of the cancer, and the general health of the patient.
Destruction by electrodessication and curettage (EDC): The tumor area is numbed with a local anesthetic and is scraped off with a sharp instrument (curette). The wound base is then cauterized with an electric needle. The advantage of this method is that it is fast, easy, and relatively inexpensive. The disadvantages are that the scar is often somewhat unsightly and the recurrence rate is as high as 15%.
Surgical excision: The area around the tumor is numbed with a local anesthetic. A football-shaped portion of tissue including the tumor is then removed and then the wound edges are closed with sutures. For very big tumors, skin grafts or flaps are needed to close the defect. The advantages of this form of treatment are that there is a greater than 90% cure rate, the surgical specimen can be examined to be sure that the whole tumor is successfully removed, and the scar produced is usually more cosmetically acceptable than that of the EDC procedure. It is a more complicated procedure and is more expensive than EDC.
Mohs micrographic surgery: The site is locally anesthetized and the surgeon removes the visible tumor with a small margin of normal tissue. The tissue is evaluated under a microscope and areas that demonstrate residual microscopic tumor involvement are re-excised and the margins are re-examined. This cycle continues until no further tumor is seen. This more complicated and expensive option is the treatment of choice for tumors where normal tissue preservation is vital, where the tumor margins are poorly defined, in tumors that have been previously treated and have recurred, and in certain high-risk tumors.
Radiation therapy: Ten to fifteen treatment sessions deliver a high dose of radiation to the tumor and a small surrounding skin area. This form of treatment is useful in those who are not candidates for any surgical procedure. The advantage of radiation therapy is that there is no cutting involved. The disadvantages of this expensive alternative are that the treated area cannot be tested to be sure that the whole tumor is gone and radiation scars always look worse over time. It is for this reason that it is usually reserved for elderly patients.