My Clinic / Skin Clinic
Dr James Kang

Skin Cancer Treatments

Treatment Options

Your treatment options are dependant on the diagnosis. Some treatments could involve topical creams and more serious conditions involving cancer could include:

 

  • excision
  • flap surgery
  • skin graft

 

The three examples below show the different surgical pathways of treatment;

Treatment for Superficial Spreading Melanoma

With invasive Superficial Spreading Melanomas (Breslow 1.2mm), the Treatment would require a
  • Wide-area excision, 
  • A negative Sentinel Lymph Node Biopsy, and 
  • Monitoring at 3 monthly intervals for the first 2 years after diagnosis.

Treatment for Atypical Moles

If an Atypical Mole is at risk of transforming, or if its status is in doubt the lesion is surgically removed.

Surgical Removal of Atypical Moles or Excision

Surgical removal of suspect Atypical Moles is the most common treatment and are almost always surgically removed under local anaesthetic. This approach offers:
  • Is immediate,
  • Removes the entire lesion
  • Lesions margins are checked to confirm the diagnosis and complete clearance
If melanoma is detected in an Atypical Mole, some of the surrounding tissue may also be removed to make sure that all of the cancerous cells are cleared.

Basal Cell Carcinoma Treatment

Surgical Removal for Basal Cell Carcinoma

Surgical removal of the Basal Cell Carcinoma is the most common treatment. Non-melanoma skin cancers are almost always surgically removed under local anaesthetic. This approach offers:
  • The highest cure rates
  • Is immediate,
  • Lesions margins are checked to confirm complete clearance
In more advanced skin cancers, some of the surrounding tissue may also be removed to make sure that all of the cancerous cells are cleared.
  • Excision Treatment Process - After careful administration of local anaesthetic, the Doctor uses a scalpel to remove the entire growth, along with surrounding apparently normal skin as a safety margin.
  • The wound around the surgical site is then closed with sutures (stitches).
  • Excision Treatment Recovery - For a few days post excision there may be minor bruising and swelling. Scarring is usually minimal. Pain or discomfort is minor.
  • Typically, where sutures are used, they are removed soon afterwards.
Surgical Excision Prognosis - Studies indicate the cure rate for primary tumours with this technique is about 92%. This rate drops to 77% for recurrent Basal Cell Carcinomas.

A repeat excision may be necessary on a subsequent occasion if evidence of skin cancer is found in the specimen.

Combination Therapy for Basal Cell Carcinoma

Combination therapy to treat the Basal Cell Carcinoma may also be considered. Some combinations are:
  • Photodynamic therapy - treats thick or crusted lesions, combined with Topical Agents. for 4-6 weeks. Benefits include reduced side effects and increase response rates.
  • Topical Agents - treats lesions requiring descaling, combined with Liquid Nitrogen. 3-4 weeks. Benefits include reduce skin spots and increase cure rates.

Topical Chemotherapy - Imiquimod for Basal Cell Carcinoma

This is a prescription-only cream and is approved for the treatment of biopsy-proven superficial Basal Cell Carcinomas that are not otherwise suitable for surgical removal, but is not appropriate for use on invasive Basal Cell Carcinomas.

Topical Chemotherapy Treatment Process - Before administering the cream, the patient should clean and moisten skin (at the most), once clean and moist, the treatment can be administered by the patient themselves or by a Registered Nurse at our Clinic.

Topical Chemotherapy Treatment Recovery - Expect some minor pain, redness, swelling, crusting up ‘like a pizza’. It is a non-invasive treatment but can be highly unsightly and cause pain for up to 2 months.

Topical Chemotherapy Prognosis - The cure rate for most shallow Basal Cell Carcinomas ranges from 70 to 80%

Photodynamic Therapy for Basal Cell Carcinoma

Photodynamic therapy (PDT) involves the use of photochemical reactions mediated through the interaction of photosensitizing agents, light, and oxygen for the treatment of superficial Basal Cell Carcinoma. It is especially useful for larger superficial Basal Cell Carcinomas on the face and scalp.

Cancerous cells accumulate more light-absorbing cells (porphyrins) than normal cells that when exposed to certain light wavelengths potentiates a beneficial chemical reaction. It is this principle that underpins the use of PDT for such tissues.

The treatment selectively destroys Basal Cell Carcinomas while causing minimal damage to surrounding normal tissue. A biopsy is usually needed to confirm the diagnosis prior.

PhotoDynamic Therapy Treatment Process - Photodynamic therapy is a 2-Step Procedure.
  • The First Step: involves the application to the target growths cells with a photosensitizer in the form of a chemical agent that reacts to light such as Aminolevulinic Acid (ALA) or methyl aminolevulinate (MAL). Curettage is needed to destroy epidermis to allow egress of sensitising cream into lesion for 1 hour under occlusion
  • The Second Step: involves the activation of the photosensitizer in the presence of oxygen with a specific wavelength of light directed toward the target tissue. The photosensitizer is preferentially absorbed by cells that are dividing (which occurs at a greater rate in Actinic Keratoses) and when the light source is directed to the affected areas of skin. This leads to activation of protoporphyrins and inflammation and destruction of the lesion.
Photodynamic therapy achieves dual selectivity with minimal damage to adjacent healthy structures. It is repeated a week later.

It may not be suitable for all patients with BCC’s. The process is invasive and can be very painful when the light is applied and for a day post-treatment, and the curettage will scar.

The approach offers less scarring than surgical excision, and is more suited to larger superficial lesions than surgery, and can be used as a field treatment for areas with multiple small Basal Cell Carcinomas. Success rates are highly operator dependent.

Common side effects are redness, pain, bleeding, and swelling.

PhotoDynamic Therapy Treatment Recovery - After treatment, patients become locally photosensitive for 48 hours where the light-sensitizing agent was applied, and must avoid both outdoor and indoor light and be careful to use sun protection.

PhotoDynamic Therapy Treatment Prognosis - 70-80% cure rate. Can mask the presence of residual disease and so delay successful treatment so an initial biopsy is strongly advised to assess the invasive potential of any Basal Cell Carcinoma prior to PDT being commenced.
Recurrence rates vary considerably (from 0 to 52%), so the technique is not currently recommended for invasive Basal Cell Carcinoma.
Share by: