Mohs Surgery

Mohs-assisted excisions are a precise form of skin cancer excision where the surgeon is the pathologist. This tissue-sparing procedure provides accurate margin evaluation and is used for the excision of tumors on the head, neck, hands, feet and genitalia. Your doctor will remove your tumor by removing progressively wider areas of skin around the skin cancer and examining them under a microscope for cancer cells. Your doctor will keep removing wider or deeper layers until no more cancer cells are present. This procedure allows your doctor to remove as little healthy skin as possible to minimize discomfort and scarring while still confirming that the entire lesion has been removed. This procedure is often used to remove skin cancers on the face.

Electrodessication & curettage

This procedure is sometimes called "scraping and burning,"and “curettage and desiccation.” Your doctor will use a surgical instrument called a curette to scrape the tumor from your skin followed by desiccation. Multiple cycles of curettage and desiccation are performed to stop any bleeding and kill any remaining cancer cells.

Cryosurgery

Your doctor will use liquid nitrogen to freeze and destroy a tumor. Your doctor may repeat this process multiple times or combine it with other treatments to destroy all the cancer. This procedure is minimally invasive and allows your doctor to treat the cancer with little damage to healthy tissue. This method is used for pre-cancerous lesions (actinic keratosis) and superficial forms of BCC and SCC.

Laser Surgery

Your doctor will use a laser, an intense beam of light, to destroy cancer cells. The number of treatments and the depth of the destruction depends on the tumor characteristics. This is a very precise procedure that is easy to control without much damage to healthy tissue. This surgery is utilized for superficial BCC and SC.

Standard Excision

Your surgeon will use a surgical knife to remove the tumor to the level of the subcutis plus a margin of healthy skin. Small excisions are often closed with stitches, while larger excision sites, if they cannot be closed with simple stitches, may require closure by rearrainging regional skin. Occasionally, skin is grafted (taking either partial or full thickness skin from another part of your body).In the correct clinical setting, excision sites are left to heal on their own (secondary intention healing). Your doctor will discuss all of these options with you, and, if the repair is very large or complex, may enlist the assistance of a surgical specialist (plastic surgeon, ophthalmic plastic surgeon, urologist or gynecologist).

Radiation Therapy

External beam radiation therapy uses waves of high energy rays to target and kill cancer cells. In external beam radiation, a large machine delivers radiation to your tumor from outside the body. For early (Stage 0 – 2) cancers, destructions or excision methods are indicated. In some cases, your doctor may recommend radiation therapy to treat areas where surgery would cause too many side effects given the size or location of the tumor. Your doctor may also recommend radiation therapy after surgery in order to destroy any remaining cancer cells.

Chemotherapy

Chemotherapy is the use of drugs to target rapidly growing cells in an effort to destroy cancer cells. Chemotherapy medications are general and do not target the tumor cells specifically. These medications may be given through the vein (intravenously) or by mouth (orally). Doctors commonly use chemotherapy to treat cancers that have spread to the lymph nodes, spread to distant sites, or have deep invasion. The use of Vitamin B3 (Nicotinamide) has been shown to have protective effects against damage caused by Ultraviolet sun exposure. Your doctor may suggest using Vitamin B to aid in chemopreventation therapy.

Immunotherapy

Immunotherapy is systemic therapy that stimulates the body’s immune system to help the body identify and destroy cancer cells. Prior to the discovery of this type of cancer treatment, there were immune modulators of the skin. These medications, when applied topically to a tumor, encourage the body’s immune system to destroy precancerous lesions and superficial BCC and SCC. Presently, immunotherapy is used for tumors that are locally-advanced, metastatic, or unresectable. Immunotherapy stimulates the body's immune system and helps it fight cancer cells.

Targeted Therapy

Targeted therapies are a class of systemic medications that attackgenetic vulnerabilities in cancer cells. Unlike conventional chemotherapy, targeted therapy does not affect all rapidly dividing cells in the body. Targeted therapy is intended to stop the growth of cancer cells by interfering with signals that cause the cancer to grow or continue to live. Although targeted therapy may work for some period and then stop working (acquired resistance) or simply does not work in all cases of advanced or metastatic disease (primary resistance), these therapies may be combined with other therapies to improve overall health outcome.

Basal layer keratinocytes that are exposed to excess UV radiation may develop genetic mutations in the hedgehog signaling pathway. This mutation cause a normal cell to become a basal cell carcinoma and grow aggressively into surrounding tissue. One form of targeted therapy, hedgehog inhibitors, blocks these signals. Hedgehog pathway inhibitors may be recommended in patients with locally advanced basal cell carcinomas, basal cell carcinomas that have recurred after surgery or radiation therapy, metastatic basal cell carcinoma (very rare), or in patients who are not candidates for surgery or radiation therapy.

Photodynamic Therapy

Photodynamic therapy is a two-step therapy. The first step involves painting the skin with a medication that is absorbed by rapidly-dividing cells (actinic keratoses) that cause the cells to become sensitive to visible light. The second step is to expose the skin to a very controlled dose of light of a specific wavelength to selectively destroy the precancerous cells.

Clinical Trials

Clinical trials allow patients to try a new treatment before it is approved by the Food and Drug Administration for use by the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation. Clinical trials are offered when conventional therapy has been unsuccessful.