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Skin Cancer Treatment

Introduction to Skin Cancer Treatment Options

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Updated October 01, 2009

The choice of skin cancer treatment depends on the type, stage, size and location of the tumor, whether or not the cancer has spread (metastasized), and your overall health. Skin cancer treatment options typically include surgery, radiation therapy, immunotherapy, and/or chemotherapy.

A team of doctors will work with you to determine the best skin cancer treatment plan. The team may include specialists such as a surgical oncologist, medical oncologist, radiation oncologist, dermatologist (a doctor who specializes in diseases of the skin), and a pathologist.

Surgery

Both non-melanoma (basal cell and squamous cell) and melanoma skin cancers can be successfully treated in almost all cases if they are diagnosed and treated when the tumor is relatively thin. Surgery to remove the tumor is the standard treatment but numerous other options are available. The type of treatment method for nonmelanoma or melanoma (early stage or late stage) cancers depends on how large the lesion is, where it is found on the body, and the specific type. Some of the common choices are as follows:

  • Simple excision (removal) of the lesion and an area of normal-appearing skin surrounding it in all directions
  • Curettage and electrodesiccation (scraping and cauterizing), which is effective for small basal cell and squamous cell cancers
  • Mohs surgery (microscopically-controlled surgery), a highly specialized technique for basal and squamous cell carcinoma that doesn't cause as much scarring as other methods

After surgery for melanoma, the surgeon or medical oncologist may also recommend so-called "adjuvant" treatment based on what information was learned about the disease during surgery. This may include immunotherapy, chemotherapy, and/or radiation therapy. If the melanoma has spread to distant organs (stage IV) or recurs (comes back after treatment), surgery may be performed again to help control the disease.

Immunotherapy

Immunotherapy (also called targeted or biologic therapy) helps the body's immune system find and attack cancer cells. It uses materials either made by the body or in a laboratory to boost, target, or restore immune function. For basal and squamous cell carcinoma, the topical cream imiquimod is an "immune response modifier" that is commonly prescribed. Immunotherapy is also used to treat melanoma, particularly in reducing the risk that the melanoma will recur. The two most common drugs used are interferon alfa-2b and interleukin-2. Immunotherapy may be used in combination with surgery and/or chemotherapy, or as part of a clinical trial. Many other targeted drugs are being tested now, including therapeutic vaccines.

Side effects of these treatments vary. They can include fatigue, fever, chills, headache, memory difficulties, muscle aches, and skin irritation. Occasionally, side effects from immunotherapy can include a change in blood pressure or cause increased fluid in the lungs. You should discuss the benefits and risks of each treatment option with your doctor.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. For melanoma, this is typically used when there is a high risk that the melanoma may spread or to control advanced disease, although cure of widespread melanoma is rare. Several combinations of chemotherapy are currently being tested in clinical trials.

Common chemotherapy drugs used for melanoma include dacarbazine (DTIC), carboplatin (Paraplatin), cisplatin (Platinol), melphalan (Alkeran), and temozolamide (Temodar). The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications you've been prescribed, their purpose, and their potential side effects or interactions with other medications. In addition to systemic chemotherapy, there are also techniques that focus the drugs on a specific region. Isolated limb perfusion (ILP) and isolated limb infusion (ILI) are examples of this method.

The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, some nerve damage resulting in alterations in sensation, and hair loss. These side effects usually go away once treatment is finished.

Radiation Therapy

Radiation therapy is the use of high-energy X-rays or other particles to kill cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body.

Radiation therapy for melanoma can be used in several ways. It is most commonly used to relieve symptoms caused by melanoma that has spread, especially to the brain and bones. It may also be used when cancer has spread to the lymph nodes, following a lymph node dissection. Finally, research is being done to test the effectiveness of chemoradiation, a combination of radiation therapy and chemotherapy.

Radiation therapy can cause skin irritation, nausea, fatigue and hair loss. If radiation therapy is used around the head and neck, side effects, such as altered taste and dry mouth, may occur. These side effects usually go away once treatment is finished. If lymph nodes near an arm or leg were affected, the person may be at higher risk of fluid build-up in that limb, a side effect called lymphedema.

Conclusion

There are many effective treatments for skin cancer. There is one catch, however: The disease has to be detected early in order for the treatments to be effective. If melanoma metastasizes to distant organs, the survival rate drops precipitously. For this reason, regular skin self-examinations and avoidance of risk factors just may save your life.

Sources:

"Melanoma – Treatment Guidelines for Patients." National Comprehensive Cancer Network and the American Cancer Society. 21 July 2008.

"What You Need to Know about Skin Cancer." National Cancer Institute. July 2002. 21 July 2008.

"All About Skin Cancer – Melanoma." American Cancer Society. July 2008. 22 July 2008.

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