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Parkwood skin clinic
Skin cancer is one of the most common forms of cancer, affecting millions of people globally. It occurs when skin cells grow uncontrollably due to DNA damage, often from ultraviolet (UV) radiation from the sun or tanning beds.
The three main types of skin cancer are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma, with melanoma being the most dangerous. Early detection and effective treatment are crucial for a positive outcome. For many years, traditional treatment methods for skin cancer included surgery, radiation therapy, and chemotherapy. Surgery involved the removal of cancerous tissue and surrounding healthy tissue to ensure complete eradication of the melanoma and non melanoma skin cancer.
BCC is the most common and least aggressive form of non melanoma skin cancers. It typically appears as a painless raised area of skin. This may be shiny with small blood vessels running over it or as a sore that won’t heal.
SCC is one of the non melanoma skin cancers that is more aggressive than BCC. SCC can spread to other parts of the body if not treated promptly. It often appears as a red, scaly, or crusty patch on the skin, a firm red nodule, or a sore that heals and reopens.
Melanoma is the most serious type of skin cancer. It can spread to nearby lymph nodes, which is an important factor in diagnosing and grading the severity of the cancer. It can develop in an existing mole or suddenly appear as a new dark spot on the skin. Early detection is critical, as melanoma can spread quickly to other parts of the body.
Excisional surgery is a common and effective treatment for skin cancer, particularly for non melanoma skin cancers such as basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and early-stage melanoma. During the procedure, the doctor removes the cancerous tissue along with a margin of surrounding healthy skin to kill skin cancer and ensure complete excision of malignant cells.
This margin is examined microscopically to confirm that no skin cancer remains. Excisional surgery is often performed under local anaesthesia in an outpatient setting for removing skin cancer. It provides a high cure rate and is especially effective for well-defined, smaller lesions. Post-surgical care includes wound management and monitoring for any signs of recurrence, making it a reliable option for treating various types of skin cancer.
Surgical treatment often involves surgical procedures to remove skin cancer, with reconstructive techniques like flaps and grafts being used to restore the affected area’s appearance and function.
Flaps involve relocating healthy tissue from one part of the body to another, ensuring that the moved tissue retains its blood supply. They are often used in areas where the removal of skin cancer has left a large defect that cannot heal on its own or with a simple closure.
Grafts involve transplanting tissue from one area of the body to another without its blood supply, relying on the recipient site’s blood supply to survive and integrate into the surrounding tissue. There are two types of grafts: Split-Thickness Skin Grafts, which includes both the epidermis and the entire dermis, and Full-Thickness Skin Grafts, which includes both the epidermis and the entire dermis.
Flaps and grafts are typically used in scenarios where large defects are present, aesthetic considerations, or functional restoration. The surgical procedure includes pre-surgical preparation, assessment, planning, surgery, wound care, follow-up visits, and activity restrictions. Benefits of flaps and grafts include enhanced healing, improved aesthetics, and functional preservation. However, there are potential risks and complications, such as infection, transplant/flap failure, and scarring.
Mohs surgery is a highly precise and effective surgical technique for treating skin cancer, particularly non melanoma skin cancers such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Developed by Dr. Frederic Mohs, this procedure involves the step-by-step removal of cancerous tissue while preserving as much healthy tissue as possible. During the surgery, the visible skin cancer is removed first, followed by the systematic excision of thin layers of surrounding tissue.
Each layer is examined under a microscope in real-time to check for cancer cells. This process continues until no cancer cells are detected in the tissue sample. Mohs surgery offers the highest cure rate for skin cancer, thanks to its meticulous approach in ensuring all cancerous cells are removed while minimising tissue loss.
It is particularly beneficial for cancers located in cosmetically sensitive areas, such as the face, ears, and hands, where preserving healthy tissue is crucial for both function and appearance. The precise nature of Mohs surgery also reduces the likelihood of recurrence of skin cancer, making it a preferred method for high-risk or recurrent skin cancers.
Curettage and electrodessication is a straightforward and effective treatment method for certain types of skin cancer, particularly non melanoma skin cancers such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in their early stages. This procedure involves two main steps: curettage and electrodessication.
During curettage, the doctor uses a curette, a sharp, spoon-shaped instrument, to scrape away the skin cancer. Following this, electrodessication is performed, where an electric needle is used to destroy any remaining cancer cells and control bleeding by applying electric currents to the affected area. This combination helps to ensure that the cancer cells are thoroughly removed while minimising bleeding and promoting healing.
Curettage and electrodessication is usually performed under local anaesthesia and is considered a minimally invasive procedure for treating skin cancer with a quick recovery time. It is particularly advantageous for treating superficial skin cancers and is associated with high success rates.
However, it may result in scarring and is typically not recommended for areas where cosmetic outcomes are a primary concern, such as the face. This method is a valuable option for patients seeking an efficient and relatively low-risk treatment for skin cancer.
Topical treatments are a non-invasive and effective option to treat skin cancer and precancerous conditions, such as superficial basal cell carcinoma (BCC), squamous cell carcinoma in situ (Bowen’s disease), and actinic keratosis. Three commonly used topical medications are Solaraze, Imiquimod, and Efudex. Solaraze is a non-steroidal anti-inflammatory drug used to treat actinic keratosis, a precancerous skin condition caused by prolonged sun exposure. It reduces inflammation and induces apoptosis in abnormal cells. Imiquimod is an immune response modifier used to treat superficial BCC, actinic keratosis, and genital warts.
It stimulates the body’s immune system to produce interferon, a protein that attacks cancerous and precancerous cells. Common side effects include redness, swelling, itching, and flaking at the application site. Efudex, also known as 5-fluorouracil (5-FU), is a topical chemotherapy cream used to treat actinic keratosis and superficial BCC. It works by interfering with the DNA synthesis of rapidly dividing abnormal cells, leading to their destruction. Patients should follow their doctor’s instructions closely and report any severe or persistent side effects. Regular follow-up appointments are essential to monitor treatment effectiveness and manage any complications.
Cryotherapy is a minimally invasive procedure used to treat various skin conditions, including precancerous lesions and certain types of skin cancer. It involves the application of extreme cold, typically using liquid nitrogen, to freeze and destroy abnormal or cancerous cells. The process involves rapidly freezing the targeted tissue, causing ice crystals to form within the cells, disrupting cell membranes and leading to cell death. The treated area forms a blister or crust, which eventually falls off, allowing new, healthy skin to form. Cryotherapy is highly effective for treating actinic keratosis, superficial basal cell carcinoma (BCC), and early squamous cell carcinoma (SCC). The procedure involves cleaning the area, applying liquid nitrogen, freezing and thawing, and post-treatment care.
Cryotherapy is a quick, convenient, and effective treatment option for small, superficial lesions, offering a high cure rate for actinic keratosis and early-stage skin cancers. However, it may cause pain, discomfort, blistering and swelling, hyperpigmentation or hyperpigmentation, and infection. It is essential to discuss the potential benefits and risks with a healthcare provider to determine the best treatment option for your specific condition.
Photodynamic therapy is used to treat skin cancers, particularly superficial basal cell carcinoma (BCC), squamous cell carcinoma in situ (Bowen’s disease), and actinic keratosis. It combines a photosensitising agent applied to the skin with a specific wavelength of light to activate the agent, causing it to selectively destroy cancer cells. Although PDT is not suitable for all skin cancers and may require multiple treatment sessions, it represents a promising non-invasive option for patients, especially those with early-stage or superficial skin cancers.
Ablative lasers, such as carbon dioxide (CO2) and erbium:YAG lasers, offer a precise and effective method for treating certain types of skin cancer, including early-stage basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), as well as precancerous lesions like actinic keratosis. These lasers work by vaporising the outer layers of the skin, removing cancerous cells and promoting the growth of healthy tissue. The procedure is typically performed under local anaesthesia and can be done on an outpatient basis. Ablative laser treatment allows for precise targeting of the affected area, minimising damage to surrounding healthy tissue and resulting in less scarring compared to traditional surgical methods. Recovery time varies, but patients generally experience a quicker healing process.
Chemical Peel treatments are non-invasive options for treating precancerous lesions. They offer the advantage of being less invasive than surgical options, with minimal scarring and downtime. However, they may cause local skin reactions, such as redness, swelling, and discomfort, which are usually temporary. Chemical treatments provide an alternative for patients who seek less invasive methods or cannot undergo surgery, making them a valuable component of skin cancer management.
Immunotherapy represents a groundbreaking approach in the treatment of skin cancer, especially for advanced melanoma or when cancer has spread. This innovative treatment harnesses the power of the body’s immune system to recognise and attack cancer cells. Immune checkpoint inhibitors work by blocking proteins that prevent immune cells from attacking cancer, thereby enhancing the immune response against the tumour. Immunotherapy can lead to significant and long-lasting remissions, even in cases where skin cancer has spread to other parts of the body. While it offers hope for many patients, immunotherapy can also cause side effects, including inflammation and autoimmune reactions. Ongoing monitoring and management by healthcare professionals are crucial to maximise the benefits and manage any adverse effects. Overall, immunotherapy is a promising and evolving treatment modality that continues to improve outcomes for skin cancer patients.
Radiotherapy, or radiation therapy, is a targeted treatment option for skin cancer that uses high-energy rays to destroy skin cancer cells. Radiation therapy is particularly effective for treating basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) when surgical options are not feasible or for patients who cannot undergo surgery due to medical conditions. Radiotherapy can also be used as an adjunctive treatment to eliminate residual cancer cells after surgery or to treat recurrences. The procedure involves directing precise doses of radiation to the affected area, minimising damage to surrounding healthy tissue. Treatments are usually given over several sessions to maximise effectiveness while allowing normal cells to recover. Common side effects include skin irritation, redness, and fatigue, but these are generally temporary. Radiotherapy offers a non-invasive alternative with good cosmetic outcomes, making it a valuable option in the comprehensive management of skin cancer. It is generally performed by a radiation oncologist.
Another breakthrough in skin cancer treatment is targeted therapy. This approach uses drugs that specifically target to kill cancer cells without harming healthy cells. Unlike chemotherapy, which affects both cancerous and healthy cells, targeted therapy works by attacking the genetic mutations within skin cells that drive their growth and survival.
Targeted therapy for skin cancer involves identifying specific genetic mutations or alterations in cancer cells and then using drugs that can inhibit or block the effects of these mutations. By doing so, targeted therapy can effectively stop the growth and spread of skin cancer.
One example of targeted therapy for skin cancer is the use of BRAF inhibitors for melanoma treatment. Approximately 50% of melanomas have mutations in the BRAF gene, which leads to uncontrolled cell growth. BRAF inhibitors work by blocking the activity of mutated BRAF proteins, thereby slowing down or stopping the growth of melanoma cells.
Targeted therapy offers a personalised treatment approach for skin cancer patients. By identifying the specific genetic alterations driving the skin cancer, doctors can tailor treatment plans to each individual, ensuring maximum effectiveness and minimising side effects.