Methods used to treat basal cell carcinomas include:
- Curettage and desiccation: Dermatologists often prefer this method, which consists of scooping out the basal cell carcinoma by using a spoon like instrument called a curette. Desiccation is the additional application of an electric current to control bleeding and kill the remaining cancer cells. The skin heals without stitching. This technique is best suited for small cancers in non-crucial areas such as the trunk and extremities.
- Surgical excision: The tumor is cut out and stitched up.
- Radiation therapy: Doctors often use radiation treatments for skin cancer occurring in areas that are difficult to treat with surgery. Obtaining a good cosmetic result generally involves many treatment sessions, perhaps 25 to 30.
- Cryosurgery: Some doctors trained in this technique achieve good results by freezing basal cell carcinomas. Typically, liquid nitrogen is applied to the growth to freeze and kill the abnormal cells.
- Mohs micrographic surgery: Named for its pioneer, Dr. Frederic Mohs, this technique of removing skin cancer is better termed 'microscopically controlled excision.' The surgeon meticulously removes a small piece of the tumor and examines it under the microscope during surgery. This sequence of cutting and microscopic examination is repeated in a painstaking fashion so that the basal cell carcinoma can be mapped and taken out without having to estimate or guess the width and depth of the lesion. This method removes as little of the healthy normal tissue as possible. Cure rate is very high, exceeding 98 Mohs micrographic surgery is preferred for large basal cell carcinomas, those that recur after previous treatment, or lesions affecting parts of the body where experience shows that recurrence is common after treatment by other methods. Such body parts include the scalp, forehead, ears, and the corners of the nose. In cases where large amounts of tissue need to be removed, the Mohs surgeon sometimes works with a plastic (reconstructive) surgeon to achieve the best possible postsurgical appearance.
- Medical therapy using creams that attack cancer cells (5-Fluorouracil--5-FU, Efudex, Fluoroplex) or stimulate the immune system (imiquimod [Aldara]). These are applied several times a week for several weeks. They produce brisk inflammation and irritation. The advantages of this method is that it avoids surgery, lets the patient perform treatment at home, and may give a better cosmetic result. Disadvantages include discomfort, which may be severe, and a lower cure rate, which makes medical treatment unsuitable for treating most skin cancers on the face.
Avoiding sun exposure in susceptible individuals is the best way to lower the risk for all types of skin cancer. Regular surveillance of susceptible individuals, both by self-examination and regular physical examination, is also a good idea for people at higher risk. People who have already had any form of skin cancer should have regular medical checkups.
Common sense preventive techniques include
- limiting recreational sun exposure;
- avoiding unprotected exposure to the sun during peak radiation times (the hours surrounding noon);
- wearing broad-brimmed hats and tightly-woven protective clothing while outdoors in the sun;
- regularly using a waterproof or water resistant sunscreen with UVA protection and SPF 30 or higher;
- undergoing regular checkups and bringing any suspicious-looking or changing lesions to the attention of the doctor; and
- avoiding the use of tanning beds and using a sunscreen with an SPF of 30 and protection against UVA (long waves of ultraviolet light.). Many people go out of their way to get an artificial tan before they leave for a sunny vacation, because they want to get a 'base coat' to prevent sun damage. Even those who are capable of getting a tan, however, only get protection to the level of SPF 6, whereas the desired level is an SPF of 30. Those who only freckle get little or no protection at all from attempting to tan; they just increase sun damage. Sunscreen must be applied liberally and reapplied every two to three hours, especially afterswimming or physical activity that promotes perspiration, which can weaken even sunscreens labeled as 'waterproof.'
About the Author
Dr. Greg Caesar
Dermatologist, Expert in Skin and Skin Diseases
