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Treatment
Getting a Second Opinion
Treatment Methods
Sometimes all of the cancer is removed during the biopsy. In such cases, no
more treatment is needed. If you do need more treatment, your doctor will
describe your options.
Treatment for skin cancer depends on the type and stage of the disease, the
size and place of the growth, and your general health and medical history. In
most cases, the aim of treatment is to remove or destroy the cancer completely.
It often helps to make a list of questions before an appointment. To help
remember what the doctor says, you may take notes or ask whether you may use a
tape recorder. You may also want to have a family member or friend with you
when you talk to the doctor -- to take part in the discussion, to take notes, or
just to listen.
Your doctor may refer you to a specialist, or you may ask for a referral.
Specialists who treat skin cancer include
dermatologists,
surgeons, and
radiation oncologists.
Before you have treatment, you might want a second opinion about the diagnosis
and treatment plan. Many insurance companies cover a second opinion if you or
your doctor requests it. It may take some time and effort to gather medical
records and arrange to see another doctor. Usually it is not a problem to take
several weeks to get a second opinion. In most cases, the delay will not make
treatment less effective. To make sure, you should discuss this delay with your
doctor. Sometimes people with skin cancer need treatment right away.
There are a number of ways to find a doctor for a second opinion:
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Your doctor may refer you to one or more specialists. At cancer centers,
several specialists often work together as a team.
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NCI's Cancer Information Service, at 1-800-4-CANCER, can tell you about nearby
treatment centers. Information Specialists also can provide online assistance
through
LiveHelp 1 at http://www.cancer.gov/cis.
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A local or state medical society, a nearby hospital, or a medical school can
usually provide the names of specialists.
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NCI provides a helpful fact sheet called "How To Find a Doctor or Treatment
Facility If You Have Cancer 2."
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You may want to ask the doctor these questions before treatment begins:
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What is the stage of the disease?
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What are my treatment choices? Which do you recommend for me? Why?
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What are the expected benefits of each kind of treatment?
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What are the risks and possible
side effects
of each treatment? What can we do
to control my side effects?
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Will the treatment affect my appearance? If so, can a
reconstructive surgeon
or
plastic surgeon
help?
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Will treatment affect my normal activities? If so, for how long?
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What is the treatment likely to cost? Does my insurance cover this treatment?
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How often should I have checkups?
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Would a
clinical trial
(research study) be appropriate for me?
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Your doctor can describe your treatment choices and what to expect. You and
your doctor can work together to develop a treatment plan that meets your
needs.
Surgery
is the usual treatment for people with skin cancer. In some cases, the
doctor may suggest
topical chemotherapy,
photodynamic therapy,
or
radiation therapy.
Because skin cancer treatment may damage healthy cells and tissues, unwanted
side effects sometimes occur. Side effects depend mainly on the type and extent
of the treatment. Side effects may not be the same for each person.
Before treatment starts, your doctor will tell you about possible side effects
and suggest ways to help you manage them.
Many skin cancers can be removed quickly and easily. Even so, you may need
supportive care
to control pain and other symptoms, to relieve the side effects
of treatment, and to ease emotional concerns. Information about such care is
available on NCI's Web site at http://www.cancer.gov/cancertopics/coping,
and from Information Specialists at 1-800-4-CANCER or
LiveHelp 1.
You may want to talk to your doctor about taking part in a clinical trial, a
research study of new ways to treat cancer or prevent it from coming back. The
section on "The Promise of Cancer
Research 3" has more information about clinical trials.
Surgery to treat skin cancer may be done in one of several ways. The method
your doctor uses depends on the size and place of the growth and other factors.
Your doctor can further describe these types of surgery:
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Excisional skin surgery
is a common treatment to remove skin cancer.
After numbing the area, the surgeon removes the growth with a scalpel. The
surgeon also removes a border of skin around the growth. This skin is the
margin.
The margin is examined under a microscope to be certain that all the
cancer cells have been removed. The size of the margin depends on the size of
the growth.
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Mohs surgery
(also called Mohs micrographic surgery) is often used for
skin cancer. The area of the growth is numbed. A specially trained surgeon
shaves away thin layers of the growth. Each layer is immediately examined under
a microscope. The surgeon continues to shave away tissue until no cancer cells
can be seen under the microscope. In this way, the surgeon can remove all the
cancer and only a small bit of healthy tissue.
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Electrodesiccation
and
curettage
is often used to remove small basal
cell skin cancers. The doctor numbs the area to be treated. The cancer is
removed with a sharp tool shaped like a spoon. This tool is a
curette.
An
electric current is sent into the treated area to control bleeding and kill any
cancer cells that may be left. Electrodesiccation and curettage is usually a
fast and simple procedure.
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Cryosurgery
is often used for people who are not able to have other
types of surgery. It uses extreme cold to treat early stage or very thin skin
cancer. Liquid nitrogen creates the cold. The doctor applies liquid nitrogen
directly to the skin growth. This treatment may cause swelling. It also may
damage nerves, which can cause a loss of feeling in the damaged area. The NCI
fact sheet "Cryosurgery in Cancer Treatment: Questions and Answers 4" has more
information.
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Laser surgery
uses a narrow beam of light to remove or destroy cancer
cells. It is most often used for growths that are on the outer layer of skin
only. The NCI fact sheet "Lasers in Cancer Treatment: Questions and Answers 5"
has more information.
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Grafts
are sometimes needed to close an opening in the skin left by
surgery. The surgeon first numbs and then removes a patch of healthy skin from
another part of the body, such as the upper thigh. The patch is then used to
cover the area where skin cancer was removed. If you have a skin graft, you may
have to take special care of the area until it heals.
The time it takes to heal after surgery is different for each person. You may
be uncomfortable for the first few days. However, medicine can usually control
the pain. Before surgery, you should discuss the plan for pain relief with your
doctor or nurse. After surgery, your doctor can adjust the plan if you need
more pain relief.
Surgery nearly always leaves some type of scar. The size and color of the scar
depend on the size of the cancer, the type of surgery, and how your skin heals.
For any type of surgery, including skin grafts or
reconstructive surgery,
it is
important to follow your doctor's advice on bathing, shaving, exercise, or
other activities.
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You may want to ask your doctor these questions about surgery:
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What kind of surgery will I have?
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Will I need a skin graft?
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What will the scar look like? Can anything be done to help reduce the scar?
Will I need
plastic surgery
or reconstructive surgery?
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How will I feel after the operation?
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If I have pain, how will it be controlled?
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Will I have to stay in the hospital?
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Am I likely to have infection, swelling, blistering, or bleeding, or to get a
scab where the cancer was removed?
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Chemotherapy uses anticancer drugs to kill skin cancer cells. When a drug is
put directly on the skin, the treatment is topical chemotherapy. It is most
often used when the skin cancer is too large for surgery. It is also used when
the doctor keeps finding new cancers.
Most often, the drug comes in a cream or lotion. It is usually applied to the
skin one or two times a day for several weeks. A drug called
fluorouracil
(5-FU) is used to treat basal cell and squamous cell cancers that are in the
top layer of the skin only. A drug called
imiquimod
also is used to treat basal
cell cancer only in the top layer of skin.
These drugs may cause your skin to turn red or swell. It also may itch, hurt,
ooze, or develop a rash. It may be sore or sensitive to the sun. These skin
changes usually go away after treatment is over. Topical chemotherapy usually
does not leave a scar. If healthy skin becomes too red or raw when the skin
cancer is treated, your doctor may stop treatment.
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You may want to ask your doctor these questions about topical chemotherapy:
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Do I need to take special care when I put chemotherapy on my skin? What do I
need to do? Will I be sensitive to the sun?
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When will treatment start? When will it end?
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Photodynamic therapy (PDT) uses a chemical along with a special light source,
such as a laser light, to kill cancer cells. The chemical is a
photosensitizing agent.
A cream is applied to the skin or the chemical is injected. It stays in
cancer cells longer than in normal cells. Several hours or days later, the
special light is focused on the growth. The chemical becomes active and
destroys nearby cancer cells.
PDT is used to treat cancer on or very near the surface of the skin.
The side effects of PDT are usually not serious. PDT may cause burning or
stinging pain. It also may cause burns, swelling, or redness. It may scar
healthy tissue near the growth. If you have PDT, you will need to avoid direct
sunlight and bright indoor light for at least 6 weeks after treatment.
The NCI fact sheet "Photodynamic Therapy for Cancer: Questions and Answers 6" has
more information.
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You may want to ask your doctor these questions about PDT:
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Will I need to stay in the hospital while the chemical is in my body?
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Will I need to have the treatment more than once?
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Radiation therapy (also called radiotherapy) uses high-energy rays to kill
cancer cells. The rays come from a large machine outside the body. They affect
cells only in the treated area. This treatment is given at a hospital or clinic
in one dose or many doses over several weeks.
Radiation is not a common treatment for skin cancer. But it may be used for
skin cancer in areas where surgery could be difficult or leave a bad scar. You
may have this treatment if you have a growth on your eyelid, ear, or nose. It
also may be used if the cancer comes back after surgery to remove it.
Side effects depend mainly on the dose of radiation and the part of your body
that is treated. During treatment your skin in the treated area may become red,
dry, and tender. Your doctor can suggest ways to relieve the side effects of
radiation therapy. Also, the NCI booklet
Radiation Therapy and You 7 offers more information.
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You may want to ask your doctor these questions about radiation therapy:
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How will I feel after the radiation?
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Am I likely to have infection, swelling, blistering, or bleeding, or to get a scar
in the treated area?
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How should I take care of the treated area?
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