There are many different skin cancers, but the vast majority are either:
- Basal cell carcinoma (BCC)
- Squamous cell carcinoma (SCC)
- Melanoma
The type of skin cancer treatment required is determined by type of skin cancer, anatomical location and patient preference.
Skin Cancer Treatment
Imiquimod
Imiquimod, also known as Aldara, is a cream that can be used to treat low risk superficial skin cancer and precancerous lesions and therefore avoid the need for surgery. Response rates are inferior to surgery and therefore its use should be limited to low risk lesions where recurrence is not going to be of a major concern. The cream comes in small sachets that are typically applied daily for up to 6 weeks depending on the lesion. Side effects are common and can be marked ranging from skin inflammation around the lesion to flu-like illness with muscle aches and pains. Your doctor should fully inform you of these side effects before commencing treatment
Efudix
Efudix cream is licensed for treating solar keratoses. Efudix selectively destroys all precancerous cells in the top layers of the skin thereby avoiding the need for surgery. Typically it is applied twice a day for 3 weeks producing a red rash at the site of application. The end result is a crusted area that slowly returns to normal healthy skin over a further few weeks. It is usually prescribed in the winter months as the cream can increase your risk of sunburn if applied during the summer.
Photodynamic therapy (PDT)
Photodynamic therapy (PDT) is a medical treatment that involves the use of a special light-activated medication, known as a photosensitizing agent, to destroy abnormal or cancerous cells in the body.
Over a certain amount of time the drug is absorbed by the cancer cells. Then light is applied to the area to be treated. The light causes the drug to react with oxygen, which forms a chemical that kills the cells. PDT can be used to treat superficial variants of BCC, actinic keratosis, squamous cell carcinoma-insitu (Bowens disease).
Daylight photodynamic therapy (PDT) is a type of PDT that is performed without the need for a special light source. Instead, it utilizes natural sunlight to activate the photosensitizing agent.
During daylight PDT, a photosensitizing agent is applied to the affected area of the skin. After a certain amount of time, the patient is instructed to go outside and expose the treated area to natural sunlight for a specific duration. The light from the sun activates the photosensitizing agent, which then targets and destroys abnormal or cancerous cells.
Compared to traditional PDT, daylight PDT has some advantages. It can be more convenient for patients, as it does not require a special light source and can be performed outdoors. It can also be less expensive, as it does not require the use of expensive light sources.
As with any medical procedure, it’s important to talk to your healthcare provider to determine if daylight PDT is the right option for your specific skin condition.
After the procedure, you may experience some redness, swelling, and discomfort at the treatment site. These side effects are usually temporary and should resolve within a few days to a week. In some cases, additional PDT sessions may be required to achieve the desired results.
What skin conditions can photodynamic therapy treat?
Although it is used in several skin conditions the main condition the Devon Hair and Skin Institute use daylight PDT for is actinic keratoses.
How is PDT delivered?
You will be asked to attend the clinic on a day when there is sufficient day light to deliver your treatment. The treatment takes up to 3 hours to deliver. You will however be able to relax in the gardens of Wood House while enjoying a meal prepared by our own inhouse chefs.
Cryosurgery
Also referred to as liquid nitrogen or freezing therapy. Liquid nitrogen is delivered using a precise spray directly onto the skin lesion. It can be used to treat both benign and cancerous lesions. Depending on the lesion treated the area will be left with a white (depigmented) scar. In the initial 24 hours a large blister often forms. Pain is minimal after 48 hours. The advantage of cryosurgery is being able to treat a large number of lesions in one clinic and its relative inexpense to invasive procedures.
Curettage and cautery (C&C)
Performed under local anaesthetic C&C is a simple technique used to remove benign warts, seborrheic keratosis, actinic keratosis, squamous cell carcinoma insitu (Bowens disease) and low risk basal cell carcinomas. Depending on how it is performed C&C wounds are often slow to heal over several weeks, painful at first eventually leaving a hypopigmented scar.
Excision biopsy
Excision biopsy is performed under local anaesthetic typically to remove concerning skin lesions that are either skin cancer or possible skin cancer. This technique aims to remove the entire lesion to allow accurate diagnosis and also definitive treatment. Excision biopsy is the preferred treatment for most basal cell carcinomas off the face (for facial lesions consider Mohs micrographic surgery), squamous cell carcinomas, suspicious or changing moles and other types of skin cancer.
Mohs micrographic surgery (MMS)
MMS is considered the ‘gold standard’ treatment for basal cell carcinoma skin cancer on cosmetically sensitive sites such as the central face or in situations where persevering as much normal healthy skin as possible is crucial such as on fingers and genitals. To understand the technique please watch the patient video produced by Dr Toby Nelson for the American College of Mohs Surgery.