Skin Cancer Diagnosis & Treatment
Your skin cancer treatment at MD Anderson includes a plan customized to your specific type of cancer. Basal and squamous cell skin cancers usually are removed by one of the treatments listed below.
Skin cancer excision
During this procedure, a doctor numbs the diseased area with a local anesthetic and then cuts it out entirely. Typically, a small amount of healthy tissue around the area is removed as well. If the patient has not been previously diagnosed, the tissue is sent to a pathologist, who examines the sample to confirm the diagnosis.
Mohs surgery
During this procedure, a dermatologic surgeon removes a very thin layer of cancer tissue and examines it under a microscope. If skin cancer cells can be seen in the layer, the doctor continues shaving off layers one at a time until no cancer cells are found. This procedure has a very high cure rate and typically results in less scarring than excisions.
Mohs surgery is usually performed at a doctor¡¯s office. The patient¡¯s skin is numbed and occasionally a mild sedative is given. MD Anderson has a Mohs and Dermasurgery Center dedicated to this procedure.
Cryosurgery
Cryosurgery is less invasive than conventional surgery. It is often used to treat actinic keratosis (a precancerous skin condition) and occasionally used for small, newly developed skin cancers.
During this procedure, the doctor uses liquid nitrogen to freeze and destroy diseased tissue. This process may be repeated. Because the doctor can focus cryosurgical treatment on a limited area, the destruction of nearby healthy tissue is typically avoided.
Topical chemotherapy
Chemotherapy drugs work by killing fast-growing cells, such as cancer cells. Skin cancer chemotherapy is delivered as a topical ointment that is applied to the affected skin. At the end of treatment, patients may have redness and some crusting on their skin, which typically heals in two to three weeks. Like cryosurgery, topical chemotherapy it is used to treat actinic keratosis and superficial skin cancers. Cryosurgery is usually limited to small areas, while topical chemotherapy can cover large sections of skin, such as a patient¡¯s entire face.
Laser surgery
Lasers surgery is used to treat precancerous conditions like actinic keratosis and early, superficial skin cancers. During laser surgery, doctors use an intense, focused beam of light to destroy skin cancer.
The laser can be set to remove the skin in controlled layers, depending on the depth of the cancer. The surgeon may remove the top layer only or the top layer plus additional deeper layers.
The laser destruction, plus the body's immune response to the injury, results in a blistered wound that takes several weeks to heal.
Electrodessication and curettage
During this procedure, doctors use a scraping instrument (curette) and electrical currents to destroy and remove small and superficial skin cancers.
High-risk or metastatic skin cancer treatment
When a patient¡¯s skin cancer has spread or is at high risk of spreading, treatment can become more complex. At MD Anderson, these treatment plans are developed by a team of doctors from multiple disciplines, including dermatology, radiation oncology and the different surgical specialties. High-risk skin cancer on the head or neck, for instance, may be treated by a head and neck surgeon. These doctors meet to discuss the patient¡¯s case and work together to develop a treatment plan. Treatments may include surgery, radiation therapy, chemotherapy and more.
Clinical trials
Because of its status as one of the world¡¯s premier cancer centers, MD Anderson participates in many clinical trials for skin cancer. Sometimes they are a patient¡¯s best option for skin cancer treatment.
Learn more about clinical trials.
Learn more about skin cancer:
Squamous cell carcinoma patient runs 28th Boston Marathon
After running the Boston Marathon 27 times, you'd think Bob Lehew would have experienced every trial a runner could face. But this year, he experienced a new challenge. Bob ran the race halfway into his six weeks of radiation treatment for squamous cell carcinoma, a type of skin cancer.
"I was happy to see the finish line," he says, shrugging off the accomplishment modestly.
At age 71, Bob has run more than 220 marathons and a handful of ultramarathons.
"I'm a pretty competitive guy," he says. "I guess pain and suffering are just my strong suit."
Showing strength during squamous cell carcinoma treatment
Bob had signed up once again for the Boston Marathon long before he was diagnosed with squamous cell carcinoma in late January. After he noticed a lump on his upper right check, he scheduled an appointment. His dentist thought it was TMJ, but the biopsy showed that it was cancer. He moved quickly and had the tumor removed by a surgeon in Dallas. He then made an appointment at MD Anderson.
The tumor was located in the parotid gland. The facial nerve passes right thru the parotid gland, and Bob worried that his surgeon would have to cut the facial nerve in order to remove the tumor. Fortunately, they were able to avoid this, but the nerve was aggravated.
The procedure saved Bob's life, but left him unable to move the right side of his face. He spoke clearly, but was unable to smile. His right eyebrow was replaced with an arch-shaped scar, often hidden by a "Boston Strong" baseball hat.
He also suffered from dysgeusia, which made it difficult for him to taste, as well as some fatigue. "I'm not opposed to taking a nap these days," he says.
Next, he began his radiation treatments. But after three weeks, Bob skipped his radiation treatment in favor of running 26.2 miles.
The Boston Marathon had always been special to Bob, and he knew this year was special to Boston. It would be his 28th consecutive Boston Marathon. He had to be there. His doctor, ?-- a marathon runner herself, "a lean, mean, running machine," in Bob's words -- knew that marathon runners can be a stubborn bunch.
"She didn't necessarily recommend that I go," Bob says. "But she said, 'If you can do it in the middle of radiation, then you'll be my hero.'"?
"That was a big inspiration," he adds.
Bob finished the race in six hours forty minutes. It was much longer than his personal record of two hours and 51 minutes at Boston back in 1988. But he finished. He attributed the accomplishment to the sacrifices of his three children, nine grandchildren, many friends and "a six pack of doctors."
The next day following the marathon he was back at MD Anderson, making up for the treatment he had missed on Monday, the day of the race.
Getting back to Boston after cancer treatment
For Bob, the Boston Marathon is what started it all. Bob has always been athletic. He played for the varsity soccer team at Ohio State University, but he was never much of a runner -- until he was out jogging one day and saw a man wearing a jacket with a patch on it. He thought the jacket looked cool and asked the man how he could get one. The man told him he had to run the Boston Marathon. From that moment on, Bob was determined. The man, Marvin, put together a training program which Bob followed and qualified for his first Boston back in 1987. He's been back every year since.
Even in 2010, after he'd undergone a bypass surgery, Bob laced up his running shoes for the race against his doctors wishes.
"No one ever accused me of being smart," Bob says.
With his 28th marathon behind him, Bob is looking forward to finishing his treatment, ringing the bell and getting back to work in Dallas. Once he's home, he can start training to get back to Boston in 2015.
"Boston's still my favorite race," he says. "I expect to be back next year, but with a much faster time."
What to expect when you have a mole removed
Moles are common growths on the skin. Moles are benign, which means they¡¯re not cancerous. But when melanocytes, the cells that make up moles, turn cancerous, we call that melanoma.
Melanomas can develop within a mole you¡¯ve had for a long time or show up as a new mole. In both cases, the mole can look unusual; it doesn¡¯t look like your other moles or is changing and/or growing in an unusual way.
Your dermatologist may find an abnormal mole during a skin cancer screening exam. To determine if a mole is cancerous, your dermatologist will send the mole for a biopsy. A skin biopsy is usually a quick, straightforward procedure.
You should check your skin regularly before visiting your dermatologist for a skin cancer screening.
Use the ABCDEs of melanoma to do a skin self-check
Before your appointment, examine your moles by doing a skin self-exam. Use the ABCDE guide for melanoma and note any of the following skin cancer symptoms so you can point them out to your dermatologist.
- Asymmetry: The two sides of the mole look different from each other.
- Border: The mole¡¯s border is crooked, jagged or irregular.
- Color: The mole is multi-colored.
- Diameter: The width is more than 6 millimeters, which is about the size of a pencil eraser.
- Evolution: The mole has changed in size, shape or feeling.
Be sure to point out any moles that are ugly ducklings. These moles look different from your other moles, or they have grown or changed noticeably. It¡¯s a red flag if you¡¯ve had a mole for a long time that suddenly starts changing, or if you have a new mole that changes and grows. Normal moles typically look like your other moles and are very slow to grow or change.
What happens during a dermatologist's exam
During the appointment, your dermatologist will look for any abnormal moles. If an abnormal mole is noted on exam, your dermatologist may recommend either monitoring it closely for any changes or removing it for a biopsy.
Monitoring moles
Atypical moles are moles that look a little unusual but aren¡¯t melanoma. If an atypical mole is flat, hasn¡¯t changed and doesn¡¯t look concerning for melanoma, your dermatologist may suggest short-term monitoring. That means they¡¯ll check it again in a few months to make sure it isn¡¯t growing or changing. The longer it¡¯s stable and not changing, the less likely it is to be cancerous.
Biopsying a mole??????????
If a mole looks concerning, a biopsy is done so that the mole¡¯s cells can be examined further under a microscope. Getting a close-up view of how the cells in the mole look and are arranged allows the pathologist to determine if the mole¡¯s cells are cancerous.
First, your dermatologist will give you a numbing injection near the mole. This may pinch a little, but it should keep you from feeling any pain during the removal. Your dermatologist will select the biopsy technique based on the type of mole and the amount of tissue sample the pathologist will need to make a diagnosis. Your dermatologist may use the following techniques to remove the mole:
- Shave biopsy ¨C A razor blade is used to shave off the mole.
- Punch biopsy ¨C A punch tool is placed over the mole and used to ¡°punch¡± out the mole.
- Excisional biopsy ¨C A scalpel is used to remove the mole, and stitches are used to help the skin heal.
These are all minor surgical procedures. The process is similar if a mole is removed for cosmetic reasons or because it bothers you. Dermatologists use cryotherapy and laser treatments to remove other growths, but they don¡¯t usually remove moles that way because they can¡¯t biopsy them. Any time a mole is removed, it¡¯s important to check that the cells are normal. That¡¯s because if the mole comes back and is melanoma, we¡¯ve delayed diagnosis and treatment.
Don¡¯t try to remove moles at home
I do not recommend trying to remove moles yourself. Often, people confuse moles with seborrheic keratoses or skin tags, which are benign skin growths. Real moles are not very easy to remove; you¡¯d have to cut them out or destroy the skin where the mole lives. You have an increased risk of pain and major scarring. Additionally, you will have no way of knowing if the mole was cancerous or not because it was never sent for biopsy.
Getting your results
After a mole is removed or biopsied, the sample is sent to a pathologist for a closer look. The pathologist will share the results with your dermatologist, and then your dermatologist will go over the results with you. If the cells that make up the mole look normal and healthy, you won¡¯t need any further treatment, and your dermatologist will help you determine when your next skin screening should be.
If the cells that make up the mole appear very abnormal or cancerous, your dermatologist will help figure out your next steps.
Having a mole biopsied is a simple, low-risk procedure. It may leave a small scar. But a biopsy scar is usually worth the peace of mind of knowing if an abnormal mole is melanoma.
, is a dermatologist at MD Anderson in Sugar Land.
or call 1-877-632-6789.