February 6, 2009

Surgery for Nonmelanoma Skin Cancer

Surgery remains the treatment of choice for most patients, but other options are available.

Each year in the U.S., more than 1,000,000 people are diagnosed with basal cell or squamous cell skin cancers.1 Unlike melanoma, these types of skin cancer are rarely deadly. They can, however, cause extensive tissue destruction and disfigurement, and they commonly occur in cosmetically sensitive areas such as the face.

To reduce the likelihood of cancer recurrence—and the more extensive treatment that may be required to manage a recurrence—effective initial treatment is important. For a majority of patients, this involves treatment with one of several different types of surgery. “The benefits of surgery,” explains Dr. Anna Bar, Assistant Professor of Dermatologic Surgery at Oregon Health & Science University, “are that it can be done in one day, it’s time tested, and it’s proven to be the most effective form of treatment with the highest cure rate.”

Surgery is the most extensively studied approach to treating nonmelanoma skin cancer and generally provides excellent cure rates. Furthermore, surgery for nonmelanoma skin cancer is usually done under local anesthesia. “Skin cancer surgery is one of the safest surgeries performed in the United States,” says Dr. Bar.

Depending the size and location of the cancer, the surgical procedure used may require only a few minutes (curettage and desiccation) or up to several hours (Mohs surgery).

Mohs surgery: This procedure is complicated and requires expertise, but is often recommended for the treatment of basal cell carcinoma or squamous cell carcinoma in cosmetically sensitive areas. In this procedure, a doctor removes thin layers of skin one at a time and evaluates them for cancer while the patient waits. The doctor keeps removing layers of skin until he or she reaches a layer that is cancer-free. This procedure removes the least amount of normal tissue, and also has the highest cure rates for both primary and recurrent cancers. 2

“Mohs surgery,” explains Dr. Bar, “is going to be used on areas where sparing tissue is paramount, such as the face.” Mohs is also a common approach to the treatment of recurrent skin cancer. “When a tumor is recurrent,” says Dr. Bar, “we often go straight to Mohs because many of the other modalities provide very poor cure rates for recurrent tumors.”

Excisional surgery: Excisional surgery involves use of a scalpel to remove the cancer and some surrounding normal tissue. The tissue that is removed is then sent to a lab, where the margins of the tissue are checked for cancer. If the margins are clear, it’s likely that the cancer was completely removed. “It’s a quicker procedure than Mohs because the patient doesn’t have to wait in the office while the tissue is checked,” says Dr. Bar. “The downside is that the patient could hear several days later that not all of the cancer was removed.” The patient would then have to return for additional surgery.

Curettage and Desiccation: “This is just a five-minute procedure,” says Dr. Bar. After numbing the area, the physician scrapes the lesion and then uses an electric current to stop the bleeding and kill remaining cancer cells. “It’s commonly used on nonaggressive subtypes of skin cancer when they’re located in lower risk areas such as the body,” says Dr. Bar, “It can also be useful on certain areas of the face. It’s a very quick procedure and there’s a very low risk to it. It has an acceptably good cure rate for most lesions—about 85 percent. The disadvantage is that we’re not checking the tissue, we’re just nonspecifically scraping away the skin cancer and using the cautery to destroy the remainder of the tumor cells.”


1 American Cancer Society. Cancer Facts & Figures 2007. Available at: http://www.cancer.org/docroot/stt/stt_0.asp (Accessed November 28, 2007).2 National Cancer Institute. Skin Cancer (PDQ®): Treatment. Health Professional Version. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/skin/HealthProfessional (accessed November 28, 2007)

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Tags: Skin Cancer, Uncategorized