Skin cancers are managed with either destructive methods or excision. Radiation therapy is use in limited circumstances for aggressive skin cancer or for treatment of skin cancers where surgery or curettage is inappropriate or not possible.
All treatments are normally preceeded by a biopsy if definitive excision is not going to be performed to obtain a diagnosis.
Destructive treatments for skin cancer management includes cryotherapy or curettage and electrocautery. Cryotherapy for skin cancer differs from cryotherapy for benign lesions. It is prolonged and a technique using a freeze thaw method used to maximise destruction of cancerous tissue. The tissue is frozen with a margin of apparently normal skin also frozen, then allowed to thaw, and then the freeze is repeated. This results in a large blister which can take some time to heal and often results in a large white patch of hypopigmented skin. Cure rates can be high for appropriately chosen lesions in experienced hands.
Curettage and electrocautery is a technique where a curved spoon shaped instrument with a blunt or sharpened edge (a curette) is used to scoop out cancerous tissue with a margin of apparently normal skin. The base or the wound is then treated with electrocautery, and then this further margin of tissue is removed with the curette and the cycle repeated until no further abnormal tissue is observed. This results in a graze like or scooped out wound which can take some time to heal and needs dressings and often antiseptics, particularly on infection prone areas of the body like the lower legs. It often results in a white patch of hypopigmented skin but this depends on the nature of the background skin – ie if the skin is red or pigmented, the pale mark may be more visible. Cure rates can be high for appropriately chosen lesions in experienced hands.
Excision of skin cancers is performed where the lesion is higher risk for recurrence and margin control is needed. This means that the lesion is excised and the edges checked to ensure that all the cancer has been removed with a margin of normal skin around it. Cure rates are typically very high but aggressive cancers can have high recurrence rates if the margins are close (<1mm)