17. PTC Cancer Life Phases: Treatment

Page title (background color coded to the topic category) : PTC Cancer Life Phases: Treatment

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Treatments for skin cancers

Treatments will vary. Treatment is based on the type, location, and size of the skin cancer, as well as various considerations of the patients overall health. Treatments that exist for skin cancer include the following:

    • Liquid Nitrogen
      This is a substance that is applied to the skin by spray gun, or by a cotton applicator, like a Q-tip. It is so cold when applied to the skin, it feels like a burn, often referred to as a "frost-bite" sensation. Application of the liquid nitrogen lasts for approximately 10-15 seconds. The area treated will immediately appear red, then a scab will form, occasionally a blister may develop. This will heal over the course of ~10 days. This is the treatment of choice for actinic keratoses. It is used for treatment of skin cancers in some cases.
    • Topical Creams
      1. 5-fluorouracil is a topical chemotherapy cream that is used on the skin. It is taken up preferentially by "precancerous" and cancerous cells in the skin. It causes these areas of the skin to turn bright red as if suffering a severe sunburn. It causes the "precancerous" and cancerous cells to scale or scab up and fall off, leaving new good skin behind. This treatment lasts ~ 4 weeks. This is a good treatment for numerous actinic keratoses.
      2. Immunomodulators such as imiquimod (Aldara) are topical creams. They cause an increase in the level of signals from the immune system in the skin (not in the body as a whole) to fight off the presence of "precancerous" or cancerous cells. It causes these areas of the skin to appear red and somewhat crusted during the treatment of ~4 weeks. This is used for the treatment of numerous actinic keratoses as well as superficial skin cancers.
      3. Retin A is a topical cream used potentially for treatment of sun-damaged skin. It is not as good as 5-fluorouracil or imiquimod for treatment of actinic keratoses, but it does have a role in treatment in some cases.
    • Photodynamic Therapy
      This is performed by the topical application of a light sensitizing solution to the skin, followed by exposure of the treated skin to red or blue light in a doctor's office. This causes damage to the "precancerous" and cancerous cells resulting in their death. The light sensitizing solution is applied and allowed to set on the skin for ~16 hours, and then the patient is exposed to light for 12-20 minutes. There is a burning sensation during the actual light exposure. The treated area will appear red and scaly to scabby after the treatment. The skin will heal in ~10 days. This is an accepted treatment for actinic keratoses.
    • Curettage and Electrodesiccation
      (Scraping and burning of the skin cancer.) Skin cancer cells do not have the regular cell-to-cell attachments of healthy skin cells. This allows them to be removed by scraping the skin where the cancer is with a curette (scraping device), leaving the surrounding non-cancerous skin intact. The area is then treated with an electric current to seal over blood vessels. The area may be treated with liquid nitrogen instead of the electric current. This is generally used for early skin cancers, especially superficial basal cell carcinoma and superficial squamous cell carcinoma. Melanoma would never be treated this way.
    • Excision
      The skin cancer is treated by numbing the area with a local anesthetic and then removing the skin cancer with a surgical knife (referred to as a scalpel). After the tumor is removed, the area is often closed with stitches. This is commonly used for basal cell carcinomas and for squamous cell carcinomas that can not be treated by curettage and electrodesiccation. This is the main treatment for early melanomas.
    • Mohs Micrographic Surgery
      Mohs surgery offers the highest cure rates for difficult skin cancers, particularly those on the head and neck. The area of skin where the skin cancer is located is numbed with local anesthetic. While sparing as much normal skin as possible, the cancer is removed with a surgical knife (scalpel). The tissue is examined completely under the microscope while the patient waits, to be certain all tumor roots are removed. If not all the tumor was removed, then the surgeon goes back and removes more in the area with persistent skin cancer. This is then looked at under the microscope as previous. This is repeated until the skin cancer has been completely removed. Mohs surgery is the most precise way to remove skin cancer while also sparing as much normal skin as possible. After complete removal of the tumor, the area is often closed with stitches. Mohs surgery is used to treat difficult basal cell carcinomas and squamous cell carcinomas on the face.

Special Situations and Alterations in your Immunosuppressive Medications

      • In special situations your dermatologist may recommend radiation therapy or lymph node operations.
      • Alterations in your immunosuppressive medications may be considered if the development of numerous and aggressive skin cancers begins. This should only be considered with the extensive input of your complete transplant team as this may increase the risk of organ rejection and death in some cases.
      • Retinoids, such as acitretin and isotretinoin, are oral medications that may be recommended by your physician in an attempt to prevent or slow down the development of new squamous cell carcinomas and basal cell carcinomas. These drugs often work well, but are only effective in suppressing skin cancers while one is taking the medicine. The effect rapidly diminishes if the medication is stopped. Many patients tolerate the medicine very well, but some have difficulties with side effects such as dry skin, dry lips and dry eyes, or hair loss. Cholesterol, triglycerides and liver enzymes must also be monitored by regular blood tests. Women who are pregnant or likely to become pregnant in the future should not take oral retinoids. The benefit of oral retinoids can be significant if a transplant recipient is developing numerous or aggressive squamous cell carcinomas and there are not other factors which would prevent the taking of this type of medicine.


How Medications Can Raise Your Skin Cancer Risk

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What Its like to have skin surgery


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