3)Treatment Options for Basal and Squamous Cell Carcinoma:
Depending on the type. size, and location of the skin cancer, a variety of treatment options are available. Most cure rates for these options are 95% or better. The best treatment option for your particular skin cancer can be determined after examination and discussion with your dermatologist. Not all options are appropriate for all skin cancers. Some tumors do not respond to common treatments, including those tumors greater than two centimeters in diameter, those in difficult locations and those complicated by previous treatment. Removing a recurrent skin cancer is more complicated because scar tissue makes it difficult to differentiate between cancerous and healthy tissue. In these cases, Mohs surgery is often recommended.

Destructive Therapy

Curettage and Cryosurgery -- a treatment in which the cancerous tumor and its extensions are scraped from the area (curettage) and liquid nitrogen is sprayed on diseased tissue and the surrounding area. The nitrogen causes the temperature of the tumor and surrounding healthy tissue to drop to -30 degrees to -50 degrees Celsius. The intracellular ice crystals that form at this temperature kill the tumor cells. The dead tissue then sloughs off, allowing the wound to heal. Because the size of the treatment area is estimated, and a margin included for additional safety, healthy tissue is also destroyed. This procedure does
not allow for pathological examination of the tumor.

Destructive therapy is most successful in the removal of superficial skin cancers. The raw area of skin takes approximately 2 weeks to heal with regular wound care. A flat white scar may result after healing, so it is not recommended for skin cancers on the face. Since tissue is not available for pathological examination of the margins, there is a higher risk of the recurrence than if treated by excision.

Topical immunotherapy therapy -- Small superficial basal cell carcinomas can be treated effectively using a topical cream called Aldara™. The cream is applied 3-5 times per week for 6 weeks and stimulates your immune system to clear the skin cancer. Significant local irritation including redness, itching, oozing and crusting commonly occurs. This reaction
may take several weeks to clear after treatment is complete. Cosmetic results are usually very good after the irritation has resolved. Cure rates are in the range of 80-90%.

Standard surgical excision -- The skin cancer and a margin of normal skin (usually 3-6mm) to include any extensions of the tumor are excised under local anesthetic. Following surgery, the specimen is sent to a laboratory where a pathologist examines the removed tissue by making vertical slices, similar to slices of bread. Depending upon the extent of the cancer found, subsequent surgeries followed by separate laboratory analysis may be required. However, only a sample of the removed tissue is evaluated. If cancer cells are present in unexamined sections, they may be missed and the cancer may recur. Cure rate is approximately 95-97%.

Mohs Micrographic Surgery -- A specialized type of excisional surgery where the surgeon removes the tissue and analyzes it under the microscope at the time of surgery. Very narrow layers of tissue are removed with each step and checked for cancer until all tumor cells are removed. Mohs micrographic surgery offers the best cure rate (>99%) of any skin cancer treatment and spares surrounding healthy tissue. After the skin cancer is removed it can be repaired immediately to restore the appearance of your skin. .The precise nature of Mohs micrographic surgery requires more time than conventional
surgical excision, so the technique is usually reserved for skin cancers that have already recurred with other methods, that are likely to recur due to large size, location, or
microscopic appearance or those located in cosmetically delicate areas such as the head, neck, hands or feet.

Radiation therapy -- This method destroys cancer cells by exposure to beams of ionizing radiation. The radiation oncologist chooses the specific type of radiation needed to reach the exact depth of the tumor and still provide a margin for safety. Treatment usually requires 3 visits per week for 6-8 weeks. Redness and tenderness are common side
effects during treatment. Because some color and texture changes may result, radiation therapy as a primary treatment is usually reserved for patients who are unable to undergo
surgery. It may also be used following surgery for particularly aggressive types of tumors that are at risk for spread to nerves or lymph nodes.