Proper treatment to skin cancer can prevent the condition from getting worse. It can even prevent death. Surgery is usually attempted to remove the tumor when skin cancer is detected. Skin cancer can also be treated with medication or radiation. Treatment choice depends on the type of cancer, the size of the tumor, and its aggressiveness.

The doctor’s choice of therapy depends on whether it is white or black skin cancer. The stage also plays a decisive role: in an advanced stage, the chances of a complete recovery are significantly lower. Black skin cancer has a considerably worse prognosis.

The most important goal in the treatment to skin cancer is to eradicate the tumor. To do this, the doctor usually cuts out the skin cancer in operation. Then, under the microscope, it is ensured that the tumor has been completely taken out.

If surgery is not possible or not desired by the patient, other forms of treatment may be considered. This may be the case. For example, surgery would leave scars if the tumor occurred on a prominent face. Possible forms of treatment include:

• irradiation
• particular light therapy (photodynamic therapy)
• the icing of cancer (cryosurgery)
• laser treatment
• local medication applied to the skin.

The most appropriate treatment depends on factors such as:

• the type of skin cancer
• the size of the tumor
• the site where the tumor has appeared
• how advanced the skin cancer is (i.e., whether it has already metastasized)
• the general state of health of the patient

If the cancer is already advanced, the patient can take particular medications. This is the case if the tumor grows in depth or has already spread to other organs. The drugs can push back and stop skin cancer – at least for a specific time.

For advanced basal cell carcinoma, so-called targeted drugs are available. These inhibit the growth of tumor cells and can thus halt the further progression of the disease.

Patients with advanced squamous cell carcinoma can receive immunotherapy with a so-called immune checkpoint inhibitor. This active ingredient binds to particular docking sites on the body’s immune cells. It stimulates them to fight cancer cells directly.

Treatment to Skin Cancer: White Skin Cancer

White skin cancer refers to squamous cell and basal cell carcinoma. They usually develop on areas of the body that are frequently exposed to the sun and are easily visible. Basal cell carcinoma (also called basal cell carcinoma) usually grows slowly and locally. However, if it is treated late or not at all, it can invade deeper tissue. This way, parts of the face, bones, spinal cord, or brain can be damaged, making treatment more difficult.

Squamous cell carcinoma, like basal cell carcinoma, grows at the origin site, destroying neighboring tissue. However, it is more aggressive than basal cell carcinoma. Without treatment, there is a risk that cancer will spread further in the body and form metastases in other organs. In most cases, however, squamous cell carcinoma is detected beforehand.

White skin cancer is usually treated with surgery; radiation therapy or chemotherapy may also be used. Metastases rarely form in white skin cancer; in most cases, they can be completely removed during surgery. During this operation, the tumor is drawn over a large area. Surrounding healthy tissue is also removed. Finally, the removed tissue is examined under a microscope. In rare cases, follow-up surgery may be necessary. 

Operation

Since white skin cancer can often be entirely removed by surgery, this treatment is the first choice. In the process, the doctor removes the tumor and some surrounding tissue. This safety margin around the tumor prevents cancer cells from remaining and spreading further in the body. While minor surgery often heals inconspicuously, major surgery can leave noticeable scars.

There are also other surgical procedures, for example:

• Mohs surgery (micrographic surgery): This surgery is named after the American surgeon Frederic C. Mohs. This surgery aims to remove cancer altogether but as little healthy tissue as possible. This can be beneficial for basal cell carcinoma when large or apparent areas of skin are involved, and little healthy skin remains to close the surgical wound. In this method, the visible part of the tumor is removed first. Then, the edges of the removed piece of skin are immediately examined in the laboratory. If tumor cells can still be found somewhere on the cut surfaces, the tumor was not completely removed. Likewise, cancer has not been wholly removed if tumor cells are still on the cut surface. This procedure is repeated until no more cancer cells are found.
• Laser therapy uses laser light to remove the damaged skin layer by layer. It is used primarily for precancerous lesions such as actinic keratosis and in the early stages.
• Cryosurgery: Cryosurgery is cold therapy. In this treatment to skin cancer, the tumor tissue is iced, so the cells die. The field of application of cryosurgery is similar to that of laser therapy.

Radiation Therapy

Radiation therapy or radiotherapy is often simply called “irradiation.” This treatment to skin cancer is intended to destroy the tumor tissue with the help of high-energy radiation. This treatment is usually only considered for white skin cancer when surgery is impossible or the risk of recurrence is high.

Medicines Therapy

In this treatment to skin cancer, there are four types of Medicine Therapy: 

1. For application to the skin

For many people, the treatment must leave as few scars as possible. In the case of superficial white skin cancer, drug therapies may be an alternative to surgery.

Medications applied as an ointment to the affected skin area for several weeks may be considered. These include the active ingredient imiquimod. This drug activates the skin’s defense reaction against cancer cells. In addition, the active ingredient 5-fluorouracil is also sometimes applied. 5-fluorouracil inhibits the proliferation of cancer cells.

Recent studies indicate that after basal cell cancer treatment with imiquimod, the risk of recurrence is slightly higher than after surgical treatment.

2. Oral use

A new agent for the treatment of advanced basal cell cancer is vismodegib. It is designed to block the transmission of signals promoting cancer cell growth.

3. As part of photodynamic therapy (light therapy)

Photodynamic therapy involves applying a cream containing a light-sensitive agent that concentrates on the cancer cells. Usually, the treated area is then covered with an opaque dressing. A few hours later, the bandage is removed, and the area around the tumor is irradiated with a cold red light. This activates the active substance and destroys the tumor cells. Photodynamic therapy is preferred for white skin cancer that has not yet grown more profound in the skin.

4. As an infusion

If squamous cell carcinoma has spread, chemotherapy is an option. The active ingredients cisplatin and 5-fluorouracil are often given as an infusion. Sometimes other agents, such as the so-called EGFR inhibitor cetuximab, are also used. Treatment is usually no longer aimed at curing cancer but at slowing its further growth (palliative therapy).

Treatment to Skin Cancer: Black Skin Cancer

Black skin cancer or malignant melanoma is a malignant tumor of the skin’s pigment cells (melanocytes). Despite a known major avoidable risk factor (excessive sun exposure), the number of cases has increased dramatically in recent years. 

If the disease is diagnosed early, there are good chances of a cure. Initially, malignant melanoma does not occur immediately within the body unless a primary focus has previously appeared on the skin’s surface.

The most significant cause of black skin cancer is excessive sun exposure or – ultraviolet irradiation. In addition, the number of pigmented birthmarks after birth plays an important role. Individuals with more than 40 birthmarks are at a 7 to 15-fold risk for the disease. 

Frequent sunburns from childhood increase the risk by 2 to 3 times. In addition, routine outdoor work increases the risk of developing the disease, as does regular use of a tanning bed. People with fair skin type, red or blond hair, those prone to freckles and sunburn, and those with hereditary diseases are also at increased risk.

Surgery is the most important and effective treatment method in treating skin cancer for black skin cancer. The goal is to remove the tumor tissue with a safety margin altogether. Under certain circumstances, the lymph nodes in the affected area are also removed. Following the operation, supportive, so-called adjuvant radiotherapy and chemotherapy are given, especially if there is an increased risk of metastases developing.

Surgery

During the procedure, the tumor tissue is removed with a safety margin to remove all cancer cells as reliably as possible. The size of the safety margin depends on the tumor thickness.

The operation is usually performed in two steps: First, the suspicious pigmented mole is removed (excision) to confirm the diagnosis. Then, in a second step, a so-called re-excision may be necessary to ensure a safety distance of 1-2 cm.

Suppose the sentinel lymph node was examined, and a positive finding with evidence of tumor cells in the lymph node was found. In that case, it may be discussed with the patient whether the lymph nodes in the affected area should be removed. This depends on how many such metastases are present and how large they are. 

Removal of the lymph nodes does not automatically provide a better prognosis. Still, it does represent an effective procedure for those affected. For example, in the case of microscopic metastases (less than 0.1 mm in diameter) or single cells in the sentinel lymph node, it is recommended that all lymph nodes in this area not be removed.

Adjuvant therapy

In patients with an increased risk of metastasis, for example, if the lymph nodes are affected, supportive, so-called adjuvant therapy is recommended after surgery. This is the case from stage II onwards. It reduces the likelihood of recurrence of the disease.

Different adjuvant therapy options depend on the stage: Radiation therapy and drugs (interferon, checkpoint blockers, targeted therapies; see table below). Factors include concomitant diseases and mutations found in your tumor.

Adjuvant radiotherapy for lymph node involvement

If regionally affected lymph nodes had to be removed during surgery, no other metastases were detected, and certain risk factors for disease recurrence are present, it is recommended that adjuvant radiation therapy be given afterward. Risk factors include:

• three or more affected lymph nodes
• lymph node metastases larger than 3 cm
• a capsular rupture in the lymph node
• recurrence of the disease in the lymph node

In such cases, adjuvant radiotherapy can achieve better regional control of the tumor and thus reduce the risk of recurrence. However, according to current knowledge, this treatment does not influence survival time. In addition, adjuvant radiotherapy can have side effects, such as lymphatic congestion.

Adjuvant interferon therapy

According to the current guidelines, patients with stage IIA and stage IIB/C tumors should be offered adjuvant therapy with interferon. Interferon is an endogenous messenger substance that non-specifically stimulates the immune system to fight cancer cells. It is usually administered as an injection. Which interferon preparation is to be used and what the therapy regimen looks like is determined individually. Adjuvant therapy with interferon prolongs the time until the disease returns in the tumor mentioned above stages but does not prolong life according to current knowledge.

Common side effects of treatment at the beginning are flu-like symptoms such as fatigue, fever, muscle pain, and sweating. Chronic exhaustion (fatigue), muscle and joint pain, and depression are especially possible in the further course. However, most side effects resolve on their own after therapy.

Adjuvant interferon therapy with checkpoint blockers

A new treatment option in stages IIIA-D and IV are checkpoint blockers. They can prolong the time of relapse. These therapies are given as infusions at 2- to 6-week intervals.

What Happens After Treatment?

The treatment to skin cancer is usually followed by aftercare. Aftercare aims to detect a recurring or new tumor that has appeared in a different location at an early stage.

After the end of treatment, a doctor examines the patient at regular intervals. How long these intervals are depends on the risk of recurrence. Patients with an increased risk of other tumors occurring are followed up more closely and over a more extended period than patients with low risk.

You can find other information about skin cancer: Basal Cell Carcinoma Nose: Treat It Early Before It Gets Worse.

In patients with squamous cell carcinoma and an increased risk of recurrence, the lymph nodes may be examined by ultrasound. However, further examination methods, such as computer tomography or magnetic resonance imaging, are only used by doctors if there are corresponding signs of disease and they want to rule out the progression of the disease.

Those affected should also examine themselves regularly to detect and treat a relapse or other tumors as early as possible.