Skin Cancer Management

Skin cancer affects 1 in 5 Americans and includes basal cell carcinomas, squamous cell carcinomas and malignant melanomas. An ounce of prevention is worth a pound of cure: always use broad spectrum sunscreen and minimize sun exposure.

Squamous cell carcinomas tend to be red scaling tumors, most common on the face, scalp, ears, lips and the tops of the hands.  On the body they look like red scaling patches.  While most are due to ultraviolet exposure, other causes include the wart virus (especially some genital wart viruses), tobacco and arsenic.  While they do not often metastasize, the risk is highest on the lips or on skin previously exposed to radiation.

Malignant melanomas are the most potentially fatal skin cancer. Long wavelength ultraviolet tanning rays (UVA) are well known as one cause.  They are expanding blue or black tumors, though some may be red.  The risk of metastasis is related to the depth of tumor invasion, and the presence of ulcerations and mitotic figures in the excised tumor.

Actinic keratoses are a common pre-malignant lesion.  They are seen in areas of chronic sun exposure, so the scalp, face, ears, lips and the tops of the hands are areas where they appear.  On the lips the condition is called actinic cheilitis.

There are a variety of treatment options for these cancers and pre-cancerous conditions.

Actinic Keratoses

The treatment of actinic keratoses includes individual destruction of solitary lesions with liquid nitrogen or electrosurgery.  When there are many, we treat entire cosmetic units (entire face or scalp).  These Zonal Treatments can include 5-fluorouracil cream, imiquimod cream, and ingemol mebutate gel.  Applied at home for two to 30 days, depending on where the actinic keratoses are and the specific medication being used, they cause redness, skin breakdown and some discomfort.  The Olympic Dermatology patient in photos below used 5-fluorouracil cream on his scalp for three weeks with successful results.

Zonal treatment of actinic keratoses with 5-fluorouracil cream
2 Weeks
3 Weeks
4 Weeks
5 Weeks


Another popular treatment for actinic keratoses  is photodynamic therapy, an in-office procedure that involves the application of a medication called aminolevulinic acid to the treatment area.  The medication is absorbed by sun-damaged skin cells, and activated by a blue-wavelength light source.  Much less irritation results from this treatment, and healing is rapid.  Several treatments may be required, and a patient must avoid intense light for 24 hours afterwards.

Basal Cell Carcinomas, Squamous Cell Carcinomas and Malignant Melanomas

Surgery is a common skin cancer management option.  Basal cell and squamous cell carcinomas can often be removed with a tangential excision followed by curettage and electrodessication. Some we excise and close with sutures to increase the cure rate or obtain a more acceptable scar. Others that are in sensitive locations or have a higher risk of recurrence may require Moh’s surgery.

Malignant melanomas are excised with a 0.5 to 2 cm margin depending on the depth of dermal invasion. Lymph node removal or sentinel lymph node biopsies may be necessary. Coordinated care with an oncologist and general surgeon is sometimes needed.

Another option for these more difficult-to-treat skin cancers is Brachytherapy.   It’s an electronic form of radiation therapy that limits exposure to the cancer area only, without affecting other tissues.  A short series of treatments results in a high cure rate with excellent cosmetic outcomes, and no surgery is required.

Thin basal and squamous cell carcinomas can occasionally be treated with imiquimod or photodynamic therapy, but a lower cure rate limits the usefulness of these treatments.

We’re here to help and tailor a skin cancer treatment plan specifically for you.  Please call us at 360-459-1700.