Most basal cell and squamous cell cancers can be successfully treated with surgery. And in most cases, the surgery is minor. The area is completely removed, often under local anaesthetic. For other situations, there are several different types of surgical technique that can be used. What is done will depend on
* The type of cancer you have
* The size of the cancer
* Where the cancer is
* The stage of the cancer (if relevant)
For skin cancer diagnosis and treatment, you should be referred to a dermatologist. If you have a skin cancer that covers a wide area or is awkward to remove, you may be operated on by a plastic surgeon.
Small cancers are often operated on under local anaesthetic. For a larger cancer, you may have a general anaesthetic. If the cancer covers a large area, you may need to have a skin graft or a more complicated repair called a skin flap. A flap is a thicker piece of skin tissue that is removed together with its own blood supply.
If there is definite cancer spread to nearby lymph nodes, your surgeon will need to remove them. You will have this done under general anaesthetic. In some cases, if your doctor thinks there is a high chance of cancer spread, you may have the lymph nodes removed even though there is no sign of actual spread. A few cancer cells can be missed. But they can still go on to develop into new tumours and spread further to other parts of the body.
may be used instead of surgery. It can be a very effective alternative for basal and squamous cell cancers. Radiotherapy is often used in areas of the face where surgery might be difficult or cause unacceptable scarring. However, its use is not recommended in young people as it causes skin damage which becomes more visible over the years.
Radiotherapy may be given after surgery if there is a risk that some cancer cells may still be present. Sometimes it is used for tumours that have grown into the deeper layers of the skin.
Photodynamic therapy (PDT)
This is a relatively new type of treatment. It is another alternative to surgery. In February 2006, the National Institute of Health and Clinical Excellence (NICE) issued guidance on PDT for skin cancers. They say there is good enough evidence to use it for several types of skin cancer. They don't recommend it for squamous cell skin cancers because there is not enough good evidence that it can control the spread of the disease and too high a risk of the cancer coming back. PDT using a cream is now available on the NHS for Bowen's disease, basal cell skin cancers and actinic keratosis (also called solar keratosis).
NICE say that PDT is best used in cases where you would need a lot of surgery. So it is best for large skin cancers that are not too deep, or where there are several cancers in an area. PDT is not suitable for deeper skin cancers because the light cannot penetrate far enough into the skin. In the trials NICE looked at, the appearance of the treated area after PDT was better than after surgery. Generally, PDT was as good as surgery at controlling basal cell cancers, actinic keratosis and Bowen's disease in these trials.