Most skin cancers can be removed by surgery without requiring chemotherapy or radiotherapy, but the treatment will always depend on the type of tumor, its location, how deeply it is rooted and the particular characteristics of each patient.
First, a biopsy of the tumor is taken, in other words a sample of the tumor tissue is analyzed in order to determine the appropriate form of treatment. In certain cases of melanoma, it might be necessary to take a biopsy of the sentinel lymph node, an obligatory diagnostic test which determines the extent of the treatment for melanomas.
Once the necessary diagnostic tests have been performed, the treatment will be defined.
Types of Treatment
1. Destroying the Tumor
There is a set of methods designed to destroy the tumor which are effective in superficial tumors or for patients who for some reason cannot undergo surgery.
These are generally outpatient techniques that do not require general anesthesia but which, on the other hand, do not permit an analysis of the tumor or a control of the margins of destruction. Consequently, there is no guarantee that the tumor will not reappear and regular subsequent check-ups are always required.
- Physical Destruction of the Tumor
The techniques for physically destroying the tumor include cryotherapy, laser therapy and radiotherapy. Photodynamic therapy is the most recent addition to these techniques and is the therapy with the highest cure rate.
- Chemical Destruction of the Tumor
Some chemical substances are effective against tumorous cells and prompt an immune response in the patient against the malign cells. Imiquimod applied in a 5% cream achieves results of nearly 80% cure rates in selected tumors.
Chemical treatments can also be used as a destructive treatment to complement a prior physical destruction technique such as photodynamic therapy or cryotherapy, thus improving the response or the degree of the cure by the selected technique.
2. Removing the Tumor
The use of surgery to remove the tumor is the recommended technique wherever possible, as it is curative and ensures the complete eradication of the tumor.
The type of surgery depends on the type of tumor, its depth and extension, and the possible effects on nearby lymph nodes.
Specifically, in the case of melanoma with a tendency to spread, the margins of safety must be broader than for local, solid tumors, which can be removed with a minimal margin to ensure adequate eradication of the tumor.
Mohs surgery allows the tumor to be removed in layers and the surgeons can analyze the margins of the tumor until they are sure it has been completely eradicated.
Although it is used in a highly selective manner, in some cases of skin cancer where it has spread, has resisted prior treatments or is inoperable, we have an arsenal of oral treatments with chemotherapy for different types of tumors.
In addition to the classic substances, there are now biological treatments which act with high precision on melanoma, sarcomas, squamous cell carcinoma and even basal cell carcinoma (vismodegib, a substance which has recently been made available in Spain).