ASK THE EXPERT: How will different skin cancer treatments affect my skin’s appearance?
By Amy Forman Taub, MD
Amy Forman Taub, MD, founded Advanced Dermatology, Skinfo® Specialty Skincare Boutique, and SKINQRI in Lincolnshire, Illinois. She is a member of numerous organizations, including the American Academy of Dermatology, the American Society for Dermatologic Surgery, the American Society for Laser Surgery and Medicine, the Leader’s Society of the Dermatology Foundation and the Medical Advisory Council of The Skin Cancer Foundation.
Q. I’m going to be treated for skin cancer. How will different skin cancer treatments affect my skin’s appearance, and how can I deal with the side effects?
A. Skin cancer therapies can affect the skin in different ways. The most common treatment is surgical excision, which typically leaves a scar. Scars vary in appearance, depending on the location and size of the tumor removed. A good dermatologic surgeon will give you the best possible cosmetic outcome and also advise you about after-care.
Silicone is an effective scar treatment. If the skin cancer is on the chest, back or shoulders, which are prone to excessive scar tissue, we often recommend applying silicone gel sheets after the stitches are removed. They protect the scar and help it absorb moisture from surrounding healthy areas, enabling more efficient healing. Silicone sheeting is rarely needed on the face, where wounds heal more easily if you simply keep them moist and covered; antibiotic ointments, Vaseline petroleum jelly, or Aquaphor will work.
Other treatments for skin cancer include electrodesiccation and curettage, radiation therapy, and topical therapy. Electrodesiccation and curettage involves scraping the tumor with a curette, then burning the skin with an electric needle. The treatment can be used when the skin cancer is superficial (doesn’t penetrate the skin) or if the patient has multiple skin cancers. It doesn’t require stitches, and is less expensive than surgery. However, it has a higher recurrence rate than excision, and a poorer cosmetic outcome. Silicone gel sheeting (particularly along the jaw line) and antihistamines (to reduce itching) may be helpful. If the scar does not fade noticeably in time, laser surgery or dermabrasion may be an option.
Radiation is used to treat inoperable skin cancers, or those that would result in real disfigurement after surgery. It can cause a long-term increased risk of additional cancers, but in certain situations can be quite helpful, especially for an elderly person with a significant skin cancer on the face. However, radiation can cause a condition known as radiation dermatitis, leading to itching and discomfort as well as pigment changes and redness. If you develop radiation dermatitis, your doctor may have you apply various dressings, topical steroids (which reduce swelling), antibiotics, and/or ointments to alleviate symptoms.
Finally, two key types of topical creams or gels can be used to treat superficial skin cancers: imiquimod and 5-Fluorouracil (5-FU). Since no surgery is done, the potential lack of scarring makes topical therapies an attractive option. Topical treatments can be very effective, but cause a significant amount of skin inflammation during the 6-12-week treatment period, and potentially prolonged pain, redness, and unsightliness. Topical treatments also make your skin more vulnerable to the sun’s harmful effects, so rigorous sun protection (including covering exposed skin, seeking the shade, and wearing a broad-spectrum high-SPF sunscreen) is advised. Your doctor may recommend moisturizers or steroid creams to help relieve the infl ammation and discomfort.
Don’t despair if you have had a skin cancer, as there are many new avenues to help you achieve your best post-treatment appearance: skin care products, lasers, and other follow-up treatments. Be sure to discuss any questions or concerns with your doctor.