Ask the Expert: I’ve been diagnosed with nonmelanoma skin cancer. What happens now?

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By Evelyn Montgomery Jones, MD

Evelyn Montgomery Jones, MD, is a dermatologist who has been practicing in Paducah, KY, since 1993. Her general and cosmetic dermatology practice comprises WellSprings Dermatology. Dr. Jones has pursued many avenues to inform her patients, clients and community about the importance of healthy skin and healthy living.


Q. I’ve been diagnosed with nonmelanoma skin cancer. What happens now, and how will it be treated?

A. First, know that you are not alone — one out of every five Americans is diagnosed with skin cancer at some point in life. Educating yourself may help ease anxiety that can accompany this diagnosis. Nonmelanoma skin cancer (NMSC) generally refers to either basal cell carcinoma (BCC) or squamous cell carcinoma (SCC). Most BCCs and SCCs are very curable, though it is important to catch them early. NSMC causes more than 3,000 deaths a year in the US, most from SCC. Generally, the same treatments are used for either BCC or SCC. The most common treatments include: 

SURGERY

NMSC surgery is typically performed in an office or an outpatient setting under local anesthetic. The tumor’s size and location and the patient’s health and age determine the surgical procedure. Once the cancer has been removed, the tissue is sent to a specialist for final diagnosis and confirmation that the cancer has been entirely removed. A scar will develop, but using scar gels and protecting the scar from the sun for up to six months after surgery will help achieve the best cosmetic result.

SURGICAL TREATMENTS FOR NMSC

Surgical excision: The entire cancer, plus a few mm (millimeters) of healthy skin as a safety margin on either side, is removed in a football-shaped excision. The skin is then closed with stitches.

Mohs micrographic surgery: The tumor, with a very thin margin of tissue around it, is removed and promptly evaluated under the microscope. If any cancer cells are present at the margins, more tissue is removed until all margins are cancer-free. Then the wound is closed with stitches.

Curettage and electrodesiccation: Small BCCs that are not aggressive or scarring may be scraped off with a sharp, ring-shaped instrument called a curette. Then an electrocautery needle is used to destroy any remaining tissue and dry up the tumor site. The procedure may be repeated to make sure all tumor cells are gone. 

NON-SURGICAL TREATMENTS

Topical Treatments: Imiquimod or 5-Fluorouracil (5-FU) can be applied to some superficial skin cancers (those that have not penetrated beyond the skin surface)  regularly for up to six weeks. US Food and Drug Administration (FDA)-approved for superficial BCC, they are also being tested with certain superficial SCCs. Because these medications can cause irritation, the skin should be monitored carefully.

Radiation: Several weeks of X-ray beam treatments can be used for some skin cancers. The cosmetic result is usually not as good as with other treatments, so radiation is reserved for specific cases.

Cryosurgery: Tumors are destroyed by freezing with liquid nitrogen. The growth becomes crusted and scabbed, and usually falls off within weeks.

Photodynamic Therapy (PDT): A light-sensitizing agent is applied to the tumor, which absorbs the agent. Later, the treated area is activated by a strong light, which destroys the tumor cells but causes little damage to surrounding healthy tissue. PDT is FDA-approved for the treatment of certain BCCS. It is used off-label (without specific FDA approval) for SCCs.

People who have had one skin cancer are at higher risk of developing another one, so regular follow-up visits to your dermatologist are highly recommended.

Additional Information about Melanoma