Treating Precancers and Cancers of the Skin

 

As a precancer condition, Actinic Keratosis (AK) may evolve to a frank cancer (squamous cell caronoma, SCC). AK should be recognized and treated appropriately. Photoprotection and periodic skin exams are necessary as this allows the dermatologist to detect the early degeneration into SCC. This transformation may happen despite precautions and AK therapeutic armamentarium, such as cryosurgery, photodynamic therapy, topical chemotherapy (with 5-Fluouracil, Imiguimod, topical Retinoids, topical Diclofenac).

 

Treatment of skin cancer depends on the accurate biopsy- proven tissue diagnosis, sin cancer includes the 2 groups: the dreadful Malignant Melanoma (MM) and the nonmelanoma Skin Cancer (NMSC), such as Basal cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC), Adnexal Carcinomas of the skin, Sarcomas of the skin, Malignant Vascular Neoplasms, HIV and HPV- isolated skin cancer, T-cell lymphocytes and Merkel Cell Carcinoma. As it is true for all kinds of cancer, early detection of the skin cancer means better prognosis. Small early NMSK can be treated appropriately with simple curettage and electrodessication.

 

Cryosurgery with liquid Nitrogen is indicated mainly for AK. However, it may be used alternatively in the treatment of inoperable BCC and SCC in-sites.

 

Photodynamic therapy is a selective noninvasive treatment for nonhyperkeratotic AK, SCC in-site, superficial and thin nodular BCC.

 

Surgical Excision remains an effective and safe therapeutic procedure for skin cancer, both MM and NMSC. Obviously, the excision has advantages over destructive methods as it allows for histologic evaluation of surgical margins and tumour characteristics that may dictate further management.

 

Moh's micrographic surgery is a very useful technique for both MM and NMSC. It involves the complete removal of the cancer as the frozen section histology ensures that 100% of the surgical margin is scrutinized and allows the sparing of normal surrounding tissue.