Treatment Options for Carcinomas
Curettage and Electrodessication (C&D)
Using local anesthesia, Dr. Brian Mekelburg will scrape off the cancerous growth then, with electrodessication, destroy any residual tumor cells. The area is again curetted, followed by another round of cautery. This may be repeated a third time just to be sure no tumor remains. The wound is left open to heal naturally. The cure rate of C&D approaches that of excisional surgery. It’s fast and easy to perform, and wound care is often minimal. The cosmetic outcome can be outstanding. C&D may not be the best option for aggressive carcinomas, or those in high risk, difficult sites.
5-Fluorouracil cream (5-FU) is the most commonly used topical therapy for actinic keratosis and superficial basal cell carcinomas. 5-FU is a chemotherapy agent, but has virtually no internal effects when used topically. When used for actinic keratosis, it has the ability to treat not just the obvious lesions, but can get rid of the subclinical ones as well. Nightly application is suggested, usually for two weeks, during which time the skin may become red and inflamed. The healing time takes about two weeks, but the cosmetic result is often outstanding with a cure rate of about 93 percent.
Imiquimod 5% cream stimulates the immune system to destroy cancerous and pre-cancerous cells. It is applied nightly for two to four weeks for treatment of superficial basal cell carcinoma. Like 5-FU, it can treat subclinical lesions as well as the more obvious actinic keratosis. It’s generally well tolerated when used twice weekly, but redness and scaling may occur. It may also be used nightly for two to four weeks for a more thorough effect. Redness and ulcerations (similar to 5-FU) may occur, they usually heal nicely in the long term.
Diclofenac gel is an anti-inflammatory agent that is applied twice a day for two to three months. It is generally well tolerated, but scaling and redness may occur.
Ingenol mebutate gel is used nightly for just three days. There is significant redness and scaling, but the results are good.
Under local anesthesia, Dr. Brian Mekelburg uses a scalpel to remove the entire growth, along with a surrounding border of normal skin. The wound is then closed with stitches. The excised tissue is sent to the laboratory to verify that the margins are clear of residual tumor. Cure rates for this technique are in the 90 percent range. The cosmetic outcomes are often excellent.
Not a very common form of treatment, cryosurgery destroys the tumor with extreme cold (using liquid nitrogen). Cryosurgery can be used for some small tumors, but is not recommended for larger ones or those on certain parts of the nose, ears, eyelids, scalp or legs.
Additional Treatment Options
Dr. Brian Mekelburg will try every option possible to help cure your carcinoma; however, there are some carcinomas that may need additional treatments that are performed outside of a dermatologist’s office. Dr. Brian Mekelburg will recommend these additional services and refer you to the appropriate doctor.
Mohs Micrographic Surgery
Under local anesthesia, the apparent tumor and a thin margin of normal-appearing tissue, is excised with a scalpel and examined under a microscope. If tumor remains, the Mohs surgeon will repeat the procedure until the last layer examined is tumor free. This technique saves the greatest amount of healthy tissue and has the highest cure rate, generally 98 percent or better. It is used for tumors that have recurred, are poorly demarcated, or are in critical areas around the eyes, nose, lips, and ears. After removal, the wound may be allowed to heal naturally, or be reconstructed using plastic surgery techniques.
Radiation therapy is often a good option for patients with large cancers, especially in areas where surgery is difficult (eyelids, ears, and nose), or for elderly patients, or those unable to tolerate surgery. It is not used as much as an initial treatment in younger patients because of the possible risk of long-term problems. Radiation is sometimes used after surgery if the entire tumor was not removed, or if there is a chance that some of the cancer remains.
Targeted Therapy for Advanced Basal Cell Carcinoma
In very rare cases where the basal cell carcinoma spreads to other parts of the body, or can’t be cured with radiation or surgery, the targeted drug, Vismodegib (Erivedge) can often shrink the tumor or slow the growth of the cancer. It may also be used to shrink a very large tumor prior to surgery. It is taken daily as a pill.
For more information on carcinoma treatment options, please give us a call and make an appointment.