We offer a broad range of treatments at the Waldman Melanoma and Skin Cancer Center—from topical medications to precision surgery. Your treatment will depend on the type of cancer and how far it has advanced. In all cases, our goal is a complete and long-lasting outcome, preservation of your appearance, and your long-term health.
Sometimes skin cells grow abnormally, but haven’t developed into cancer yet. There are a number of treatments available that provide good outcomes. Your dermatologist will discuss what may be best for you.
A chemical peel can be performed in a doctor’s office with local anesthesia. It’s often used to treat actinic keratosis, a precancerous skin condition. Actinic keratosis can develop into squamous cell carcinoma, so it is recommended to act early to treat it. During a chemical peel, your dermatologist applies a mild acid to your skin, leaves it for a few minutes, and then removes it. Depending on how deep into the skin the treatment penetrates, a mild sedative and anti-inflammatory medications may be given beforehand. Afterward, your skin will be treated with cool compresses and lotions. There is less scarring with chemical peels than other treatments. Chemical peels are also used for cosmetic purposes, such as reducing lines and wrinkles, and evening skin tone.
Cryotherapy is used to freeze and kill abnormal skin cells such as actinic keratosis. Liquid nitrogen is either applied with a cotton applicator stick or sprayed on. The process may be repeated as necessary. The wound may blister afterward, but usually heals within three to six weeks.
Curettage and Electrodessication
For mild, well-defined, and shallow skin cancers, curettage and electrodessication is a fast, in-office procedure. Sometimes called “scrape and burn,” this procedure is often used to treat superficial basal cell carcinomas, squamous cell carcinomas, or even some warts. The area to be treated is first numbed with a local anesthetic, and then the dermatologist uses a sharp instrument called a curette to scrape away the growth. Because basal cell carcinomas are softer than regular skin, they often scrape away easily. Squamous cell carcinomas are harder than normal skin, so it is easy to tell when the growth has been removed. After scraping, the area is electrically cauterized, which burns away any remaining cancer cells. The process is typically repeated until only healthy cells remain. While quick and beneficial, the process is usually only used on skin cancers that have a low chance of spreading to other areas of the body. There may also be scarring, so other procedures may be more appropriate for areas on the face, or other highly visible areas.
Laser therapy uses high-intensity, focused light waves to vaporize abnormal skin cells. This type of therapy is only effective on the outermost layer of the skin, and is used mostly on precancerous conditions. The advantage is that it is quick, and healing times are shorter. There is also less bleeding, swelling, and scarring. However, it may not remove all the cancerous or precancerous cells, and there is more likelihood of reoccurrence.
Photodynamic therapy uses a combination of special medications and light to destroy cancer cells. The medications only activate after being exposed to light. A special cream with the medication is applied to the skin. It may take a couple of hours to be absorbed into the target cells. Once the drug is exposed to light, it is activated and kills the precancerous or cancer cells. Photodynamic therapy is only effective where light can reach, so it is used for shallow growths. Also, this therapy is only used on cancers or growths that are unlikely to spread. The advantages are very little scarring, few side effects, precise targeting of abnormal tissue, and the convenience of outpatient treatment.
Red-Light Photodynamic Therapy (PDT) is a non-invasive method to treat photo damage, precancerous lesions, and other skin conditions. We apply a gel medication called aminolevulinic acid to the area being treated. This medication is converted into a light-sensitive agent when it penetrates the skin. Next, we focus a red light on the treatment area, which activates the agent and destroys the targeted cells. PDT is an effective way to treat large areas, and patients may prefer it over topical medications since the treatment is done in 1 day at the office and avoids the hassle of applying topical medications for weeks at a time.
For some patients with skin cancer, radiation may be the first line of treatment. For basal cell and squamous cell carcinomas in places where surgery would be difficult—near the eyes, in a nostril, or on an earlobe—radiation is a good option. Also, some patients may not be candidates for surgery due to frailty or the type of medications they are on. Radiation therapy is also used as the main treatment when large areas of skin are affected by cancer. Radiation can also be combined with other treatments. For instance, radiation may be prescribed after surgery to prevent recurrence.
Radiation therapy is similar to getting an X-ray, but the radiation is high-intensity and much more precise. Often, your treatment is broken into short sessions that are repeated over days or weeks. Small, high-intensity doses spare surrounding tissue and prevent side effects.
For many basal cell and squamous cell carcinomas, Mohs surgery delivers the best outcomes. The procedure is done in stages, all in one visit. The surgeon removes a layer of skin and then examines it under a microscope for cancer. The surgeon proceeds layer by layer until all the cancer has been removed. This procedure requires highly advanced, specific expertise, and Mount Sinai is a world leader in this technique. The precision of Mohs surgery means that there is minimal scarring, because only the cancerous tissue is removed, and the surrounding tissue is spared. And by completely removing the cancer, recurrences are prevented.
Excision surgery is similar in technique to a biopsy, only the diagnosis is already known. A local anesthetic is used to numb the area, and then the surgeon removes the cancer along with a margin of healthy tissue around it. Afterward, the incision is closed with stitches. If the incision is large, a skin graft may need to be performed. There is usually scarring with this type of procedure, so if the cancer is on an area such as the face, Mohs surgery may be a better option.
If you have actinic keratosis, or basal cell or squamous cell carcinoma that has not spread to the lymph nodes, your dermatologist may recommend topical chemotherapy. These cancer-fighting drugs come in the form of a cream or lotion that is applied daily, often for many weeks or a few months. It’s convenient since you can do it at home, and since there is no surgery, the results are typically cosmetically appealing. However, this treatment isn’t appropriate for all types of cancer. And in most cases, you will have to minimize exposure to direct sunlight during the treatment period.