Pallavi Kumar, MD, medical oncologist for melanoma patients, checks on a patient at The Harry and Jeanette Weinberg Cancer Institute at MedStar Franklin Square. Chemotherapy may be suggested as part of a patient's skin cancer treatment.
To plan the best treatment for each patient, your MedStar Health doctor considers the location and size of the cancer; the risk of scarring; and the person's age, general health, and medical history.
Fortunately, when treated at an early stage of development, skin cancer has a very high rate of cure. Treatment for skin cancer usually involves some type of surgery. In some cases, doctors suggest radiation therapy or chemotherapy. Sometimes a combination of these methods is used.
Whatever the stage of your skin cancer, you can rest assured that the skin cancer and melanoma specialists at MedStar Health’s Baltimore Cancer Network are trained in the latest comprehensive skin cancer treatment options.
Skin Cancer Treatment
Adjuvant therapy is treatment given after the primary surgical treatment to increase the chances of a cure. Doctors work closely with patients and use diagnostic tools to determine which standard or experimental therapy is best. We recommend that patients with early melanomas be evaluated by physical examination at least twice yearly for two years, and then annually or as clinically needed. Patients who are at high-risk should be evaluated every three months or as clinically needed.
In cryosurgery, liquid nitrogen is applied to the growth to freeze and kill the abnormal cells. After the area thaws, the dead tissue falls off. More than one freezing may be needed to remove the growth completely. Cryosurgery is virtually painless, but patients may have pain and swelling after the area thaws. A white scar may form in the treated area.
When a large cancer is removed, a skin graft is needed to close the wound and reduce the amount of scarring. For this procedure, the doctor takes a piece of healthy skin from another part of the body to replace the skin that was removed.
This treatment uses a narrow beam of light to remove or destroy cancer cells in the outer layer of skin.
Limb Perfusion and Infusion
Limb infusion is a form of regional cancer therapy. MedStar Health doctors use this treatment method to treat one limb of the body when there are too many tumors to remove surgically, or when removal of all the tumors would require an amputation. Regional infusion treatments may provide treatment for these tumors while preserving the limb.
In this treatment, limbs are washed with a high-dose of chemotherapy. Your doctors will isolate the arterial blood flow to the limb using catheters and tight bandages, essentially blocking it off from the rest of the body to protect it from the high-dose of chemotherapy.
Skin cancer responds well to radiation therapy, which uses high-energy rays to damage cancer cells and stop them from growing. Doctors often use this treatment for cancers that occur in areas that are hard to treat with surgery, such as the eyelid, the tip of the nose, or the ear. Several treatments may be needed to destroy all of the cancer cells. Radiation therapy may cause a rash or make the skin in the area dry or red. Changes in skin color and/or texture may develop after the treatment is over and may become more noticeable many years later.
External Beam Radiation Therapy
External beam radiation uses a large machine to aim high-energy radiation beams at your cancer from outside your body. Our specialists treat as small an area as possible to avoid causing unnecessary damage to your healthy tissue.
High-Dose Rate (HDR) Brachytherapy
This is a method of brachytherapy that delivers radiation to the lesion at the surface of the skin. In HDR brachytherapy, a radioactive wire is attached to a highly specialized robotic machine. The robotic machine carefully guides the delivery of the radiation directly into the tumor and removes the wire after the session.
Total Skin Electron Therapy
Rotational Total Skin Electron Therapy (RTSEI) and static Total Skin Electron Irradiation (TSEI) are advanced approaches to treating this skin disorder. During TSEI, a patient's entire skin is treated with low-energy electrons. This radiation penetrates very superficially, protecting internal organs and other structures.
Sentinel Lymph Node Biopsy
As cancer cells spread, they can metastasize through the lymphatic system (the nodes, tissues, and organs that produce and store infection-fighting white blood cells). The first lymph nodes the cancer cells come in contact with as they move from their tumor of origin are called sentinel lymph nodes
Sentinel lymph node biopsy is surgery to identify, remove, and microscopically examine the lymph nodes directly in the pathway of spreading cancer cells. This way, only those lymph nodes that may be affected by abnormal cells are removed, increasing the potential to save lives while eliminating, in most cases, the need for a more complicated surgery.
Surgery can include removing the cancerous tissue itself, healthy tissue surrounding it, as well as any affected lymph nodes. Many skin cancers can be cut from the skin quickly and easily. In fact, the cancer is sometimes completely removed at the time of the biopsy, and no further treatment is needed.
- Wide local excision removes the tumor and up to two centimeters of surrounding tissue.
- Lymphoscintigraphy and sentinel lymph node dissection help to identify whether the melanoma has spread to lymph nodes near the area of the tumor. The nearest lymph nodes to the original lesion are biopsied and examined for potential spread. Additional lymph nodes may be removed.
- Elective lymph node dissection removes both the tumor and the surrounding lymph nodes, if the sentinel lymph node biopsy is positive.
- Curettage and electrodesiccation is a technique where the area is numbed and the cancer is cut out. An electric current from a special machine is used to control bleeding and kill any cancer cells remaining around the edge of the wound. Most patients develop a flat, white scar.
- Mohs Surgery removes all of the cancerous tissue and as little of the healthy tissue as possible. This procedure is especially helpful when the shape and depth of the tumor is unknown. In addition, this method is used to remove large tumors, those in hard-to-treat places, and cancers that have recurred. The patient is given a local anesthetic, and the cancer is shaved off one thin layer at a time. Each layer is checked under a microscope until the entire tumor is removed. The degree of scarring depends on the location and size of the treated area.
Systemic Treatment of Advanced Melanoma
- Chemotherapy: Melanoma is notoriously chemo-resistant. A minority of patients respond and are cured with traditional single and multi-drug chemotherapy regimens.
- Immunotherapy: This class of therapy involves drugs that manipulate your immune system. Medications include interferon (a synthetic version of a naturally occurring protein in your body that can fight cancer cells. It is considered in patients with melanoma at Stage IIB, IIC, IIIA, IIIB and IIIC), interleukin-2, and others.
- Biochemotherapy: This multi-drug approach combines traditional chemotherapy with immunotherapy.
Topical chemotherapy is the use of anticancer drugs in a cream or lotion applied to the skin. This treatment is also useful for cancers limited to the top layer of skin.
Follow-up Care for Skin Cancer
Even though most skin cancers can be cured, the disease can recur in the same place. If you’ve been treated for skin cancer in the past, you have the increased risk of developing new cancer elsewhere on the skin. Because of the increased risk of skin cancer recurrence, it's important for you to continue to perform regular skin cancer self-exams, visit your MedStar doctor for regular checkups and to follow your doctor's instructions on how to reduce the risk of developing skin cancer again.
At MedStar Health’s Baltimore Cancer Network, we do not just treat skin cancer. We treat the whole patient, which is why we place so much value on continued care.