The first step is to confirm the diagnosis of BCC or SCC with biopsy. In this procedure, the skin is first numbed with local anesthesia. A sample of the tissue is then removed and sent to be examined under a microscope in the laboratory to seek a definitive diagnosis. If tumor cells are present, treatment is required. Fortunately, there are several effective methods for eliminating BCC or SCC. Choice of treatment is based on the type, size, location, and depth of penetration of the tumor, the patient’s age and general health, and the likely outcome to his or her appearance.

Using a scalpel, the plastic surgeon removes the entire growth along with a surrounding border of apparently normal skin as a safety margin. The skin around the surgical site is closed with stitches, and the tissue specimen is sent to the laboratory to verify that all cancerous cells have been removed. Cure rates are generally above 95 percent in most body areas. A repeat excision may be necessary on a subsequent occasion if evidence of skin cancer is found in the specimen.

MOHS surgery:

The plastic surgeon removes a thin layer of tissue containing the tumor. While the patient waits, frozen sections of this excised layer are mapped in detail and examined under a microscope, generally in an on-site laboratory. If skin cancer is present in any area of the excised tissue, the procedure is repeated only on the body area where those cancer cells were identified. This technique can save the greatest amount of healthy tissue and has the highest cure rate, 99 percent or better. It is often used as a first treatment in large tumors in cosmetically important areas, and those that have recurred, are poorly demarcated (hard to pinpoint), or are in critical areas around the eyes, nose, lips, and ears, temple, scalp, or fingers.

 

This technique is usually reserved only for small lesions. The growth is scraped off with a curette,(an instrument with a sharp, ring-shaped tip), then the tumor site is desiccated (burned) with an electrocautery needle. The procedure has cure rates generally under 95 percent. In some areas of the body, it is repeated a few times to help assure that all cancer cells are eliminated. Local anesthesia is required. The technique may not be as useful for aggressive skin cancers, those in high-risk sites, or sites that would be left with cosmetically undesirable results. Typically, a round, whitish scar is left at the surgery site.

Tumor tissue is destroyed by freezing. Liquid nitrogen is applied to the growth with a cotton-tipped applicator or spray device, freezing it without requiring any cutting or anesthesia. The procedure may be repeated at the same session to ensure total destruction of malignant cells. The growth subsequently blisters or becomes crusted and falls off, usually within weeks. Temporary redness and swelling can occur, and in most cases, pigment may be lost at the site. Cryosurgery is only effective for small lesions, especially superficial BCC, but has a lower cure rate than the surgical techniques–approximately 85-90 percent, depending on the physician’s expertise.

It is important to note that (unlike Mohs surgery and excisional surgery), curettage and electrodesiccation, cryosurgery, or topical medications all have one significant drawback in common – since no tissue is examined under the microscope, there is no way to determine how completely the tumor was removed.