Non-Surgical Skin Cancer Removal Therapy Proves Effective and Cosmetically Preferential

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One of the difficulties of non-malignant skin cancers such as basal cell and squamous cell carcinomas is the healing afterward of the skin and potential patient embarrassment from scarring on the face after a skin cancer has been surgically removed. While there is some patient relief that a cancer threat has been removed, the scarring left behind can be both a reminder and regret that is not so easily removed. Researchers announced recently that an alternative skin cancer removal therapy that uses X-ray radiation to remove non-malignant spots on the face has thus far proven to be effective in treating skin cancer and offers a cosmetically preferential choice for some patients.

Basal Cell Carcinoma (BCC) is the most common non-malignant skin cancer that can develop anywhere on the body. Typically, BCC appears on the body where the sun has had the most exposure to the skin such as on the face. Basal cell carcinomas grow slowly and can present the following signs:

• A sore that bleeds, heals and returns
• A pimple that doesn’t clear
• A persistent reddish patch of dry skin
• A hard, flat sunken growth that is white or yellow
• A waxy-feeling scar that can be flesh colored, whiter or yellow
• A pearl-shaped lump that’s skin-colored, pink, brown or red with a depressed center

Squamous Cell Carcinoma (SCC) is a second type of common, non-malignant skin cancer that also occurs on the sun-exposed skin areas, but can also appear in the mouth, on the lips or genitals. Squamous cell carcinomas typically appear as:

• An open sore that itches and bleeds that might heal, but then returns
• A hard and scaly or crusty reddish bump, patch or pearl-shaped growth
• A scaly patch on the lip that thickens

After a suspicious spot on the skin has been biopsied by a dermatologist and found to be a basal cell or squamous cell carcinoma needing removal, a variety of options are available that will take care of the job.

For basal cell and squamous cell carcinoma, removal may include the following procedures:

1. Simple excision to cut away a shallow patch of affected skin.

2. Mohs micrographic surgery where the tumor is removed in thin layers one at a time until no more cancer cells are visible. This is common for facial spots where the least amount of tissue removed is the goal.

3. Cryosurgery where the affected tissue is frozen to destroy the skin cancer cells. Liquid nitrogen or liquid carbon dioxide are typically used to freeze the tissue.

4. Photodynamic therapy where a photo-reactive drug and a beam of laser light are used to kill the cancer cells. The photo-reactive drug becomes active once the laser is shined on the affected spot.

5. Chemotherapy where a topical cream or lotion with cancer-killing components are applied to the skin.

6. Biologic therapy where a substance such as an interferon can improve the body's natural defenses against disease. Interferons can interfere with the division of cancer cells and slow tumor growth.

7. Radiation therapy where various levels of high to low energy X-rays or other types of radiation are used to kill cancer cells or prevent them from growing any further.

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The problem with using surgical methods for removing basal and squamous cell carcinoma is that it often leaves behind scarring that is unpredictable. Some people may show very little scarring, whereas others can develop a significant facial flaw. Scarring is dependent upon how your skin heals, the extent and size of the region of the skin cancer—and thereby the degree of excision, and the skill of the surgeon.

According to a recent study published in the Journal of the American Academy of Dermatology, one of the least damaging skin cancer removal methods is gaining support as an effective option for patients who are concerned about cosmetic damage to their face when having a skin cancer removed.

In the study, 1,715 histologically confirmed primary cutaneous basal cell and squamous cell carcinoma patients treated between 2000 and 2010 were analyzed 2 and 5 years following their skin cancer removal therapy to evaluate the efficacy and viability of using superficial x-ray therapy in the treatment of basal cell and squamous cell carcinoma in an outpatient setting.

What the researchers found was that the cumulative recurrence rates of all skin cancer cases at 2 and 5 years were 1.9% and 5.0% respectively. In cases involving basal cell carcinoma alone, the recurrence at 2 and 5 years was 2% and 4.2% respectively. For squamous cell carcinoma cases, the recurrence of the skin cancer at 2 and 5 years was 1.8% and 5.8% respectively.

Furthermore, their findings also indicated that male patients who had a skin cancer with a diameter over 2 centimeters (0.8 inches) had a statistically significant increase in recurrence likelihood of the cancer.

According to the authors of the analysis, "Superficial X-ray therapy remains a viable nonsurgical option for the treatment of primary BCC and SCC in patients where surgical intervention is declined, unadvisable, or potentially associated with significant cosmetic or functional limitations."

While superficial X-ray therapy is an attractive option for removal of skin cancers, it is not suitable for all types of skin cancers or patients. Some of the factors affecting whether radiation therapy can be used include:

• Type of cancer
• Site of the cancer
• Previous use of radiation therapy
• Suitability of other treatments
• Patient preference
• Type of cancer

To determine whether superficial X-ray therapy is right for you, you will have to consult with your dermatologist about your particular condition.

For more information about basal cell and squamous cell carcinoma, follow this link to an informative article titled “Is it a Mole or is it Skin Cancer?”

Image Source: Courtesy of CDC

References:


“Superficial x-ray in the treatment of basal and squamous cell carcinomas: A viable option in select patients”
Journal of the American Academy of Dermatology (23 July 2012); Armand B. Coqnetta et al.

“Skin Cancer (Non-Melanoma)” American Society of Clinical Oncology


“Superficial X-Ray Therapy for Skin Cancers”
TriStar Sarah Cannon Cancer Center

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