SKIN CANCER
 TREATMENT

ESPECIALLY SKIN CANCER ON THE FACE, NOSE AND LIP


What do we mean by 'Skin Cancer'? Skin Cancer can be found on any part of the body. It is the most common cancer diagnosed in Australia. Skin Cancers are either Melanoma or Non-Melanoma Skin Cancers (NMSC). Our focus is Skin Cancer on the head and neck, especially the face, nose and lip. Information about other types of Head and Neck Cancers can be found here.


 
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1. Treatment options for Skin Cancer

The most appropriate treatment of Skin Cancer depends on many factors. These include:

  • type, size and location of the cancer and whether it has spread

  • personal factors (e.g. age, general health and treatment history)

  • types of treatment available  

  • your preferences for treatment

Most common Skin Cancers (e.g. non melanoma Skin Cancer) will be treated by a local excision only.

Skin Cancers become invasive when they breakthrough the bottom layer of the skin (dermis) and invade into the deeper tissues.

Ideally, Skin Cancers are treated when still within the skin - “in situ cancer”.

Treatment of in situ Skin Cancer can be with surgery (including excision or curettage also called scooping), radiation therapy or other treatments including liquid nitrogen therapy (freezing), cautery (using heat) or topical medications (e.g. creams or ointments).


2. Surgery for Skin Cancer

Surgery is an important treatment for many Skin Cancers. For people, where the cancer has invaded the skin, there is a chance that the cancer may invade deeper structures and spread.

The different operations that can be used for Skin Cancer are​:

LOCAL EXCISION (WIDE LOCAL EXCISION)

This operation involves cutting out the Skin Cancer with a margin of healthy tissue to ensure all of the cancer is removed. It may require cutting away skin, or other soft tissue and bone. 
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SENTINEL LYMPH NODE BIOPSY

This is an investigation that may be done at the time a Skin Cancer is treated. It is done when there is a high risk of the cancer spreading to lymph nodes, but no nodes are obviously involved. This is most often done in people with melanoma or MCC and rarely done for people with SCC or BCC.
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RECONSTRUCTIVE SURGERY

This may be considered if a large area of tissue is removed. This operation is done by your head and neck surgeon or a surgeon who specialises in reconstructive surgery. Reconstructive surgery may involve:
  • Skin grafting, which is taking skin from another part of your body (such as your thigh) and transplanting it to cover the area where you had surgery.

  • Flap repair, which is taking tissue from another part of your body to rebuild the area where you have had surgery. You can have local flap or a free flap surgery. 

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NECK DISSECTION

This involves removal of lymph nodes from your neck. This is important even when there is no sign of cancer in the lymph nodes on your scan, because there is a risk of microscopic cancer in the lymph glands of the neck.
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PAROTIDECTOMY

This is the removal of your parotid glands (pair of major salivary glands located in front of each ear) and the surrounding tissue, because of direct invasion in to the gland or because of spread to lymph nodes lying within the salivary gland.
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FACIAL NERVE SACRIFICE (RADICAL PAROTIDECTOMY)

This is the removal of your facial nerve, which controls changes in face or expressions. It is used when a cancer in the parotid gland has spread to the nearby facial nerve.
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LATERAL TEMPORAL BONE SURGERY

This is the removal of some or all of the bone in the temple and behind the ear. It is used when a cancer in the parotid gland has spread into the nearby bone.
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ORBITAL EXENTERATION

This involves the removal of the eye or eye lid. It is used when the cancer has spread into the eye socket and cannot be treated any other way.
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3. Radiation therapy for Skin Cancer

Radiation therapy can be used to treat both melanoma and NMSC.

Most people with melanoma will have surgery but some people with widespread in situ melanoma, or with metastatic lymph nodes after surgery may be referred to a radiation oncologist to consider having radiation therapy.
 
The common type of radiation therapy for Skin Cancer is called external beam radiation therapy. This type of radiation therapy is applied from outside of the body. The machines used to deliver radiation therapy for Skin Cancer give less penetrating radiation that is because these Skin Cancers are on the skin surface. Some people will need deeper treatment with deeply penetrating x-rays called megavoltage photons.

Radiation therapy can be used in the following ways: 

Definitive

Definitive radiotherapy can be used on its own (without surgery) to cure Skin Cancer.

It may be recommended if surgery is not appropriate because of the size and location of the Skin Cancer or an operation is not safe for the person involved. This therapy is more common for people with a NMSC.

Adjuvant
Done after surgery. It is used as an additional treatment to kill any cancer cells that may not have been removed during surgery.
Palliative
Used to relieve symptoms of advanced Skin Cancer, such as pain and bleeding or if the cancer has spread to other parts of the body such as the bones.

4. Chemotherapy for Skin Cancer

Chemotherapy for non-melanoma Skin Cancers is rarely used but is usually given into a vein through a needle with a cannula (tube) attached. Chemotherapy works by attacking rapidly dividing cells, such as cancer.

People with melanoma may be recommended types of systemic treatment called immunotherapy. Many people with melanoma may also be asked to take part in a clinical trial of different types of these drugs.
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