Raleigh Dermatology

Treatment of Skin Cancer

When a patient’s skin biopsy reveals cancer, Raleigh Dermatology considers an array of medical and surgical treatment procedures, depending on the type of cancer, its location and the patient’s needs. Surgical treatments include electrodessication and curettage (ED&C), which involves alternately scraping or burning the tumor in combination with low levels of electricity; cryosurgery, which involves freezing the tumor using liquid nitrogen; and laser surgery. Mohs micrographic surgery is a special procedure that removes the entire tumor while sparing as much normal skin as possible.


Treatment Options for Actinic Keratoses (AK) Lesions

Photo Dynamic Therapy (PDT) offers a non-invasive, two-step treatment for AK lesions that have not yet expanded or thickened on the face or scalp. PDT combines light and a clear, topical, light-activated solution called Levulan that targets and destroys AKs. Raleigh Dermatology applies Levulan to the lesion and leaves it on for 15 to 60 minutes. BLU-U, a specific wavelength of light, activates the Levulan for 8 to 10 minutes. Targeted AK cells absorb the Levulan and become sensitive to the light. We then remove the Levulan and administer the light treatment, which successfully destroys the AKs.

Solaraze is a clear, colorless to pale yellow non-greasy gel containing the drug diclofenac sodium, a non-steroidal anti-inflammatory drug. Patients typically smooth a small amount of the gel onto the affected skin twice a day. Diclofenac inhibits production of a substance called cyclo-oxygenase, which is involved in the production of prostaglandins and other chemicals in the body. This inhibiting action reduces prostaglandin production. Solaraze gel is thought to reduce a specific prostaglandin called PGE2.

Solaraze gel should not be applied to open skin wounds, infections or inflamed, scaly skin. Patients should wash their hands thoroughly after using Solaraze gel, and stay out of the sun or cover skin while outdoors during the treatment period, which typically lasts 60 to 90 days.

Fluorouracil safely and effectively targets and eliminates abnormal AK cells above and below the skin’s surface before they progress into a more aggressive AK or squamous cell carcinoma. Raleigh Dermatology prescribes several fluorouracil creams to treat AK cells, including Efudex®, Fluoroplex® and Carac®. Patients should apply just enough fluorouracil to cover the lesion and avoid the corners of the eyes, eyelids and corners of the nose and mouth unless directed otherwise. Most dermatologists prescribe that patients apply the cream twice a day for two to four weeks.

Patients experience four phases of symptoms during treatment. Mild inflammation occurs during the early inflammatory phase. Next, during the more intense inflammation phase, redness and swelling with some crusting and burning occurs. During the tumor disintegration phase, lesions resolve as the skin exfoliates. Finally, new skin grows into the treatment area over a two-week healing phase. Complete healing occurs within two months after the treatment ends and patients experience healthy skin again.

Cryosurgery (freezing) using liquid nitrogen can also remove AK lesions. Often, Fluorouracil is used prior to or following cryosurgery as interval therapy in patients with severe AK lesions.

Raleigh Dermatology may prescribe Aldara (Imiquimod) cream for patients with AK cells. Aldara works by activating immune cells to travel to targeted AK cells and eliminate them before they progress into a more aggressive AK or squamous cell carcinoma. Aldara cream should be applied in 2-by-2-inch patches to the treatment area once a day for two days a week, three to four days apart. Patients should wash off the Aldara cream after eight hours, and treatment typically continues for 16 weeks. Patients may experience some reddening, peeling, swelling, burning or itching at the targeted area.