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Know eight treatments for non-melanoma skin cancer

Know eight treatments for non-melanoma skin cancer

On the National Day to Combat Cancer of the Skin (November 30), the Brazilian Society of Dermatology (SBD) will promote a full day dedicated to examining the population for prevention and diagnosis of skin cancer. which is expected to register more than 140,000 new cases this year in Brazil, according to estimates by the National Cancer Institute (INCA). This year, about 4,000 volunteer doctors and other health care professionals will do free care in 139 health service stations in 24 states. Between 9:00 am and 3:00 pm, the patient will undergo clinical evaluation and, if diagnosed with skin cancer, will be referred to treat the disease - all for free. Anyone at one of these posts will have access to informative talks and will receive leaflets with information about the disease and about sun protection.

For those who have already been diagnosed with non-melanoma skin cancer, the most appropriate treatment, called the "gold standard", is surgery to treat cancer. removal of the tumor. "This way, surgery is always the first choice of treatment for skin cancer," says dermatologist Marcus Maia, Coordinator of the National Skin Cancer Control Program of the Brazilian Society of Dermatology. However, some people may have no indication for surgery - usually elderly people with some comorbidity or bedridden people, who have difficulty locomotion. There are other situations in which surgery alone may not be sufficient for the total withdrawal of the tumor, or the behavior of the tumor may require other measures. In these cases, the doctor may indicate other measures to eradicate cancer. Understand how surgery for skin cancer is done and know other treatment options when the procedure is not indicated:

Surgical Excision

Surgery is considered the gold standard among treatments available for skin cancer, for assessment of tumor margins. Surgical excision is done with a scalpel, and consists of removal of the skin containing the lesion plus a safety margin of non-cancerous skin, the size of which varies according to the type of cancer. It is by analyzing that margin that the specialists will ensure that the tumor has been completely removed. This surgery is indicated for all types of skin cancer. "The risks involved are small, depending on the clinical situation of the patient and the extent of the tumor," says dermatologist Paulo Issa, coordinator of the skin cancer alert campaign of the Brazilian Society of Dermatology Regional Rio de Janeiro (SBD-RJ) . However, there are some conditions that may contraindicate a surgery, and these should be indicated by the doctor. In these cases there are other treatments that can be used.

Mohs surgery

Surgical excision is the gold standard treatment for skin cancer - Photo: Getty Images

This technique is an improvement of standard surgery , allowing the microscopic visualization of the tumor cells, thus making possible their selective withdrawal, with minimal damage to normal skin. "Tumors with poorly delimited borders and recurrent neoplasms after proper treatment are the focus of the procedure," says dermatologist Selma Cernea of ​​the Israelita Albert Einstein Hospital. Mohs surgery is also indicated for more aggressive skin tumors, which present a greater chance of relapse, to make sure that the cancer has been completely removed. During extensive surgery, the surgeon uses a scalpel to remove the visible portion of the cancer along with a thin layer. of underlying tissue. Then the surgeon takes this tissue to the laboratory for analysis so that he can know how many layers of tissue were exactly affected by skin cancer and in which locations. The tissue is evaluated, the doctor will know exactly where the cancer cells are, if it is necessary to continue removing the tissue and where. In this way, skin layers containing the cancer are progressively removed and examined until on only tissue without cancer. The goal is to remove as much skin cancer as possible with minimal damage to the surrounding healthy tissue.

Immunomodulatory ointments

"Some very superficial and small tumors can be treated with immunomodulating ointments with good results," says dermatologist Selma. According to dermatologist Marcus Maia, Coordinator of the National Skin Cancer Control Program of the Brazilian Society of Dermatology, the ointments are more used to treat the skin where the cancer has already been removed, since the cells surrounding the cancer there existed may already have become cancerous - and the ointment ensures the treatment of those. These products act by modifying the body's immune response, favoring the remission of specific skin lesions. According to the dermatologist Paulo, the application of the ointment may be indicated for superficial basal cell carcinomas in the trunk, not very extensive lesions on the face and without infiltration - except in the so-called T zone, corresponding to the forehead, nose and chin region - and in the case of carcinomas spinocellular "in situ". The treatment lasts from six to twelve weeks and usually cause a great irritation in the applied area, with appearance of redness, swelling and desquamation. Marcus also claims that this therapy is used as an exception, since superficial tumors can also be removed with surgery.

Photodynamic therapy

Some people may not be eligible for surgery - usually elderly people with some comorbidity or bedridden , which has difficulty locomotion

"This can be used successfully for the treatment of superficial and primary basal cell carcinomas off the face," explains dermatologist Paulo. According to Selma Cérnea, photodynamic therapy is also indicated for patients with a large number of premalignant lesions on the face or scalp. The treatment is performed with the initial application of a cream, which should remain on the areas to be treated for about two to three hours. After this period the patient should be exposed for a few minutes to a specific wavelength light. This period of exposure causes a burning in the skin that, explains Selma, can be quite painful. "In the days following the procedure there is redness and swelling on the treated skin, but with the passage of time the aesthetic results are usually very good." The product used for photodynamic therapy is no longer available on the market and should be handled in the office.


Generally made with the application of liquid nitrogen, cryotherapy is indicated for the treatment of premalignant lesions, tumors well-delimited tumors located in areas that are not at risk of having deeper penetrations, superficial tumors in the trunk or primary tumors on the face that do not exceed half a centimeter and are not recurrent. It is also an option for patients who are debilitated, have a pacemaker or are on anticoagulants. "The technique works with the use of liquid nitrogen, kept at a negative 196 degrees celsius, which when in contact with the skin goes to approximately 70 degrees Celsius negative, causing the destruction of tumor cells," says Paulo Issa. Cryotherapy often causes blistering to cause tissue destruction through a skin burn. "These deserve intensive care with the application of compresses and dressings on treated sites, and they can still generate scars," says dermatologist Selma.

Curettage and electrocoagulation

Dermatologist Paul says that curettage is a method used to remove various skin lesions, both benign and malignant, using an instrument called a curette. The procedure is a kind of scraping of the skin, thus removing the superficial layers of the skin. "Electrocoagulation is a surgical technique done with a needle with electric current, where heat is released onto the skin, destroying the cancer base that has not been removed by curettage," he says. The procedure, also called electrocautery, is indicated for the treatment of multiple basal cell carcinomas, preferably superficial, both in the trunk and in the face. This is also an exception treatment for surgery

CO2 Laser

Just like the electrocautery, the destruction of the tissues caused by the CO2 laser occurs by heat. "The big difference is that in this technique there is a greater precision of the application of this energy, causing the healthy skin in the neighborhood of the tumor to be spared, resulting in a smaller scar," says dermatologist Selma. It is indicated for the treatment of well delimited and superficial tumors. According to Paulo Issa, the CO2 laser is also an instrument to improve the scars from other treatments for skin cancer. "It vaporizes the skin where the scar is located, allowing the formation of new layers of skin with better quality in its place."


"Radiotherapy is currently little used in skin cancer treatments and should be indicated in cases in which the patient does not present surgical conditions or can not be referred for other treatments, "says Selma Cernea. It can also be used as a complement to surgery in more aggressive tumors, or that have spread to the lymph nodes. It should be done in the office and the application is daily, and its treatment generates inflammations in the skin. "Radiation therapy should be avoided in young patients with a history of previous and / or excessively clear irradiation, and should not be indicated for areas prone to trauma, such as bony prominences, and areas of hair growth, such as eyebrows and eyelashes," the dermatologist Paulo.

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