Treatment choices aid cancer patients, doctors

One of the obvious staples of the dermatology profession is the treatment of skin cancer.

In recent years, the armamentarium of treatments for basal cell and squamous cellcarcinoma has been expanding.

Excision might be the original gold standard, but curettage and electrodesiccation, cryosurgery, phototherapy, radiation and even topical medications, can now be offered to patients as options for the treatment of non-melanoma skin cancers.

All of the doctors use a variety of treatments for skin cancer. They differ, however, in how much of a role each procedure plays in their practices. Arguably, the biggest advance in skin cancer therapy is the development of topical medications. Some physicians seem to be embracing the new treatments, while others are taking a more cautious look at this new option.

Stephen D. Behlmer, M.D., in Helena, Mont., has been practicing for 23 years. For the most part he is most comfortable with straight surgical excision.

"My five-year recurrence rate is less than 1 percent. With that kind of cure rate, I find that's the way I like to go."

Dr. Behlmer does incorporate some of the Mohs technique into his surgical procedures.

"I have all the peripheral and deep margins checked tangentially, as with the Mohs method, but I don't do frozen sections."

Although Dr. Behlmer relies a lot on excision, he says other methods benefit patients in special circumstances.

"I do curettage on selected patients who either have the desire to avoid stitches and conventional surgery, or who are old enough that even with the increased risk of recurrence with curettage, it's still a reasonable approach. I also use it for debilitated patients or for patients whose general health wouldn't justify surgery.

Depends on size, location"Cryosurgery is primarily a palliative therapy for me because, at least in my hands, I don't consider cryosurgery as curative as the other methods - we certainly don't have margins to check."In Greenbelt, Md., Anita R. Iyer, M.D., says treatment definitely depends on the size and location of the lesions. She describes herself as rather conservative in her approach when the face is involved.

"If there is a larger skin cancer on the scalp, nose or ears, especially squamous cells, I tend to send those people to Mohs surgeons. Certainly, if it is a younger person with skin cancer in the middle of their face, I would send that to a Mohs surgeon so they would get an optimal repair and removal.

"Lesions on the trunk, arms, and legs, I will excise myself. If it's only a superficial lesion, identified by biopsy, I may just do electrodesiccation and curettage.

"I know there is potentially a higher recurrence rate compared to something like Mohs, but for superficial lesions, it's very safe and effective, and is still a good treatment - because generally you tend to get the entire cancer out. It's a good treatment that definitely has its place, but I won't do it if it's anything deeper than a superficial or in situ lesion."

Dr. Iyer, in practice almost four years, isn't comfortable with using cryosurgery on skin cancers.