The right treatment for skin cancer

Therapy of malignant melanoma: The therapy of malignant melanoma focuses on the surgical removal of the diseased tissue. Depending on the size of the findings, the exact therapy is adapted. Skin cancer that is only superficially present is removed with a safety margin of half a centimeter.

If the thickness of the tumor is up to 2mm, the safety margin is 1cm, if the tumor is thicker than 2mm, the resection is performed with a safety margin of 2cm. This is done to ensure that the degenerated tissue is removed completely. In the case of skin cancer of 1mm and larger, the nearest lymph node in the lymph drainage area is also removed (so-called sentinel lymph node) to see whether it is already affected by tumor cells.

If this is the case, the entire lymph node station must be cleared. If the sentinel lymph node is tumor-free, no further lymph nodes are removed. If the tumor has already formed metastases, these must also be surgically removed if possible.

If it is not possible to remove the skin cancer or its metastases completely, radiation and/or chemotherapy are used. Various therapeutic agents are available for this purpose. Therapy of white skin cancer (basal cell carcinoma): White skin cancer is also preferably treated surgically.

The goal is the complete removal of the degenerated tissue. In the case of white skin cancer, however, there are alternative procedures that can be chosen if the cancer is in a very early stage or if surgery is not possible due to the patient’s advanced age or tumor localization. For example, in the case of very superficial or small basal cell carcinomas, a scraping can be performed with a sharp spoon.

However, the recurrence rate of skin cancer is higher with this procedure than with conventional surgical therapy. A further alternative is photodynamic therapy (PDT), in which the affected skin area is first pre-treated with a specific substance (for example with 5-aminolevulinic acid cream). This increases the light sensitivity of this area of skin.

This is followed by irradiation with red cold light, which then selectively destroys the malignant skin cancer cells. In the case of superficial basal cell carcinomas, special creams can also be applied to the corresponding skin area for several weeks, which then externally lead to the killing of the tumor cells. Regular application of the cream is crucial for the success of the therapy.

Possible side effects are strong inflammatory reactions of the skin to ingredients of the cream. Last but not least, the degenerated tissue can also be frozen with liquid nitrogen. This procedure is called cryotherapy.

Nitrogen from -70°C to -196°C is applied directly to the tissue and kills the tumor cells. This procedure is particularly used for older patients who cannot be operated on. Finally, a last alternative is the irradiation of white skin cancer.