The mainstay of treatment for NMSC is surgical excision. There are several techniques that are used depending on the size and location of the lesion.
Excisional surgery: The majority of NMSC’s may be removed by surgical excision. Surgical excision may be performed in the office or in the operating room, depending on the size and location of the lesion. Recurrence rates after surgical excision are <10%.
Mohs micrographic surgery: Mohs micrographic surgery (MMS) is a specialized technique that is utilized for the removal of skin tumors and is the most accurate way to remove NMSC. Serial horizontal sections of tumor are removed and the margins of resection are immediately evaluated to determine if the entire tumor is removed. While the majority of NMSC may be excised using conventional excisional techniques without microscopic evaluation, there are some specific situations in which MMS is indicated. These include resection of lesions in cosmetically sensitive areas, lesions with high recurrence rates (midface and ears), tumors greater than 2 cm in size, recurrent tumors, tumors with aggressive histologic growth patterns, and tumors with ill-defined borders. The goal of MMS is to remove all tumor while preserving as much healthy tissue as possible. Mohs micrographic surgery is available through the Department of Dermatology at the University of Maryland.
Curettage and Electrodesiccation: Curettage and electrodesiccation is an additional surgical technique for removal of superficial NMSC. A curette, which is a cutting device, is used to scrape away the tumor cells, and then electrodessication is used to kill the surrounding cells. This is usually repeated 2-3 times to eliminate the entire tumor. This technique is only appropriate for superficial tumors that are not of an aggressive type.
Radiation therapy is the use of high-energy x-rays to kill cancer cells. Radiation may be used as the primary treatment for patients with NMSC or may be used in addition to surgical excision. The decision to use radiation as the primary treatment for NMSC depends on the size and location of the lesion and patient comorbidities. Radiation may also be considered for more aggressive tumors where there is evidence of nerve invasion or lymph node metastases.
Topical 5-fluorouracil is the most commonly used chemotherapy agent for the treatment of NMSC. This agent is applied for 4-6 weeks. Because the depth of tissue penetration of 5-fluorouracil is limited, this treatment is only appropriate for very superficial BCCa’s or SCCa’s. This agent has also been used to treat actinic keratoses, which may develop into SCCa. Imiquimod is another topical agent that stimulates the host antitumor immune response. This agent has been used for the treatment of actinic keratoses, superficial BCCa and non-invasive (in situ) SCCa.