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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for skin cancer on the head

My father is 86 and previously had shingles before. This morning he complained of an itchy back. Before leaving for work I applied calomine lotion. His back is still itchy, and a bit warm. To me it looks like shingles. On the right side of his body he has one black spot (?) I've never seen this before. He does have prostate cancer, and recently was diagosned with skin cancer ( on his head.... bald..) He also covers his arms. He has been under the weather with a cold for the last 4 days. I have only given him aspirin for pain and tylenol No. 3 if necessary, and Benylin... cough, (cold and sore throat). He is currently taking Tamsulosin; apo-oxybutynin; apo-atenol; apo-indapamide; aricept; fucidin (cream ..applied to his head and side of his ears ~ where he sometimes bleeds)~not much just a tiny bit. I asked him if he was upset or worried about anything, since mom had died on June 7, 2009. With Valentines Day, he may have become sentimental from within and perhaps he is surpressing his emotions. They were suppose to have celebrated their 62nd wedding anniversary. Dad never really has gotten over mom's loss. He wasn't eating very much, so I made homemade "Chicken soup." That's one way to make him eat and take his meds! Am I on the right track or am I overlooking something?
Wed, 10 Jan 2018
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Oncologist 's  Response
Hi
In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams also include a variety of other health care professionals, including physician assistants, nurses, social workers, pharmacists, counselors, dietitians, and others.

Descriptions of the most common treatment options for non-melanoma skin cancer are listed below. Treatment options and recommendations depend on several factors, including:

The size and location of the skin cancer

Possible side effects

The patient’s preferences and overall health

Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.
Surgery is the removal of the tumor and surrounding tissue during a medical procedure. Many skin cancers can be removed from the skin quickly and easily during a simple surgical procedure. Often, no additional treatment is needed.

Different types of surgical procedures are used depending on the size of the lesion and where it is located. Most of these surgical procedures use a local anesthetic to numb the skin beforehand and can be done outside of a hospital by a dermatologist, general surgeon, plastic surgeon, nurse practitioner, or physician assistant.

Surgeries and other procedures for skin cancer include:

Curettage and electrodessication. During this common procedure, the skin lesion is removed with a curette, which is a sharp, spoon-shaped instrument. The area is then treated with an electric current that helps control bleeding and destroys any remaining cancer cells. This is called electrodessication. Many people have a flat, pale scar after this procedure.

Mohs surgery. This technique, also known as complete margin assessment surgery, involves removing the visible tumor, in addition to small fragments around the edge of the area where the tumor was located. Each small fragment is examined under a microscope until all of the cancer is removed. This is typically used for a larger tumor, a tumor located in the head-and-neck region, and for cancer that has come back in the same place.
Freezing. This procedure, which is also called cryotherapy, uses liquid nitrogen to freeze and destroy abnormal cells. It is usually used to treat precancerous skin conditions. The liquid nitrogen will sting when it is first applied to the skin, and then the skin will blister and shed off. More than 1 freezing may be needed. Sometimes this procedure leaves a pale scar.

Laser therapy. A narrow beam of high-intensity light can destroy precancerous skin conditions that are located only in the outer layer of the skin.

Wide excision. When a large tumor is removed, the incision may be too large to close, so surgeons may use skin from another part of the body to close the wound, help with healing, and reduce scarring.

Reconstructive surgery. Since skin cancer often develops on a person’s face, a reconstructive (plastic) surgeon or facial specialist may be part of the health care team. Before any surgery for skin cancer, talk with your doctor about whether changes to your appearance are likely.

Photodynamic therapy. In this procedure, the specific area(s) of the skin, such as the face, scalp, or arm, is treated with a chemical that makes the skin more sensitive to a specific type of light emitted from a device at a doctor’s office. Then the area is exposed to this light, and the cancerous and precancerous cells are eliminated. It may be painful, so your doctor usually may give you a pain-controlling medication before the procedure.
Radiation therapy
Radiation therapy is the use of high-energy rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. Radiation therapy may be used instead of surgery for skin cancer that is located in a hard-to-treat place, such as on the eyelid, the tip of the nose, or the ear. It is also used in some people who would like to avoid scarring from surgery. Sometimes radiation therapy may be recommended after surgery to help prevent the skin cancer from coming back.

The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. Several treatments may be needed to eliminate the cancer. A less common type of radiation treatment for skin cancer is brachytherapy. This involves placing the radiation source very close to or inside of the skin cancer.

Radiation therapy is not recommended as a treatment option for people with nevoid basal cell carcinoma syndrome.

The side effects from radiation therapy may include a rash, skin infections, itchy or red skin, or a change in the color of the skin. However, these side effects can usually be prevented by applying a corticosteroid or antibiotic on the skin. If side effects develop, most go away a few weeks after treatment has finished. Learn more about the basics of radiation therapy.

Topical treatments
To treat precancerous skin conditions or a cancerous lesion located only in the top layer of the skin, doctors may prescribe chemotherapy as a cream or lotion. Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. These drugs are usually applied to the skin every day for several weeks. They may cause skin inflammation or irritation, which will go away once treatment is finished.

Topical diclofenac (Solaraze), fluorouracil (Efudex), and ingenol mebutate (Picato) are approved for the treatment of precancerous actinic keratosis. All of these creams can cause irritation, burning, redness, and stinging during treatment. These symptoms usually go away soon after treatment has been completed. These creams do not cause scars to form, which is why many doctors use them to treat the face or other areas where cosmetic results are important.

For small basal cell cancers not located on the face, topical imiquimod (Aldara), which stimulates the immune system, may be recommended. The cream must be applied once a day, 5 days a week, for 6 to 12 weeks. Topical fluorouracil is also approved by the U.S. Food and Drug Administration (FDA) to treat superficial (very thin) basal cell carcinomas. It should be applied twice daily for 3 to 6 weeks. Some irritation and redness in the area of the basal cell carcinoma is expected with this treatment.

Photodynamic therapy is a combination treatment for actinic keratosis. First, a topical medication called aminolevulinic acid (Levulan) is applied over areas with many actinic keratoses. Then this area is exposed to a special light-emitting device for several minutes to a few hours. The aminolevulinic acid makes the skin very sensitive, so the procedure can be painful. Your doctor may recommend taking pain-controlling medication before the procedure. In addition, the chemical makes the skin very sensitive to the sun, so it is important to avoid sun exposure and wear protective glasses, clothing, and sunscreen for a few days after the procedure. The skin will remain very red and irritated for a few days, but the actinic keratoses quickly disappear once the redness goes away.
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