Facial skin cancer

Simple treatment of skin cancer is often undertaken by dermatologists or by general practitioners / primary care physicians with suitable training. Techniques such as cryotherapy (locally applied extremely low temperatures), curettage (scraping) and cautery (locally applying very high temperature by an electrically heated ‘knife’, stops bleeding), photodynamic therapy and local excision will treat the majority of skin tumours successfully. Only a small percentage of cases require formal surgical excision and reconstruction. The evidence base for the best choice curative treatment does, however, support surgery.

The overall philosophy for curative treatment by surgery is summarised in Figure 1: it involves the complete removal of the lesion, with a clear margin if at all possible. For benign lesions (top of Figure 1) the margin can be minimal; for malignant skin lesions (bottom of Figure 1) the margin needs to be more substantial which, in turn, may necessitate repair and reconstruction for an optimal cosmetic and functional outcome.

Figure 1: Surgical removal of skin lesions. Top trace: removal of a benign lesion, with minimal damage; bottom trace: removal of a malignant lesion with more demanding requirements for excision with a clear margin.

Both basal cell carcinoma, BCC, and squamous cell carcinoma, SCC, can be successfully treated by radiotherapy or surgery. However, the overwhelming preference is for surgery for a variety of reasons: aesthetics, speed, tumour bulk and histopathological evidence of clearance of the tumour. Radiotherapy (particularly electron beam) is used as an adjuvant therapy after surgery and when surgery is inappropriate for a variety of reasons.

Next section: Facial skin cancer