Skin Cancers

A thorough skin examination is essential for identifying premalignant and malignant lesions. This will include dermoscopy assessment which is a vital diagnostic modality. Usefulness of dermoscopy to improve the clinical and histopathologic diagnosis of skin cancers – PubMed. This is, in effect, a handheld magnifier to assess suspicious lesions, giving vital information to include the location, texture, size, colour, shape, borders and any recent changes in appearance to suggest malignant or benign features.

From this, suspected malignant lesions will undergo biopsy. This involves the removal of a small piece of the concerning tissue typically through a shave or punch technique, which is appropriate for most NMSC, while complete excision is usually indicated for MSC. These will be sent for histology to confirm the diagnosis.

Skin cancer treatment depends on the type, location, stage of the disease and evidence of metastases (spread to a different part of the body). Common treatment options include,

• Surgery: this is the most common medical procedure which involves cutting out the tumour and a margin of the healthy skin. Wide local incision is the current standard of care for localised cutaneous melanoma. Surgical Management of Melanoma – Cutaneous Melanoma – NCBI Bookshelf
• Mohs micrographic surgery, reserved mainly for basal cell carcinomas and squamous cell carcinomas. This technique offers precise microscopic control of the entire tumour margin while maximising conservation of healthy tissue. The tissue-sparring properties of Mohs micrographic surgery make it particular useful in areas of functional and aesthetic importance, such as the face, head, hands and feet. Mohs Micrographic Surgery – StatPearls – NCBI Bookshelf.
• Curettage and electrodesiccation: this is a minimally invasive technique used to treat superficial basal cell carcinomas and squamous cell carcinomas. The tumour is removed by scraping it down to healthy tissue in the dermis followed by denaturing the tissue with electrodessications. Patient-Reported Outcomes of Electrodessication & Curettage for Treatment of Non-Melanoma Skin Cancer – PMC
• Cryotherapy (freezing). Liquid nitrogen can be used to freeze and destroy small, superficial skin cancers. It is not the first-line therapy and is typically reserved for patients who are not good candidates for excision and do not have any contraindications to the treatment Cryotherapy in Dermatology – StatPearls – NCBI Bookshelf 
• Radiotherapy uses high-energy rays to destroy cancer cells, often again used if surgery is not possible or deemed high risk in patients with NMSC. It can also be used as a follow-up treatment to reduce the risk of reoccurrence. The Role of Radiation Therapy in the Treatment of Non-Melanoma Skin Cancer – PubMed
• Topical medications, immunotherapy or chemotherapy creams offer non-invasive treatment options and can treat early superficial NMSC Treatment of Cutaneous Malignancies With Topical, Oral, and Injectable Medication – StatPearls – NCBI Bookshelf

Targeted therapy & immunotherapy: for advanced, deep or spread skin cancers, they may be treated with drugs that target specific gene mutations or help boost the immune system to fight the cancer. The combination of immunotherapy and targeted therapy can help improve therapeutic effects, delay drug resistance and mitigate adverse side effects when compared to other systemic treatments. Advances in Immunotherapy and Targeted Therapy of Malignant Melanoma – PMC