Our Treatment Approach

Melanoma and Other Skin Cancers

Multidisciplinary Care
About Skin Cancer
What Skin Cancer Looks Like
Testing for Skin Cancer
Treatments Options for Nonmelanoma Skin Cancer
Treatments Options for Melanoma
Clinical Trials

Multidisciplinary Care
The Siteman Cancer Center is uniquely qualified in the diagnosis, evaluation and treatment of all forms of skin cancer.

Many skin cancer patients require treatment from several medical and surgical specialists, including dermatologists, dermatologic surgeons, medical and surgical oncologists, radiologists, radiation oncologists, ophthalmologists, otolaryngologists and plastic surgeons. Siteman physicians from these fields routinely meet to coordinate and discuss treatment options for patients. In these multidisciplinary meetings, careful consideration is given to determining the best approach to treatment.

About Skin Cancer
Skin cancer is the most common form of cancer, affecting more than 1 million people each year. It most often appears on parts of the body regularly exposed to sunlight or artificial sunlight, such as the face, neck, hands and arms, but it can occur anywhere on the body.

In all skin cancers, those who have fair features, such as light hair and blue or green eyes, are at greatest risk. There are two forms of nonmelanoma skin cancer. The most common form is basal cell carcinoma, and the second is squamous cell carcinoma. Both are caused most often by long-term exposure to sunlight. With either form of nonmelanoma skin cancer, there is a small chance that the cancer will spread to other parts of the body.

Melanoma skin cancer poses a more serious threat. It occurs in the cells of the skin called melanocytes, which are pigment-producing cells. Because it is a more aggressive type of skin cancer that more commonly spreads to other organs, it is important to diagnose and treat melanoma early, when it may be cured.

What Skin Cancer Looks Like
The symptoms of nonmelanoma and melanoma skin cancer differ. Often the signs of nonmelanoma skin cancer are subtle, and they may resemble those of other skin conditions, such as psoriasis and eczema. Common signs of nonmelanoma skin cancer include:

  • An open, nonhealing sore that lasts for three or more weeks
  • A reddish patch that may itch or cause some pain
  • A new pearly or translucent bump that could be confused for a mole
  • A crusty or scaly patch of skin that may bleed at times

In many cases, skin cancer appears as a combination of the above symptoms. You should consult with a skin doctor, or dermatologist, if you notice any of these signs.

Melanoma skin cancer usually resembles an irregularly shaped mole and typically is pigmented, often with variations in color that include brown, black and red. Other common signs are asymmetric shape and size larger in diameter than a pencil eraser. Moles having these characteristics, particularly if new or changing, should be evaluated by a physician.

Melanoma also may occur within the eye in pigment cells that are similar to melanocytes in the skin. If it occurs on the inner surface of the eyelid, or on visible areas of the eye, melanoma may be diagnosed early. When melanoma occurs within the deeper structures of the eye, it often is not detected until later, with symptoms of changes in vision. An ophthalmologist, or eye doctor, is instrumental in the diagnosis and treatment of these tumors.

Testing for Skin Cancer
At Siteman, once it has been determined that your skin condition may be cancerous, a biopsy is performed, where all or part of the skin cancer is removed for examination under a microscope. From this skin sample, a diagnosis will be made, and the appropriate method for removing the tumor will be determined.

Treatment Options for Nonmelanoma Skin Cancer
A process called curettage and electrodessication is the most common method of treating basal cell carcinoma on the trunk and extremities. Using a spoon-shaped, semisharp instrument, a physician removes the cancerous tissue and then treats the surrounding area to destroy any cancer cells remaining at the edge of the wound. Another procedure used for all forms of skin cancer is called standard excision, which involves removing the skin cancer as well as a portion of skin surrounding the cancer. One benefit of standard excision is that the skin cells can be taken to a lab, where a pathologist can determine whether the cancer has been completely removed.

Another form of specialized surgery called Mohs micrographic surgery is performed by specially trained physicians at Siteman who carefully examine tumor tissue during surgery to make sure the cancer is completely removed. Using Mohs surgery, physicians remove the first layer of skin containing the cancerous tissue visible to the eye. With this first layer, they map the surgical site, and then they microscopi­cally examine the remaining skin tissue in the affected area to determine if there is more cancer that needs to be removed. The advantage of this procedure over others is its level of precision – physicians remove only the skin tissue that is cancerous, which reduces the potential for a larger scar.

Radiation therapy also is a common treatment option for nonmelanoma skin cancer, especially for tumors that are large or are located on areas of the body that are difficult to treat. It also may be the best option for patients who have other medical complications in addition to their skin cancer. With this procedure, high-energy particles are delivered to the affected area over several treatment sessions to destroy the cancerous tissue.

Treatment Options for Melanoma
The standard treatment for primary melanoma skin cancer is surgical removal. The size of the excision around the tumor depends on how far the melanoma has invaded the deeper layers of the skin. Removal may be performed by a dermatologist or a surgeon.

Lymphoscintigraphy and sentinel lymph node biopsy are specialized procedures that may be performed in conjunction with surgical removal for deeper melanomas to evaluate for any microscopic spread of melanoma tumor cells to the lymph nodes.

Clinical Trials
Clinical trials are constantly expanding our understanding of available cancer treatments and frequently result in improved, more effective therapies. For example, at Siteman, we have developed a vaccine to treat melanoma that is being evaluated in one study. Patients who choose to participate in any clinical studies being conducted at Siteman are closely monitored for their health and any side effects they may be experiencing. Patients should consult with their physician to determine whether a clinical study might be helpful.