Fast Five Quiz: Melanoma and Other Skin Cancers

William James, MD


July 01, 2021

Several effective treatment modalities exist for precancerous skin lesions, and for SCC in situ. Topical application of 5-fluororacil or imiquimod is effective in treating precancerous skin lesions. Electrodessication and curettage has also been successfully used to treat SCC in situ.

Low-risk cutaneous SCC on the trunk and extremities can be treated with electrodessication and curettage. Electrodessication and curettage is a simple technique that can be used to treat localized, superficial cutaneous SCC. This procedure destroys the tumor and a surrounding margin of clinically unaffected tissue via cauterization and scraping of the area with a curette. The process is repeated several times to maximize the probability of complete tumor extirpation.

Standard excision with conventional permanent (ie, paraffin-embedded) tissue sections is a highly effective and well-tolerated therapy for primary cutaneous SCCs that lack high-risk features and are located in areas where tissue sparing is not critical. Surgical excision offers the advantages of histologic verification of tumor margins, rapid healing, and improved cosmesis.

A 4-mm margin of healthy tissue is recommended for lower-risk lesions. In this category are well-differentiated tumors < 2 cm in diameter that do not occur on the scalp, ears, eyelids, lips, or nose and do not involve subcutaneous fat. Therefore, simple excision is most valuable in the treatment of small primary SCCs on the trunk, extremities, or neck, where tissue sparing is less essential. A 6-mm margin of healthy tissue is recommended for lesions that are larger than 2 cm, invasive to fat, or in high-risk locations (ie, central face, ears, scalp, genitalia, hands, feet).

Because of its numerous advantages, Mohs micrographic surgery is the procedure of choice in the following situations:

  • SCC in which tissue preservation is needed

  • Ill-defined SCC

  • Recurrent tumors

  • High-risk SCC

Radiation therapy as primary treatment for cutaneous SCC is typically reserved for patients who cannot undergo surgical excision. More frequently, radiation therapy is used as an adjuvant to surgery for improved locoregional control. Postoperative radiation therapy is considered for tumors that exhibit perineural invasion or other high-risk features and for those that involve regional metastasis.

Read more about the treatment of SCCs.


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