Treatment
For patients visiting our clinic, understanding the different treatment options for skin cancer is key to feeling informed and comfortable. Here's a breakdown of common procedures:
Local Anaesthetic
Local anaesthetic is a liquid medicine that temporarily numbs a specific area of your body, stopping you from feeling pain. Unlike general anaesthesia, you stay awake during the procedure.
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For skin cancer biopsies and excisions, local anaesthetic is injected with a needle into the skin around the spot to be treated. This makes the area completely numb so you won't feel any cutting or removal of tissue. You will feel a sting from the injection, and some pressure or tugging during the procedure, but no sharp pain.
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Afterwards, the numbness will wear off in a few hours. You might feel some soreness or mild pain at the site, which can usually be managed with simple pain relief like paracetamol or anti-inflammatory medication.
Biopsy vs. Excision: What's the Difference?
When a suspicious spot is identified on your skin, the first step is often to confirm if it is skin cancer and what sort it is.​
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Biopsy: A biopsy is a diagnostic procedure where a small sample of the suspicious skin lesion is removed and sent to a laboratory for examination under a microscope by a pathologist.
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This helps us confirm whether the spot is cancerous, and if so, what type of skin cancer it is. Some cancers will need a larger excision than others, special planning for removal or referral to a plastic surgeon if they’re on a tricky area like the ears, nose and rest of the face.
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There are different types of biopsies, including shave biopsies (removing the top layers of skin), punch biopsies (removing a small, circular core of skin), and incisional biopsies (removing a portion of a larger lesion). A biopsy is primarily for diagnosis only and if the lesion is cancerous, then an excision will be needed.
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Excision: An excision is a surgical procedure where the entire skin cancer, along with a margin of healthy-looking skin around and normal tissue below it, is removed by cutting. The goal of an excision is to completely remove the cancer and ensure clear margins (meaning no cancer cells are left at the edges or below the removed tissue). The size of the margin depends on the type and size of the skin cancer. For some very early or obvious skin cancers, an excision without a biopsy prior may be sufficient as the only procedure required​
Cryotherapy: Freezing Off Skin Lesions
Cryotherapy is a non-surgical treatment that uses extreme cold, usually liquid nitrogen, to freeze and destroy abnormal skin cells.
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How it works: Liquid nitrogen is sprayed onto the lesion, causing the cells to freeze and then thaw, which kills the damaged cells The treated area will typically blister, scab, and then heal over several weeks. There is a small risk of leaving a paler area of skin behind.
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When it's used: Cryotherapy is most often used for pre-cancerous sunspots (actinic keratosis), and some small, superficial basal cell carcinomas (BCCs) and squamous cell carcinomas in situ (Bowen's disease). It's a quick procedure, often chosen for its simplicity and good cosmetic outcomes for appropriate lesions.
Field Treatment for Sun-Damaged Skin and Early Skin Cancers
If you have widespread sun damage, pre-cancerous spots, or certain early skin cancers, your doctor might suggest a "field treatment" using a special cream. These creams work on a larger area of skin, rather than just one spot. The two most common creams used for this are Efudix (5-Fluorouracil) and Aldara (Imiquimod).
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How Efudix (5-Fluorouracil) works: Efudix is a chemotherapy cream that targets and destroys fast-growing, abnormal skin cells caused by sun damage. It leaves your healthy skin cells mostly untouched. When you apply it, your skin will likely become red, crusty, and peel. This reaction, while uncomfortable, shows the cream is doing its job by getting rid of the damaged cells.
When it's used: Doctors often prescribe Efudix for widespread sunspots (actinic keratoses) and early forms of basal cell carcinoma and squamous cell carcinoma (Bowen's disease). It's especially helpful for larger areas of sun-damaged skin or places that are tricky to treat with surgery. You'll use it for several weeks, and your doctor will give you clear instructions on how to apply it and what to expect during treatment.
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How Aldara (Imiquimod) Works: Aldara is another type of cream that works differently. Instead of directly killing cells, it helps your body's own immune system fight off the abnormal skin cells. It triggers a local immune response in the treated area, leading to inflammation that helps clear away the damaged cells.
When it's used: Aldara is commonly used for certain types of actinic keratoses and superficial basal cell carcinomas. Like Efudix, you'll apply it for a few weeks, and your skin will likely show a reaction like redness, swelling, and scabbing. Your doctor will guide you on the best way to use Aldara and what to look out for.
Both creams are effective ways to treat sun-damaged skin and early skin cancers without surgery. They can also make skin cancers that may have been hiding in sun damaged skin more obvious, so they can be treated with an excision.