Treatment of skin cancers

Created 2017.

Melanoma

1. Diagnostic excision of suspicious lesion with 2-mm clinical margin.
2. Partial biopsies should not be undertaken in primary care (refer).
3. Wide local excision; margin depends of Breslow thickness.
4. Primary care may manage Tis, T1a lesions if within capability. Others to be referred to regional melanoma service or private melanoma specialist (surgical dermatologist, plastic surgeon, oncologic surgeon, general  surgeon depending on region within NZ).
5. Primary care shares or takes over follow-up; interval depends on Stage. Check scar, regional lymph nodes, lesions concerning the patient, and full skin examination.
6. Metastatic disease managed by surgeon and/or oncology. Discussed at multidisciplinary meeting (MDM) by multidisciplinary team (MDT).
7. New targeted therapies are evolving. Encourage patients to enrol in clinical trial, if offered. 

Basal cell carcinoma

1. Surgery is used for all forms of basal cell cancer.
2. Mohs surgery for mid-facial, poor-risk lesions.
3. Superficial BCC has some extra options:

• Cryotherapy
• Imiquimod cream
• Photodynamic therapy

Squamous cell carcinoma

1. Surgery is used for all forms of squamous cell cancer.
2. Intraepidermal carcinoma has some extra options:

• Cryotherapy
• Fluorouracil cream
• Imiquimod cream
• Photodynamic therapy

Actinic keratoses

1. Encourage daily sunscreen to all affected areas.
2. Asymptomatic lesions may be observed.
3. Cryotherapy to hyperkeratotic lesions.
4. Fluorouracil cream to flat diffuse lesions.
5. Imiquimod cream to flat diffuse lesions.
6. Daylight photodynamic therapy to flat diffuse lesions.