Improving outcomes for people with skin tumours including melanoma

Improving Outcomes for
People with Skin Tumours
including Melanoma
Initial investigation,
diagnosis, staging and
management
Isolated limb perfusion (ILP) may be an option for selected patients,
especially those at risk of limb loss, with remission rates of up to 60%
for periods of up to 2 years but with a small risk of serious morbidity.
This option should be reserved for advanced in-transit disease when
simpler and safer methods have been exhausted. Isolated limb
infusion (ILI) is a relatively new technique that appears to be of equal
efficacy; it is less invasive and easier to repeat, but toxicity is similar
to ILP. Worldwide there is less experience of ILI than of ILP.
Correspondingly, there is less evidence available for ILI than for ILP.
Both methods are occasionally used to treat other types of skin
cancers and sarcomas.
4
Non-melanoma skin cancer
The standard effective treatment is surgical excision and all excised
specimens should be sent for histopathological examination.
However, there are a range of other surgical and non-surgical
procedures, which are well described in clinical guidelines. Where the
other non-surgical treatments exclude histological confirmation of the
diagnosis, an incisional biopsy for confirmation of the diagnosis
should usually be obtained before treatment.
Other surgical and non-surgical procedures include:
• Curettage and cautery/electrodesiccation. This technique is
performed using a curette to remove soft material from the
tumour. The base of the tumour is then destroyed, using either
hyfrecation or cautery. This may be used to treat small (less than
1 cm) primary BCCs, in situ SCCs and AKs. It is safe and well
tolerated, and usually produces a good cosmetic outcome. It is
suitable for patients with multiple lesions. However, the
histology may be difficult to interpret as the lesion may be
incompletely removed and margins of excision cannot be
assessed optimally.
• Cryotherapy/cryosurgery. Cryotherapy is the destruction of
skin lesions using liquid nitrogen. It is a cost-effective treatment
and is well established for small lesions including AK, superficial
BCC and in situ SCC. However, histology is not available unless
an incisional biopsy is taken first.
• Topical treatment. Imiquimod (Aldara 5% cream). This is a
new immune-response-modifying agent that has recently been
licensed for the treatment of small superficial BCCs.
Fluorouracil (Efudix 5% cream). This is licensed for ‘superficial
malignant and precancerous skin lesions’.
82
National Institute for Health and Clinical Excellence