Improving outcomes for people with skin tumours including melanoma

Diclofenac 3% gel (Solaraze) is licensed for the treatment of AK.
This is a widely used treatment for AK, with a favourable
tolerability profile for primary care use.
• Photodynamic therapy (PDT). PDT involves the use of light
therapy in combination with a topical photosensitising agent to
destroy cancer cells. Its use has been well described in the
treatment of AK, in situ SCC and superficial BCC. The
advantages of PDT include a low rate of adverse effects and
good cosmesis. The disadvantages are that the patient has to be
available for a period of at least 3–4 hours for treatment, and
that the photosensitiser and equipment are relatively expensive.
A role for systemic PDT is being explored. At present there is
little information available on long-term cure rates.
Improving Outcomes for
People with Skin Tumours
including Melanoma
Initial investigation,
diagnosis, staging and
management
• Mohs micrographic surgery. Mohs micrographic surgery is a
precise technique in which excision of the skin lesion (usually a
BCC) is carried out in stages and each stage checked
histologically. It is advocated for use in cases where it is critical
to obtain a clear margin while preserving the maximum amount
of normal surrounding tissue, in particular for recurrent and
high-risk aggressive growth pattern BCCs such as morphoeictype
BCCs. The main problems with this technique include the
length of the procedure, the need for special equipment and
training, and the relatively high cost. The availability of the
procedure in the UK is, at present, limited.
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• Radiotherapy. Radiotherapy is a useful treatment for a subset
of patients with NMSC who cannot or prefer not to be treated by
surgery. The cure rates are over 90% for most skin lesions, but
the long-term cosmesis, particularly for young patients, is inferior
to that following other treatments. The same area cannot be
treated twice and so, if there is a recurrence, surgery is needed,
which may be more difficult than if the lesion had been
removed surgically to start with. Radiotherapy can also be used
in cases when the margins of excision appear to be incomplete
on histopathological examination. It should not be used to treat
patients with Gorlin’s syndrome because of the carcinogenic
potential of low-dose irradiation at the margins of the treated
areas.
Traditionally radiotherapy for skin cancer has been given with
superficial (orthovoltage) X-ray machines. High-energy electron
(linear accelerator) treatments are increasingly being used, but
orthovoltage treatment may be easier to use for small tumours
and for frail patients. It is therefore important that radiotherapy
departments continue to provide access to such machines.
Guidance on cancer services: skin tumours including melanoma 83