Skin Cancer Diagnosis & Treatment

Any persistent changes to the skin should be brought to a doctor's attention. They will then conduct a physical exam of the suspected area of tissue. To get a definitive diagnosis, this suspicious tissue must be examined under a microscope. The process of retrieving this tissue is known as a biopsy.

There are different types of biopsies to diagnose skin cancer. Doctors recommend the specific procedure based on the size, shape, and location of the growth. Patients typically are given a local anesthetic before the procedure and may receive stitches afterward to close the wound.

Types of skin cancer biopsies

Local excision/excisional biopsy: All or part of the suspicious area is removed with a scalpel under local anesthetic. Depending on the size and location of the area, this type of biopsy may be done in a doctor's office or as an outpatient procedure at a hospital. If the growth is small enough to be removed entirely during the biopsy, local excision can be both a diagnostic procedure and a treatment.

Punch biopsy: The doctor uses a special tool to punch through the suspicious area and remove a round cylinder of tissue. If needed, patients may receive stitches to close the wound.

Shave biopsy: The doctor shaves off a piece of the growth. This can be performed with a scalpel, surgical scissors or other special tools. Typically, no stitches are needed.

Biopsy results

After the biopsy procedure, the skin sample is sent to a pathologist, a doctor who specializes in diagnosing disease. After examining the tissue under a microscope, the pathologist will make a diagnosis.

Abnormal results include benign (non-cancerous) growths such as moles, warts, and benign skin tumors. If the sample reveals cancer, the pathologist will determine if it is a basal cell carcinoma, squamous cell carcinoma, or melanoma.

Determining if your cancer has spread

Basal cell cancer usually remains in one location and does not spread. However, especially for melanoma or squamous cell cancer that encompasses large areas of skin, additional tests may be needed to see if cancer has spread (metastasized). Skin cancer may invade other layers of skin or travel to surrounding nerves or lymph nodes. Patients may undergo some medical imagining or have their lymph nodes biopsied if the doctor suspects that cancer has spread.

Getting a skin cancer second opinion at MD Anderson

The pathologists at MD Anderson are highly specialized in diagnosing common and rare skin cancers. We welcome the opportunity to provide second opinions for skin cancer.

Skin cancer treatment

Your skin cancer treatment at MD Anderson includes a plan customized to your specific type of cancer. Basal and squamous cell skin cancers usually are removed by one of the treatments listed below.

Skin cancer excision

During this procedure, a doctor numbs the diseased area with a local anesthetic and then cuts it out entirely. Typically, a small amount of healthy tissue around the area is removed as well. If the patient has not been previously diagnosed, the tissue is sent to a pathologist, who examines the sample to confirm the diagnosis.

Mohs surgery for skin cancer

During this procedure, a dermatologic surgeon removes a very thin layer of cancer tissue and examines it under a microscope. If skin cancer cells can be seen in the layer, the doctor continues shaving off layers one at a time until no cancer cells are found. This procedure has a very high cure rate and typically results in less scarring than excisions.

Mohs surgery is usually performed at a doctor’s office. The patient’s skin is numbed and occasionally a mild sedative is given. MD Anderson has a Mohs and Dermasurgery Center dedicated to this procedure.

Cryosurgery for skin cancer

Cryosurgery is less invasive than conventional surgery. It is often used to treat actinic keratosis (a precancerous skin condition) and occasionally used for small, newly developed skin cancers.

During this procedure, the doctor uses liquid nitrogen to freeze and destroy diseased tissue. This process may be repeated. Because the doctor can focus cryosurgical treatment on a limited area, the destruction of nearby healthy tissue is typically avoided.

Topical chemotherapy for skin cancer

Chemotherapy drugs work by killing fast-growing cells, such as cancer cells. Skin cancer chemotherapy is delivered as a topical ointment that is applied to the affected skin. At the end of treatment, patients may have redness and some crusting on their skin, which typically heals in two to three weeks. Like cryosurgery, topical chemotherapy it is used to treat actinic keratosis and superficial skin cancers. Cryosurgery is usually limited to small areas, while topical chemotherapy can cover large sections of skin, such as a patient’s entire face.

Laser surgery for skin cancer

Lasers surgery is used to treat precancerous conditions like actinic keratosis and early, superficial skin cancers. During laser surgery, doctors use an intense, focused beam of light to destroy skin cancer.

The laser can be set to remove the skin in controlled layers, depending on the depth of the cancer. The surgeon may remove the top layer only or the top layer plus additional deeper layers.

The laser destruction, plus the body's immune response to the injury, results in a blistered wound that takes several weeks to heal.

Electrodessication and curettage

During this procedure, doctors use a scraping instrument (curette) and electrical currents to destroy and remove small and superficial skin cancers.

High-risk or metastatic skin cancer treatment

When a patient’s skin cancer has spread or is at high risk of spreading, treatment can become more complex. At MD Anderson, these treatment plans are developed by a team of doctors from multiple disciplines, including dermatology, radiation oncology and the different surgical specialties. High-risk skin cancer on the head or neck, for instance, may be treated by a head and neck surgeon. These doctors meet to discuss the patient’s case and work together to develop a treatment plan. Treatments may include surgery, radiation therapy, chemotherapy and more.

Skin cancer clinical trials

Because of its status as one of the world’s premier cancer centers, MD Anderson participates in many clinical trials for skin cancer. Sometimes they are a patient’s best option for skin cancer treatment. Learn more about clinical trials.