New skin-cancer therapy may be on way

Traditional treatments for skin cancer involve cutting it out or destroying the tissue. But new, promising methods are being tested that preserve skin, with the possibility of expanding treatment options.

That's according to Dr. C. David Hansen, acting chairman of dermatology at LDS Hospital and an associate professor in the University of Utah School of Medicine. He and Dr. Karen Stolman, a dermatologist at Alta View Hospital and the Sandy IHC Health Clinic, will be featured today on the Deseret Morning News/Intermountain Health Care Hotline from 10 a.m. to noon.

Among important questions when treating skin cancer are what type of cancer it is and how extensive it is. Biopsies determine the answer to the latter.

Treatment is normally an outpatient process, with the exception of caring for patients who have advanced malignant melanoma. Doctors do 80 percent of excisional surgeries in their office, Hansen said.

Taking care of early-stage basal or squamous cell cancers is relatively simple. The doctor just removes it. If it's in an area that's "cosmetically important," the physician may choose to use what's called "Moh's Micrographic" surgery, which leaves little or no scar. That may also be used with a cancer that has recurred or has ill-defined borders.

If melanoma is less than one millimeter and is not ulcerated, it can be cut out with little fear that it has spread, something that happens in less than 2 percent of those cases. If it's deeper or has moved to the lymph nodes, everything changes. Then, "We need more information," Hansen said. The cancer is still removed and the margins examined, testing done to see if it's in the lymph nodes.

"Melanoma can go into the bloodstream and we see distant metastasis in places like the lungs and brain. Once it spreads, it's just a horrible cancer," he said. Such cases are referred to a surgical oncologist who is also likely to involve a medical oncologist for what Hansen calls "a battle of survival."

Researchers are always looking for new, better ways to handle skin cancer.

One of interest to Hansen is Imiquimod, which he calls the "first of what I think is an exciting new generation of treatment." First approved for warts, it regulates or increases the body's immune system response to viral-infected cells or tumor cells. One of the problems with skin cancer is the body doesn't "see" it. The medicine somehow "makes the body's immune system" go after and kill the tumor. With it, during a clinical trial, about 85 percent of superficial basal cells cleared up over about six weeks. It also seems to work in melanoma.