I. Drug treatment
1.Topical treatment
It is mainly local topical application, local dressing and local injection. In the early years, 0.5% colchicine ointment was used for local topical application of tumor, and the effect was better. In recent years, 5-Fu ointment and bleomycin ointment are used, which also have good effect.
(1) Bleomycin: Generally, 0.1% or 2% ointment is used, which is applied 1~2 times a day, generally without side effects. The ointment can be kept at room temperature for 6 months without decreasing its potency. Sun Xinxin, Department of Oncology Radiotherapy, The Third People’s Hospital of Hubei Province
(2) Fluorouracil: Generally, 0.5% ointment is used clinically and applied 1~2 times a day, which is very effective for superficial basal cell carcinoma and squamous cell carcinoma in situ.
2.Systemic treatment
(1) Indications: For squamous cell carcinoma occurring on the basis of original scar, squamous carcinoma at the junction of skin and mucous membrane, patients with low immune function and those with regional lymph nodes and distant metastasis need to use systemic chemotherapy.
(2) BLM is more effective for squamous carcinoma of outward proliferation type, and the administration method is 10mg intramuscularly or intravenously, twice a week, 300-400mg for a course of treatment.
(3) PEP (pileomycin): It is not only sensitive to the primary foci but also has an efficiency of about 30% in lymph node metastasis cases. Usage: 5mg once, 6 times a week by intramuscular injection, stop for 1 day, repeat 5-7 times.
(4) DDP and ADM combination: chemotherapy method is DDP 75mg/m2 intravenous drip with hydration, that is, a large number of infusion and give diuretics, ADM 50mg + injection water 40ml in 5 minutes. The interval was 3 weeks and all patients received adequate chemotherapy with a remission rate of 87% during chemotherapy.
II. Cryotherapy
Skin cancers suitable for curettage are also suitable for cryotherapy, especially for those cases rich in fibrous components that are not suitable for curettage, and for those cases that recur after curettage and radiation therapy. However, the lesion must be limited to the skin, and those invading other tissues and organs are not suitable for cryotherapy. Biopsy must be performed before treatment, as there is no specimen available for pathological examination after cryotherapy.
D20°C is the optimal temperature to ensure tumor cell death. Then thawing is started. Slow thawing is more effective in killing tumor cells than decisive thawing, and rapid thawing is used only to prevent damage to more normal tissues.
The advantage of cryotherapy is that it has a more aesthetic wound than curettage, and its cure rate can reach 95-97%. For lesions in the eye area, this method can still be applied as long as the eye is covered with a hot protector. However, the recurrence rate of this method is high after treating scalp cancer, so it is mostly considered inappropriate.
III. Radiotherapy
Both basal cell carcinoma and squamous carcinoma are sensitive to radiotherapy, i.e., the efficacy is very good. Before determining radiotherapy, the patient’s age, gender, tumor history, anatomical site, cure and recurrence, and the final cosmetic effect achieved must be considered.
1.Advantages of radiotherapy.
①It can protect the tumor uninvolved tissues.
②The damage produced is less.
③No scar and no change of human appearance.
④No formation of hypertrophic scar, keloid tumor, skin contracture.
⑤No pain during treatment.
⑥Light psychological trauma to the patient.
⑦No need for hospitalization.
2.Disadvantages of radiation therapy.
①Hairs fall off after contact and are not easily regenerated.
② Loss of sweat gland function in the treatment area.
③ Skin atrophy, capillary dilation, pigment loss or deposition, dryness or keratinization.
④Histopathological examination cannot be made and the exact boundary of the tumor cannot be controlled.
IV. Laser treatment
There are various lasers commonly used in dermatology, such as carbon dioxide laser, helium-neon laser, etc., and their uses are different. In the treatment of skin cancer, carbon dioxide laser is mainly used, and carbon dioxide laser can replace electric drying method. Carbon dioxide laser is an infrared beam with a wavelength of 10600nm. When the beam is dispersed, it can be used to vaporize skin tumors, such as basal cell carcinoma and superficial squamous carcinoma, and make the skin tumors disappear, and it can be used in combination with scraping.
V. Surgical treatment
At present, surgery is still one of the main methods to treat skin cancer. For basal cell carcinoma with small lesions, superficial and clear border, 0.5 cm from the edge of the tumor can be excised to achieve the purpose of healing. For cases with large lesions and extensive infiltration, resection should be performed 3-5 cm away from the primary lesion, and frozen section should be performed in hospitals with conditions.
The local recurrence rate of basal cell carcinoma with negative margins is 1%-5%. The extent of resection of tumor base depends on the depth of infiltration of the lesion, such as superficial basal cell carcinoma in scalp, which can be widely excised and then implanted; if it involves periosteum, the periosteum should be excised together and then repaired with tipped flap and implantation. The scope of resection for squamous cell carcinoma is basically the same as that of basal cell carcinoma, but those with regional lymph node metastasis should undergo lymph node dissection.
Immunotherapy
Immunotherapy applied to interferon for skin cancer treatment has shown that it may be an effective therapy in the future. γ2-interferon injected locally into the tumor of basal cell carcinoma can be remitted in the short term.