Skin Cancer Treatment: Surgery, Mohs, Immunotherapy & More

The most common treatment for all skin cancers. The surgeon removes the tumor along with a margin of normal-appearing skin. Margins range from 1-2cm depending on tumor type and thickness. The removed tissue is examined under a microscope to confirm all cancer cells have been removed (clear margins). Cure rates for early-stage skin cancers exceed 95%.

Mohs surgery removes skin cancer one thin layer at a time, examining each layer under a microscope immediately. This process continues until no cancer cells remain. It achieves the highest cure rates (99% for primary BCC) while removing the least amount of healthy tissue.

Mohs is recommended for skin cancers on the face, ears, nose, eyelids, and other areas where tissue preservation matters. It is also used for recurrent cancers and aggressive subtypes.

Checkpoint inhibitors have revolutionized melanoma treatment. Pembrolizumab (Keytruda) and nivolumab (Opdivo) block PD-1, allowing the immune system to attack melanoma cells. Ipilimumab (Yervoy) blocks CTLA-4. These drugs have improved 5-year survival for stage IV melanoma from under 10% to 40-50%.

Immunotherapy is now also used for high-risk stage II and III melanoma as adjuvant (post-surgery) treatment to reduce recurrence.

About 40-50% of melanomas have BRAF mutations. BRAF inhibitors (vemurafenib, dabrafenib) combined with MEK inhibitors (trametinib, cobimetinib) target these specific mutations. Response rates are high (about 70%) but resistance often develops within 6-12 months. Targeted therapy is typically used when rapid tumor shrinkage is needed.

Radiation is used when surgery is not feasible (frail patients, difficult locations), as adjuvant treatment after surgery for high-risk tumors, and for brain metastases from melanoma. It is not first-line for most skin cancers but plays an important role in comprehensive treatment plans.

For very early or superficial skin cancers: imiquimod cream stimulates local immune response (used for superficial BCC and actinic keratoses). 5-fluorouracil (5-FU) cream destroys precancerous and superficial cancerous cells. Photodynamic therapy (PDT) uses a photosensitizing agent activated by light. These are not appropriate for invasive skin cancers.

Follow-up is critical. After skin cancer treatment, you will need regular skin checks - typically every 3-6 months for the first 2 years, then annually. Having one skin cancer increases your risk of developing another. Monthly self-examination becomes a lifelong practice.