Skin checks save lives.
Non Surgical Treatment of Sun Damage and Early Skin Cancers
Topical Treatments in General
Precancerous sun damage can be treated topically to decrease the chances of developing skin cancer and also decrease the appearances of photoaging.
Early skin cancers can also be treated this way, however, if they return after being treated in this manner it is important to investigate further to ensure that there isn't a deeper component to the cancer which can continue to grow while the surface heals normally.
After you have been treated you should return for review of the skin in that in 3-12 months.
Cryotherapy
Liquid nitrogen may be used to freeze pre cancerous and early skin cancers such as sun spots, bowen's disease and superficial BCCs.
It may also be used to slow the progression of early skin cancers until another topical modality is practical such as PDT or effudex.
It is important if a spot comes back repeatedly after being frozen that it is investigated with a biopsy.
Efudix
Fluorouracil
Efudix is a medication used to treat sun spots and Bowen's disease (intraepithelial carcinoma).
It may be used as the primary treatment and can also be used when an excision is incomplete. In the case of an invasive SCC it may be used as a field treatment to decrease the chances of further cancers in the future. It isn't used alone in the treatment of an invasive SCC.
Efudix is also used to treat other cancers via injection and can be used in the management of hypertrophic scarring.
Tretinon
Tretinoin is a retinoid cream which is most commonly used for the management of Acne. It can also be used to manage sun damage of the skin and sun spots. It is also used in smaller doses in some antiaging creams. It generally is unsuccessful in managing Bowen's disease. It may be used as a pre treatment for other medications.
When there is sun damage to the skin there can often be an oversupply of undifferentiated cells which fail to differentiate into the different skin cells. the Tretanoin acts by stimulating the immune system to clears up these excessive cells.
Salycilic acid
Topical salycilic acid can be used to treat solar keratosis. its particularly effective in the treatment of the hyperkeratotic or rough lesions. when applied it loosens the links to the the underlying skin layers. It will not be effective in treating skin cancers. This medication may also be used prior to PDT, aldara or effudix to improve the effectiveness of these medications.
It may also be used in the treatment of some benign skin conditions.
Photo-dynamic Therapy
(ALA)
Photodynamic therapy is most commonly undertaken with a chemical know as 5-Aminolevulic acid (ALA). This chemical is absorbed by skin cells when applied to the skin. It then goes through a series of chemical reactions. In normal cells it is metabolized into a harmless chemical, in sun damaged cells and skin cancers it gets stuck at a specific step. This results in the accumulation of porphyrins in the cell. When exposed to light of specific frequencies these porphyrins will cause the cell to combust.
There are 2 options for photodynamic therapy (PDT), the first option is daylight PTD where the ALA is applied and you go out in the sunlight for 2 hours. The other option is red light therapy where an intense light generated at a specific frequencie activate the chemicals. This focused light therapy is shorter, but there is an incubation period of a variable length.
Daylight PDT is generally less painful, it may not be as effective at treating skin cancers.
Intense light therapy is more predictable in its effects but can be more painful. This is a good way to treat superficial skin cancers and also manage early sun damage decreasing the risk of developing skin cancers in the future.
It is important that you are reviewed after PDT to ensure that this therapy has been effective.
Aldara
Imiquimod
Aldara is a medication which stimulates the immune system and is used topically to manage BCCs, solar keratosis and viral warts.
It is applied topically to the area of concern.
Laser
Laser is quite effective at breaking down pigmentation associated with sun damaged skin and can also stimulate the body to clear up sun damaged cells. It should be operated by a doctor or by a professional who has had training in the appropriate use of laser.