Editing Non-melanoma skin cancer (section)

=== '''Treatment''' ===

*** '''Local options:'''
**** Excision with 5-10mm margins (depending on ease of reaching these margins, and risk profile of lesion)
***** Often surrounding inflammation and hard to determine the exact extent of tumour. Can perform punch biopsies prior to excision. May just need to treat the edge of inflammation as the edge of the lesion.
***** MMS can be a good option for sensitive areas
**** Field therapies
***** Cryotherapy (small superficial lesions - effective >90%)
***** Curettage - superficial lesions <2cm
***** Topical therapies
****** See separate section under 'oncology'
****** Biopsy is indicated when the actinic keratosis is raised or recurrent after topical therapy
***** Electrodessication and curettage
***** Carbon dioxide laser
***** Dermabrasion
***** Chemical peel
*** '''Management of nodal disease:'''

**** Aggressive surgical resection of involved nodal disease
**** One positive lymph node <3cm with no extracapsular extension can also have adjuvant RTX
**** SLNB indications are not well-defined, but can be considered for high-risk lesions

** Adjuvant radiotherapy indications:

*** High-risk tumours with clear margins
*** Salvage therapy for incomplete resection
*** Perineural invasion
*** Recurrence following clear margins

** Adjuvant systemic therapy

*** Usually platinum-based with variable response rates
*** There is a new PD-1 inhibitor (cemiplimab), however advanced SCC remains a difficult disease to treat

** Follow-up: full skin examination and regional node examination

*** Local disease: every 3-6 months for 2 years, then 6-12 months for 3 years, then annually for life
*** Regional: 1-3 months for 1 year, then 2-4 months for 1 year, the 4-6 months for 3 years, then 6-12 months for life