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1701 Divisadero St.,
3rd Floor
San Francisco, CA
Skin Cancer
Skin Cancer Guide
Transplant Patient Guide
Caring for Transplant Patients
Organ Transplant Immunosuppressed High Risk Skin Cancer Clinic
Tumor Board
Mohs Surgery
Contact and Referrals
Research and Clinical Trials
Dermatology Faculty


Surgical Treatment of Skin Cancer
  • Cryosurgery
    • Very cold! (-321°F or -196°C)
    • Treatment of choice for individual pre-cancers
    • Applied with a spray gun or cotton tipped applicator
    • A burning or "frostbite" sensation is felt
    • Treated areas turn red, swollen, and sometimes blister during healing
  • Curettage with electrodessication
    • Precancerous lesions are scraped away with a curette
    • Then the area is cauterized with an electric needle to control bleeding and kill any remaining cancerous cells
  • Photodynamic therapy
    • A light-sensitizing solution is applied to the skin and allowed to absorb over several hours
    • Chemical is selectively absorbed by the abnormal cells
    • An activating light is shined on the patient, causing destruction of the abnormal cells
    • Burning sensation is experienced
    • Lesions turn red and crusty
    • Patients must avoid any sun exposure after treatment, as their skin is still light sensitive
  • Mohs micrographic surgery
    • Technique of surgery that has the highest five-year cure rates for surgical treatment of both primary (96 %) and recurrent (90 %) skin cancers
    • Removes all of the cancerous tissue and as little of the healthy tissue as possible to minimize scaring and maximize cosmetic outcome
    • The cancer is shaved off one thin layer at a time. Each layer is checked under a microscope until the entire tumor is removed
    • This method should be used only by physicians who are specially trained in this type of surgery
    • More detail on Mohs micrographic surgery

Recommended Surgical Treatment of High Risk Lesions Based Upon Tumor Type:

Tumor Characteristics Management
Invasive SCC MMS or excision
Aggressive histology MMS or excision
Perineural SCC MMS or excision followed by Radiotherapy
High risk anatomical site MMS or excision
Large tumor
MMS or excision
Recurrent Cancer MMS or excision
In-transit metastases Excision, Radiotherapy, Oral retinoids, Reduction of immunosuppressions

Table 5: Management of High Risk Squamous Cell Carcinoma in Transplant Recipients (4, 5)

SCC = squamous cell carcinoma
MMS = Mohs Micrographic surgery

1. J. A. Carucci et al., Dermatologic Surgery 30, 651 (2004).
2. I. Penn, J Pediatr Surg 29, 221 (Feb, 1994).
3. J.-C. Martinez et al., Arch Dermatol 139, 301 (March 1, 2003, 2003).
4. P. Jensen et al., J Am Acad Dermatol 40, 177 (Feb, 1999).
5. P. O'Donovan et al., Science 309, 1871 (Sep 16, 2005).
6. J. D. Wagner et al., Arch Dermatol 140, 75 (Jan, 2004).
7. T. Stasko et al., Dermatol Surg 30, 642 (Apr, 2004).
8. M. T. Ballo, K. K. Ang, Oncology (Williston Park) 18, 99 (Jan, 2004).
9. J. C. Martinez, C. C. Otley, S. H. Okuno, R. L. Foote, J. L. Kasperbauer, Dermatol Surg 30, 679 (Apr, 2004).
10. C. C. Otley, S. L. Maragh, Dermatol Surg 31, 163 (Feb, 2005).
11. S. Euvrard, C. Ulrich, N. Lefrancois, Dermatol Surg 30, 628 (Apr, 2004).
12. C. Traywick, F. M. Reilly, Dermatologic Therapy 18, 12 (2005).
13. I. M. Neuhaus, W. D. Tope, Dermatol Ther 18, 28 (Jan-Feb, 2005).
14. G. Stallone et al., N Engl J Med 352, 1317 (Mar 31, 2005).

Updated: May 4, 2007
This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.
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