Non surgical treatment of skin cancer can have unfortunate
consequences. This man has had cryotherapy for superficial basal cell
carcinomas and SCC in situ on his back on multiple occasions. If cryotherapy is
not carried out properly with adequate edge margins then you get recurrences
like this. Elderly patients living alone find it impossible to apply creams to
the back such as Imiquimod or Efudix.
Photodynamic therapy with amino laevulinic acid can be effective for
small lesions on the back but would not clear recurrences like this. Any
excisional surgery here would be very extensive but could be done over a series
of treatment sessions. Radiotherapy could be carried out to the whole area but
would require 25 to 30 fractionated
treatments. Another technique that could be tried on the back is curette and
cautery but any deeper areas of recurrence might be missed and the wounds would
require clinic visits for dressings until crusted over. These lesions were
biopsied and were scc in situ. I will discuss radiotherapy and staged surgical
excision with him.
