Skin Cancer Treatments

City of Hope’s approach to treating skin cancer starts with a coordinated, multidisciplinary care team whose main goal is offering you the best, most individualized treatment plan. Your plan includes the newest therapies — including immunotherapies — and innovative treatment combinations effective for even the most advanced melanoma patients.

We treat patients at all stages of disease, from initial diagnosis to advanced stages, including those with:

  • Recurrent disease
  • Metastatic disease
  • Disease that has spread to lymph nodes

The goal for everyone we treat revolves around options, starting with the important opportunity to participate in clinical trials at every stage of your cancer. This provides you with leading-edge treatments and access to studies that will define the next generation of best treatments. Our treatment approach involves:

  • Consultation with a specially trained comprehensive dermatology group
  • A layered, thorough and accurate diagnostic process led by deeply experienced pathology staff
  • Regular input from experts in various subspecialties at every stage of your treatment
  • Near-constant refinement of therapies designed to adapt to changes in your disease
  • Best-practice prevention and management of all treatment-related side effects

Surgery

Surgery is the most common treatment for both melanoma and nonmelanoma skin cancer. The goal of surgery is to completely remove the cancer while trying to preserve healthy tissue.

Nonmelanoma Skin Cancer Surgery

  • Curettage and electrodessication involves numbing the cancerous area and using a spoon-shaped instrument (curette) to remove the cancer.
  • Simple excision is a procedure in which cancer, along with surrounding normal tissue (called a margin), are removed using a scalpel.
  • Shave excision involves removing tumors affecting only the top skin layers. A small blade is used to remove the tumor at its base.
  • Cryosurgery uses cold to destroy cancer cells and involves spraying liquid nitrogen onto the tumor. This process freezes and destroys the cells, which eventually fall off.
  • Laser therapy uses a narrow beam of intense light to remove cancer cells.
  • Dermabrasion removes layers of skin using particles or a device that rubs away skin cells.

Melanoma Surgery

  • Sentinel node biopsy is a procedure in which lymph nodes are checked for cancer cells. In a group of lymph nodes, one tends to be the primary channel into which cancer will drain. If that lymph node, called the sentinel, tests negative for cancer, the rest are left intact. However, if tests on the sentinel node reveal cancer cells, that and other lymph nodes are removed.
  • Lymph node dissection is surgery to remove lymph nodes when melanoma is found in the sentinel and other lymph nodes. 
  • Wide local excision involves removing melanoma, along with normal tissue surrounding it. If a large swath of skin is removed during the procedure, a skin graft may be required to replace it.

Advanced Technologies

City of Hope’s skin cancer surgery team routinely performs complex operations for advanced skin cancers — and uses advanced minimally invasive technologies, such as robotic sentinel lymph node biopsy, to accurately identify whether and how far cancer has spread.

And frequent collaborations between our melanoma and plastic surgery teams ensure that procedures are performed that minimize deformity and complications; restore appearance; and preserve quality of life.

For melanomas that have spread, our experienced surgical team performs minimally invasive procedures such as pulmonary metastatectomy, a robotic surgery procedure designed to remove tumors that have spread to the lungs.

Isolated Limb Infusion

City of Hope is the only center on the West Coast performing isolated limb infusion (ILI) for extremity melanomas — a focused method of delivering chemotherapy (isolated to the affected limb) that greatly reduces side effects common with whole-body chemotherapy. ILI is effective for melanoma patients with multiple tumors and/or recurrences in a specific limb.

Skin Excision Clinic

The Skin Cancer Excision Clinic is located in the Women’s Center, in the lower level of the Geri & Richard Brawerman Ambulatory Care Center at the Duarte campus of City of Hope.

Wai-Yee Li, M.D., Ph.D., performs many types of reconstructive procedures including:

  • Skin cancer excisions
  • Burn and scar revisions
  • Skin grafting, full and split thickness
  • Local tissue rearrangement
  • Transfer of muscle and skin for breast, chest, abdominal wall, head and neck reconstruction

What to Expect

Arranging your visit
  • Once your dermatologist determines you need a surgical procedure, he or she should refer you to Dr. Li for a consultation. You may also call 626-218-5015 to schedule a visit or 626-471-7100, ext. 88541.
Before your procedure
  • Dr. Li will perform a complete history and physical exam to let you know whether or not you are a suitable candidate for same day excision. If you are, she will explain the procedure to you and you will be moved to another room for the procedure.
During your procedure
  • The area for excision is marked out and numbed using local anesthetic, similar to a dental procedure.
  • The skin is prepped using antiseptic solution and sterile towels are used to isolate the surgical site.
  • Once the area is ready, Dr. Li will remove your skin cancer together with a "margin" of tissue. This margin is essential to reduce the risk of the cancer coming back.
  • After the cancer is removed, it is sent to the lab for further testing by a pathologist.
  • Dr. Li will close your wound using dissolvable suture material.
  • A special dressing is placed over your sutures, which allows you to shower the same day.
After your procedure
  • A nurse will provide home-care instructions. You will be given a follow-up visit with Dr. Li or a member of her plastic surgery team within seven to 10 days for a wound check. The dressing may stay on during this time. A printed copy of your pathology testing report will be provided during this follow-up visit.

Clinical Trials

City of Hope clinical trials include access to the latest drug therapies and combinations to treat melanoma. Many are based on the genetic changes driving tumors so that therapies may be tailored to specific mutations — others use unique combinations of immunotherapy agents.

Promising new treatments as part of our clinical trials program include new and investigational therapies such as TVEC, an oncolytic virus that directly targets melanoma tumors.

City of Hope patients also benefit from our collaboration with various groups, providing access to the newest therapies and clinical trials, including the Cancer Immunotherapy Trials Network.

Radiation Therapy

Radiation therapy uses high-energy radiation to kill cancer cells and shrink tumors. Radiation therapy is involved in melanoma treatment when:

  • Surgery is not a good option.
  • Melanoma is not completely removed by surgery.
  • Lymph nodes have been removed but cancer is at high risk of returning.
  • Melanoma returns and begins growing again on skin or in lymph nodes.
  • Pain or other symptoms can be reduced by radiation therapy.
  • Melanoma has spread to the brain or spinal cord.

City of Hope offers advanced and highly targeted radiation treatments for melanoma. In addition to using techniques that direct radiation to tumor tissue while sparing normal tissue, our experienced radiology team works closely with surgeons, oncologists and others members of our multidisciplinary team to perform advanced procedures such as isolated limb infusion and robotic sentinel lymph node biopsy.