This depends largely on the type of tumor, its location, size, depth, and the condition of the patient, etc.
A biopsy (sample analysis) is compulsory. Treatment subsequent to a biopsy is sometimes not necessary, since all the lesion is extirpated when the sample is taken. Most treatment can be carried out under local anesthetic at a local clinic or surgery.
The techniques employed may be of two types: destruction or extirpation of thetumor
- Destructive techniques have the advantage of being more straightforward and some require no local anesthetic. The main drawback is that we cannot "obtain" a tumor for subsequent analysis (because it has been destroyed), and therefore we are unable to calculate the surgical safety margins exactly. Thus we do not know for sure if the cancer has been definitively removed. These techniques are therefore employed in superficial cases, where a recurrent tumor (a tumor that develops again) presents no problems, or in patients with conditions that make surgical extirpation difficult. Such techniques always require regular check-ups. The most commonly employed destructive methods are: cryosurgery (freezing), laser treatment, curretage, radiation therapy, topical imiquimod (immunotherapy) and photodynamic therapy.
- Surgical extirpation of a tumor is the technique recommended wherever possible, since it is curative and enables us to analyze the margins of resection to determine if all the tumor has been removed. In tumors with a tendency to spread (melanoma), the extent of the safety margins is determined according to the depth of the tumor, and sometimes also neighboring glands must be analyzed to check for any possible spread. In solid tumors with local invasion (basal cell carcinoma), the surgical safety margins may be the minimum required; the smaller the margin the smaller the defect, and the smaller the defect the better the aesthetic and functional result. Mohs micrographic surgery is a special technique involving a phased extirpation of the tumor, with microscopic analysis of surrounding tissue performed during the operation itself. Thus the entire tumor is extirpated while conserving healthy skin tissue in the region as far as possible. Results obtained as regards cure are better than in other tumor treatment techniques. The complexity of this treatment means that it is employed only in specific cases.
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