Here there are many different types. The type and size will determine the exact treatment. The most common ones are basal cell carcinoma, squamous cell carcinoma, melanoma, and sarcoma.
Basal cell carcinoma is typically slow-growing and spreads rarely. Typically, surgery is the treatment of choice. Radiation is given for advanced disease or those at high risk of recurrence. Surgery is occasionally done in the office (we coordinate surgery with a Mohs dermatologist who removes them) and less commonly in the operating room. Then we close the defects made after tumor removal with flaps (moving tissue around) or skin grafts brought from other parts of the body.
Squamous cell carcinoma of the skin is treated in a similar fashion but does have more propensity to spread. Often, in larger cancers, we will perform scans to determine if they have spread and often it is necessary to remove some lymph nodes from the neck or parotid region (neck dissection and parotidectomy respectively) due to the risk of spread to these areas. Radiation therapy is given more often in these cancers than in basal cell carcinomas.
Chemotherapy has very little role in the treatment of basal or squamous cell carcinomas.
Melanomas are very unpredictable cancers that can and often do spread in unusual patterns. Thus, we perform imaging early in these tumors such as PET scans or CT/MRI. As long as there is no evidence of spread, we often treat these tumors with initial surgery and patients may get immunotherapy and/or radiation afterward in advanced cancers. Sentinel lymph node biopsies are often done do determine which lymph node areas if any, need to be removed. Here, the patient gets an injection of a special dye right before surgery in radiology that helps guide us in surgery.
Sarcomas are aggressive cancers that (except one type called dermatofibrosarcoma) are locally destructive as well as having the propensity to spread. They are generally treated with surgery primarily. Radiation is given after surgery in high-risk areas and chemotherapy may be an adjunct.