Other Treatments for Rodent Ulcers
There are a number of other methods to treat Rodent Ulcers, each with advantages and disadvantages.
Cryotherapy
Cryotherapy is the freezing of an area of skin with liquid nitrogen. It does not distinguish between normal cells and skin cancer cells. It is not recommended for rodent ulcers of the head and neck, as it has poor cosmetic results with white scarring, up to 40% recurrence rates, and subsequent difficulty for a surgeon treating the recurrence to be able to distinguish the tumour from scarring. Current advice is that GPs and dermatologists should not freeze head and neck rodent ulcers.
Curettage and Cautery
This can be an effective treatment in skilled hands for low risk tumours in non-head and neck sites. It involves scraping and then cauterising (burning) the base of a tumour. It has a much higher rate of recurrence than excisional surgery if used for head and neck skin cancers.It is occasionally the right treatment in the very elderly, where recurrence in several years time is unlikely to be problem. The pictures below show the result from curettage and cautery in a lady who presented with a disfiguring skin tumour on the end of her nose at the age of 103.
Photodynamic therapy
PDT involves the application of a cream, which is preferentially taken up by tumour cells, and the application of a light of specific wave length. The light energy is absorbed by the chemical in the cream, causing the tumour cells to pop, leaving normal skin cells intact. It is indicated in thin, superficial rodent ulcers, as the cream cannot get into the deeper layers of thicker tumours.
Imiquimod cream
Imiquimod cream is a special cream that boosts the immune system in the skin around a superficial rodent ulcer, and results in only the rodent ulcer cells and sometimes other skin damaged cells being recognised and destroyed by the immune system. It does not work for most common rodent ulcers, as they are too thick to absorb the cream in their deeper layers.It cures about 8 out of 10 superficial (thin) rodent ulcers. It can result in less scarring than excisional surgery, particularly in large superficial BCCs.The treatment lasts for 6 weeks, and causes significant inflammation and sometimes crusting of the area, and occasional flu-like symptoms.
Radiotherapy
Radiotherapy (X-ray treatment) is an effective treatment for rodent ulcers, but has a higher rate of recurrence and a worse cosmetic outcome than surgery. It is used sometimes where a patient is unfit to undergo surgery, or to help reduce the risk of recurrence where some rodent ulcer has possibly been left behind, and further surgery thought not advisable.
Mohs micrographic surgery
Mohs Surgery is indicated in specific circumstances for rodent ulcers, such as recurrent tumours in anatomical sites where there is little spare skin, and in infiltrative tumours where the extent of the cancer can be difficult to determine.
Miss Newlands refers selected patients to specialist dermatology colleagues who offer this very specific technique. The majority of patients with BCCs can be managed by simple excisional surgery.
Mohs surgery needs to be carried out under local anaesthetic, and is available in only a few centres in the UK. Reconstruction is still necessary after confirmation of histological (under the microscope) clearance, and patients often return to have this done by a reconstructive surgeon.
More information on Mohs surgery
Vismodegib
This is a new drug which can help shrink large rodent ulcers which are too advanced to be treated by any other means. It specifically inhibits part of the pathway by which rodent ulcer cells replicate. It may have a role in making inoperable tumours small enough that surgery becomes an option; this is presently under investigation in a clinical trial.
No treatment
Sometimes, if a patient is very elderly or infirm, doing nothing for a rodent ulcer is the best option, in the absence of any symptoms or problems. This can always be re-assessed if the situation changes, such as problematic bleeding occurring.
If a rodent ulcer has been neglected for many years, sometimes cure is not possible.