Skin cancer diagnosis and treatment
Once a skin cancer has been diagnosed, the treatment will depend on the type of skin cancer, the size, the location, and the number to be treated.
Diagnosing melanoma
Dr Elizabeth Baird outlines the procedure used to remove and diagnose a melanoma.
Select here to view video transcript and copyright information.
Most skin cancers are treated by cutting out the lesion entirely and by removing sufficient surrounding tissue to be sure that all the cancer has gone and the edges are free of cancerous cells. This can mean removing a 2 centimetre margin around the spot. Surgery has the highest overall cure rate for early cancers.
Lower risk cancers
For lower risk cancers, such as squamous and basal cell carcinomas, there are several other treatments that can be used, but they will only provide adequate control for low-risk cases.
Curetting and cauterising – The cancer is scraped out (using a tool called a curette) and the wound is cauterised (burned to stop the bleeding).
Moh’s controlled excision – The cancer is removed with a smaller amount of surrounding tissue and the excised tissue is examined for cancer cells under a microscope while the patient is still in the operating room. Further tissue is then removed and examined layer by layer. It may take several ‘slices’ before the microscopic examination no longer shows signs of cancerous cells.
Cryotherapy (freezing) – Liquid nitrogen can be used to freeze off small cancers.
Radiotherapy (X-ray treatment) – Radiation (most commonly X-rays) is directed to the target tissue and transmits energy that damages and destroys the cancer cells. Of course, this will also damage normal cells, but they can recover from the damage. Radiation may be used after the removal of a high-risk cancer.
Photodynamic therapy – Photosensitising drugs, oxygen and light are used to create a photochemical reaction that destroys the cancer cells. This can be used for superficial basal cell and squamous cell carcinomas.
Chemotherapy – If the cancer has spread (metastasised), chemotherapy may be required. This is treating the cancer with chemicals that kill cells. Broadly, chemotherapeutic drugs work by impairing cell division, effectively targeting the fast dividing cancer cells. Unfortunately, this means that other fast dividing cells, such as those responsible for hair growth, are also affected.
Excision of a carcinoma
Surgical excision of a carcinoma.
Melanoma
Melanoma is the most serious skin cancer because it can readily spread to other parts of the body (metastasise). It is also the most difficult to treat. Surgery is the primary treatment at all stages of a melanoma. Complete removal of the melanoma before it has spread is the most effective cure.
Lymphoscintigraphy in the armpit
Lymphoscintigraphy showing a sentinel lymph node in the armpit. A radioactive tracer has been injected at the tumor site in order to identify the sentinel node(s). A blue tracer dye has also been used for greater accuracy of identification. The node will be removed and biopsied.
A biopsy of the removed tissue will determine how deeply into the skin the melanoma has gone. This is called the Breslow's depth. In general, the thinner the melanoma, the better the outcome. In its earliest stages, melanoma cells are only found in the outer layers of the skin and don’t invade the body. It is more advanced if the melanoma is thicker than 4 mm. Some types of melanoma develop quickly over a period of weeks or months (they become thick fast), while others develop over months or sometimes even years.
Sentinel lymph nodes
Dr Elizabeth Baird and Professor Rod Dunbar discuss sentinel lymph nodes - the node or nodes where a cancer first spreads to, from the primary tumour.
Select here to view video transcript, discussion questions and copyright information.
Melanomas that spread usually do so to lymph nodes first. A technique called lymphoscintigraphy can be used to identify the sentinel lymph nodes – the lymph node(s) that the cancer cells have drained to first – and these lymph nodes can be removed.
What is lymphoscintigraphy?
Professor Rod Dunbar (University of Auckland) explains the procedure of lymphoscintigraphy as a technique to determine the first lymph nodes melanoma will spread to.
Select here to view video transcript and copyright information.
Chemotherapy has not been found to be very effective for melanoma – although occasionally it does work very well. Radiation shrinks and slows – but does not usually cure – melanoma.
Immunology treatments that help the body’s own immune system to find and attack cancer cells are proving useful in treating melanoma. In New Zealand, patients with melanoma that has spread, is in a more advanced stage, or is inoperable, can access immunotherapy drugs like Keytruda.
Nature of science
Scientific knowledge is tentative, and medical science relies on scientific knowledge. This means that doctors cannot be certain that they know how to cure diseases – it depends on their understanding of the disease at the time, the patient and the community’s resources.
The future
Research is ongoing into a number of other possible treatments for all types of skin cancer. In Sea sponges and rongoā, discover how a natural compound found in sea sponges has the potential to be a powerful anti-cancer drug. It is part of the Project Mātauranga television series that investigates Māori world views and methodologies within the scientific community.
International research is exploring Chimeric Antigen Receptor T-cell therapy (CAR T-cell therapy) to treat melanoma. This is a treatment where a patient’s immune cells (T-cells) are modified and then returned to them, where they can attack and destroy cancer cells. As of 2026 it is not currently available in New Zealand for melanoma treatment, but clinical trials are being undertaken here for other clinical purposes.
Related content
These related articles explain more about skin cancer, why New Zealand skin cancer rates are so high, and some of the risk factors.
Activity idea
For those interested in protection from UV, see The face of melanoma – an activity that looks at lifestyle factors that contribute to skin cancer.
Useful links
In this 2025 press release, Melanoma New Zealand explains the decision to fund new immunology and other treatments for people with melanoma. The Case Studies section of their website profiles research into new treatments for melanoma.
The Malaghan Institute of Medical Research is leading a major trial to develop and test its own CAR T-cell therapy for patients with lymphoma. Learn more about the therapy here.
The SunSmart website is designed for students, teachers, schools and parents. It has information about UV, shade, hats, sunscreen, skin cancer and sun protection, as well as cross-curricula resources for teachers in the SunSmart Schools section.
The Cancer Society of New Zealand is the leading organisation dedicated to reducing the incidence of cancer and ensuring the best cancer care for everyone in New Zealand.
This Skin Cancer Foundation web page looks at skin types and at risk groups.
This HealthMatch article, Top 20 skin cancer hot spots in the world and why they're on the list, explores the roles that personal, cultural, and global habits play in rates of skin cancer and what we can do to change them.
Te Aho o Te Kahu Cancer Control Agency is a government agency created in recognition of the impact cancer has on the lives of New Zealanders.
