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Overview wide surgical excision mohs micrographic surgery radiation therapy & side-effects chemotherapy & side-effects complementary & alternative therapies follow-up care     overview it is important to emphasize that optimal care depends on many issues that are highly variable between patients. viagra side effects stuffy nose It is thus best to obtain care from a multi-disciplinary team of physicians with significant experience with this disease and who take into consideration many factors such as: overall health of the patient, immune suppression, node status, tumor size and location, lymphovascular invasion in the primary lesion, age, and importantly, the patient's personal philosophy in making decisions affecting quality vs quantity of life. cheap viagra online Treatment is generally based on the stage of the disease. viagra 5mg enough There are four major treatments for mcc: 1) surgical excision of the primary lesion, 2) lymph node surgery, 3) radiation therapy, and 4) chemotherapy. cheap viagra Each will be reviewed below in greater detail. buy generic viagra on line Depending on how well a patient tolerates the treatments, surgery, radiation therapy and chemotherapy may be given at the same time or one after the other. viagra 5mg enough For most cases of mcc, excision of the primary lesion with a greater than or equal to 2 cm margin (wide surgical excision) may be a recommended part of care. As discussed above, it is important for almost all cases in which there is no obvious lymph node disease to also undergo sentinel lymph node biopsy at the time of wide surgical excision to determine whether or not microscopic disease is present. When microscopic disease is found, radiation of the affected nodes, or surgical removal of the remaining lymph nodes in a draining lymph node basin (lymph node dissection) may be indicated and results in a high 'cure' rate for the affected nodal region. viagra canada online We typically recommend radiation therapy to the site of the primary lesion and to the draining lymph node basin in stage i, ii and iii disease.   chemotherapy should be reserved for patients with stage iv disease. directions taking soft viagra Metastatic disease should be treated with radiotherapy and/or chemotherapy. The purpose of treatment in stage iv disease is palliative. viagra 5mg enough   palliative therapy is given to relieve symptoms, such as pain, and to help patients live more comfortably. It is important to emphasize that optimal care depends on many issues that are highly variable between patients. It is thus important to obtain care from a multi-disciplinary team of physicians with significant experience with this disease and who take into consider. order viagra canada pharmacy generic viagra mg pills  

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