What's the Treatment for Nonmelanoma Skin Cancer?

If you’ve just been diagnosed with nonmelanoma skin cancer, be glad you and your doctor caught it. Most of the time it’s curable, especially when it’s found and treated early. And you have a number of treatment options to choose from, depending on what type it is.

But you need to talk to your doctor about the pros and cons of each one before you decide what is right for you.

Localized Treatments

For precancers, very small skin cancers or those at the top layer of your skin, treatment could be pretty simple. There are a number of methods that don’t require cuts or unnecessary strain to other parts of your body.
Gels and creams.  Chemotherapy drugs target and kill cancer cells, while immune response drugs tell your body’s own defenses to attack a certain area. There are several topical forms available of both that you can apply to the affected area of your skin. Depending on which kind you use, your treatment could last from 2 days to 3 months, and cause mild to severe irritation to your skin.
Liquid nitrogen. Your doctor may suggest freezing off the cancerous skin tumor. They might have to do it a couple of times, but it eventually kills the cancerous cells. Your skin will blister and crust up, but once it heals all you’ll be left with is a scar.

Surgery

Basal cell and squamous cell skin cancers are the two most common nonmelanoma skin cancers. Surgery is often used to treat them. These procedures usually take a matter of minutes to an hour and only require local anesthesia.
Excision. Your doctor will use a blade to remove the cancer, as well as some cancer-free skin. This is a quick process that often requires stitches and will leave a scar.
Electrodessication and Curettages. This procedure gets its name from the scoop-shaped tool called the curette. After your doctor removes the cancerous cells, they’ll use an electric needle to probe the skin around the area to kill any leftover cancer cells. You may repeat the process a couple of times during your visit, and you’ll probably end up with a scar.
Mohs surgery. During this surgery, your doctor will remove thin layers of skin from the affected area and review them under a microscope to look for cancerous cells. It usually takes hours because your doctor repeats the procedure, removing a thin layer of skin and putting it under the microscope, until they no longer see any cancer cells. Mohs is common for cancers found on the face.

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Radiation

If you’re trying to avoid surgery or if your cancer is too large, radiation might be an option. It uses high-energy rays (such as X-rays) or particles (such as photons, electrons, or protons) to kill your cancer cells. You may have radiation after surgery to kill cancer cells that might have been left behind. It’s sometimes recommended as the only treatment for elderly people or those who have health conditions that make it dangerous for them to have surgery. Radiation also might be used instead of surgery if your tumor is very large or in a hard-to-treat area (like your eyelids or the tip of your nose) and the surgery might affect how you look.

To treat skin cancer, external radiation is focused on the cancerous tumor to kill or stop its growth. To help limit some of the side effects, your doctor will likely use a type of radiation called electron beam radiation because it doesn’t go deeper than your skin. The goal is to destroy as much of the cancer as possible without hurting the rest of your body.

Your doctor might also use internal radiation -- putting radioactive materials inside the affected area -- to go with other treatments, especially if your cancer has metastasized, meaning spread to other parts of your body, such as your lymph nodes.

Most often, the radiation is delivered by a machine. It’s a lot like getting an X-ray -- it doesn’t hurt and is fairly quick. But you may need to have several sessions.

The side effects of radiation therapy include:

  • Skin irritation
  • Changes in skin color and texture
  • Hair loss to the treatment site
  • Damage to saliva-making glands and teeth (when treating near those areas)

Nonmelanoma skin cancers treated only with radiation are more likely to come back than ones treated with surgery. And if you have certain other health issues, such as lupus or scleroderma, radiation therapy can sometimes make those conditions worse.

Photodynamic Therapy

Photodynamic therapy (PDT), also called phototherapy, might be an option if you have:

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With PDT, your doctor uses a special light along with a drug to kill cancer cells. The drug goes on as a cream that your doctor rubs onto your skin over the cancer.

Then, you need to wait at least 3-6 hours for your skin to absorb the medicine. In some cases, you may need to wait as long as 14-16 hours. When your doctor turns on the light, it kicks the drug into action to destroy the cancer.

You can't get PDT for cancers that go deep into your skin because the light can't reach that far. It's mainly used for cancer that covers a large section of skin or that's clustered in one area.

PDT tends to work just as well as other treatments like surgery and radiation, but there are usually no long-term side effects, and it doesn't leave a scar.

Other Options

Your doctor might suggest other treatments based on the type of skin cancer you have, whether it continues to happen, and your overall health. These could include less common treatments, non-FDA-approved procedures, or even clinical trials. Talk to your doctor about your specific goals and concerns.

After Treatment

Once your treatment is complete and the affected area is healed, you need to protect your skin. Many of these treatments can make your skin more sensitive to the sun. You will need to wear a daily broad-spectrum sunscreen to all exposed skin and reapply it every 2 hours when outside or near a window, cover up with hats and long sleeves, and avoid the sun, especially from 10 a.m. to 4 p.m.

Your odds for getting skin cancer again go up if you’ve had it before. So it’s now more important than ever to perform regular skin checks, know what raises your odds of skin cancer, and take all necessary steps to prevent it from coming back. Your doctor may even recommend twice-a-year check-ups going forward.

WebMD Medical Reference Reviewed by Stephanie S. Gardner, MD on July 20, 2021

Sources

SOURCES:

American Cancer Society: “Cancer Facts & Figures 2016,” “What are basal and squamous cell skin cancers?” "Photodynamic Therapy,"  “How Does Radiation Therapy Work?” “Radiation Therapy for Basal and Squamous Cell Skin Cancers.”

UCLA Health: “Skin Cancer.”

National Cancer Institute: “Skin Cancer Treatment.”

Mayo Clinic: “Nonmelanoma skin cancer.”

Canadian Cancer Society: "Photodynamic Therapy for Non-melanoma skin cancer."

Macmillan Cancer Support: "What Is Photodynamic Therapy for Skin Cancer?"

Cancer Research UK: "Photodynamic Therapy (PDT)."

Cleveland Clinic: “Nonmelanoma Skin Cancer.”

National Cancer Institute: “Skin Cancer Treatment: Patient Version.”

Journal of Clinical and Aesthetic Dermatology: “Superficial Radiation Therapy for the Treatment of Nonmelanoma Skin Cancers.”

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