Surgery is the main treatment for non-melanoma skin cancer, although it may depend on your individual circumstances.
Overall, treatment is successful for more than 90% of people with non-melanoma skin cancer.
People with cancer should be cared for by a team of specialists that often includes a dermatologist, a plastic surgeon, an oncologist (a radiotherapy and chemotherapy specialist), a pathologist and a specialist nurse.
If you have non-melanoma skin cancer, you may see several (or all) of these professionals as part of your treatment.
When deciding what treatment is best for you, your doctors will consider:
- the type of cancer you have
- the stage of your cancer (how big it is and how far it has spread)
- your general health
Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.
Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions you would like to ask the specialist. For example, you may want to find out what the advantages and disadvantages of particular treatments are.
The National Institute for Health and Care Excellence (NICE) has produced healthcare guidelines about NHS skin cancer services. These outline NICE’s main recommendations on how, over the coming years, people with skin cancer or melanoma should be treated.
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Surgical excision is an operation to cut out the cancer along with surrounding healthy tissue to ensure the cancer is completely removed.
It may be done in combination with a skin graft, if it's likely to leave significant scarring. A skin graft involves removing a patch of healthy skin, usually from a part of your body where any scarring cannot be seen, such as your back. It is then connected, or grafted, to the affected area.
In many cases, this operation is enough to cure skin cancer.
Curettage and electrocautery
Curettage and electrocautery is a similar technique to surgical excision, but is only suitable for cases where the cancer is quite small.
The surgeon will use a small, spoon-shaped blade to remove the cancer and an electric needle to remove the skin surrounding the wound. The procedure may need to be repeated two or three times to ensure the cancer is completely removed.
Cryotherapy uses cold treatment to destroy the cancer. It is sometimes used for non-melanoma skin cancers in their early stages. Liquid nitrogen is used to freeze the cancer, and this causes the area to scab over.
After about a month, the scab containing the cancer will fall off your skin. Cryotherapy may leave a small white scar on your skin.
Mohs micrographic surgery
Mohs micrographic surgery (MMS) is used to treat non-melanoma skin cancers when:
- it's felt there is a high risk of the cancer spreading or returning
- the cancer is in an area where it would be important to remove as little skin as possible, such as the nose or eyes
It involves removing the tumour bit by bit, as well as a small area of skin surrounding it. This minimises the removal of healthy tissue and reduces scarring.
Each time a piece of tissue is removed, it is checked for cancer. The procedure may need to be repeated two or three times to ensure the cancer is completely removed.
Chemotherapy involves using medicines to kill cancerous cells. In the case of non-melanoma skin cancer, chemotherapy is only recommended when the tumour is contained within the top layer of the skin.
This type of chemotherapy involves applying a cream containing cancer-killing medicines to the affected area. As only the surface of the skin is affected, you will not experience the side effects associated with other forms of chemotherapy, such as vomiting or hair loss. However, your skin may feel sore for several weeks afterwards.
Photodynamic therapy (PDT)
Photodynamic therapy (PDT) is used to treat basal cell carcinoma, Bowen's disease and actinic keratoses. It involves using a cream which makes the skin highly sensitive to light.
After the cream has been applied, a strong light source is shone onto the affected area of your skin, which kills the cancer. PDT may cause a burning sensation and around 2% of people who have this treatment will be left with some superficial scarring.
Imiquimod cream is a treatment for basal cell carcinoma with a diameter of less than 2cm (0.8 inches). It's also used to treat actinic keratoses. Imiquimod encourages your immune system to attack the cancer in the skin.
Common side effects of imiquimod include redness, flaking or peeling skin and itchiness.
Less common and more serious side effects of imiquimod include blistering or ulceration of your skin.
Wash the cream off and contact your GP if your skin blisters or you develop ulcers after using it.
Radiotherapy involves using low doses of radiation to destroy the cancer. The level of radiation involved is perfectly safe. However, your skin may feel sore for a few weeks after radiotherapy.
Radiotherapy is sometimes used to treat basal cell and squamous cell carcinomas if:
- surgery would be unsuitable
- the cancer covers a large area
- the area is difficult to operate on
Radiotherapy is sometimes used after surgical excision to try to prevent the cancer coming back. This is called adjuvant radiotherapy.
Electrochemotherapy is a possible treatment for non-melanoma skin cancer. It may be considered if:
- surgery isn't suitable or hasn't worked
- radiotherapy and chemotherapy haven't worked
The procedure involves giving chemotherapy intravenously (directly into a vein). Short, powerful pulses of electricity are then directed to the tumour using electrodes.
These electrical pulses allow the medicine to enter the tumour cells more effectively and cause more damage to the tumour. The procedure is usually carried out using general anaesthetic (where you're asleep) but some people may be able to have local anaesthetic (where you're awake but the area is numbed).
Depending on how many tumours need to be treated, the procedure can take up to an hour to complete. The main side effect is some pain where the electrode was used, which can last for a few days and may require painkillers.
It usually takes around six weeks for results to appear and the procedure usually needs to be repeated.
Your specialist can give you more detailed information about this treatment option.
Read the NICE (2013) guidelines on Electrochemotherapy for metastases in the skin.
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