Treatment & Management of Skin Cancers

Moh's and non surgical treatment of skin cancer.

Treatment & Management of Skin Cancer

Medically reviewed by Dr. C.H. Weaver M.D. Medical Editor 10/2018

Non-melanoma skin cancer refers to all types of skin cancer other than melanoma. The two most common types of non-melanoma skin cancer are basal cell carcinoma and squamous cell carcinoma.

Treatment for non-melanoma skin cancer most often involves surgery, but there are non-surgical approaches that may be considered in certain circumstances.

About this Non-Melanoma Skin Cancer Treatment Information

The following is a general overview of treatment for non-melanoma skin cancer. Treatment may consist of surgery, radiation therapy, or topical therapy. The information on this website is intended to help educate patients about their treatment options and to facilitate a mutual or shared decision-making process with their physician.

Surgery for Non-Melanoma Skin Cancer

Each year in the U.S., more than 1,000,000 people are diagnosed with basal cell or squamous cell skin cancers.(1) Unlike melanoma, these types of skin cancer are rarely deadly. They can, however, cause extensive tissue destruction and disfigurement, and they commonly occur in cosmetically sensitive areas such as the face.

To reduce the likelihood of cancer recurrence—and the more extensive treatment that may be required to manage a recurrence—effective initial treatment is important. For a majority of patients, this involves treatment with one of several different types of surgery. The key benefits of surgery are that it can be done in one day, it’s time tested, and it’s proven to be the most effective form of treatment with the highest cure rate.

Surgery is the most extensively studied approach to treating nonmelanoma skin cancer and generally provides excellent cure rates. Depending the size and location of the cancer, the surgical procedure used may require only a few minutes (curettage and desiccation) or up to several hours (Mohs surgery).

Mohs surgery: This procedure is complicated and requires expertise, but is often recommended for the treatment of basal cell carcinoma or squamous cell carcinoma in cosmetically sensitive areas. In this procedure, a doctor removes thin layers of skin one at a time and evaluates them for cancer while the patient waits. The doctor keeps removing layers of skin until he or she reaches a layer that is cancer-free. This procedure removes the least amount of normal tissue, and also has the highest cure rates for both primary and recurrent cancers.(1,2)

Excisional surgery: Excisional surgery involves use of a scalpel to remove the cancer and some surrounding normal tissue. The tissue that is removed is then sent to a lab, where the margins of the tissue are checked for cancer. If the margins are clear, it’s likely that the cancer was completely removed. It is a quicker procedure than Mohs because the patient doesn’t have to wait in the office while the tissue is checked, however the downside is that the patient could hear several days later that not all of the cancer was removed. The patient would then have to return for additional surgery.(2)

Curettage and Desiccation: This is just a five-minute procedure. After numbing the area, the physician scrapes the lesion and then uses an electric current to stop the bleeding and kill remaining cancer cells. It’s commonly used on nonaggressive subtypes of skin cancer when they’re located in lower risk areas such as the body.It’s a very quick procedure and there’s a very low risk to it. It has an acceptably good cure rate for most lesions—about 85 percent. The disadvantage is that the tissue is not checked, doctors just nonspecifically scrape away the skin cancer and using the cautery to destroy the remainder of the tumor cells.(2)

Cryosurgery: Cryosurgery involves the destruction of abnormal tissue through freezing. It may be used for patients with small basal cell carcinoma or in situ (stage 0) squamous cell carcinoma, particularly for patients who are debilitated and cannot tolerate other procedures.(3)

Laser surgery: This procedure uses a laser to destroy cancer tissue. It may be used to treat superficial basal cell carcinoma (a subtype of basal cell carcinoma) or in situ (stage 0) squamous cell carcinoma.(1,2)

Non-Surgical Treatment of Non-Melanoma Skin Cancer

Radiation therapy: Radiation therapy uses high-energy rays to damage or kill cancer cells by preventing them from growing and dividing. This treatment may be appropriate for older, debilitated patients who cannot tolerate extensive surgery or in cases where surgery may be very disfiguring.[2]Radiation therapy is generally considered more appropriate for older patients than for younger patients because of the risk of poor long-term cosmetic results or later cancer.(4)

Topical Therapy: Topical therapy involves the application of medications such as fluorouracil (5-FU) or Aldara® (imiquimod) to the skin. Fluorouracil, a chemotherapy drug, may be used to treat selected patients with superficial basal cell carcinoma or in situ (stage 0) squamous cell carcinoma.(1,2) Aldara was approved by the Food and Drug Administration (FDA) for the treatment of actinic keratoses, as well as treatment of certain patients with small, superficial basal cell carcinoma. Aldara acts as an immune response modifier, meaning that it stimulates the immune system to help fight “foreign” material, such as bacteria, viruses, and cancer cells.

Treatment of Metastatic Non-Melanoma Skin Cancer

For squamous cell carcinoma that has spread to nearby lymph nodes, treatment may involve surgical removal of the lymph nodes, radiation therapy, or both.(2) The optimal approach to treatment of non-melanoma skin cancer that has spread to distant sites in the body is still being evaluated. Patients with metastatic cancer may wish to consider participating in a clinical trial of promising therapeutic approaches.

Treatment of Actinic Keratoses

Actinic keratoses are precancerous changes to the skin. Treatment of actinic keratoses may reduce the risk of squamous cell carcinoma. Treatments include topical medications, cryosurgery, electrodessication and curettage, laser surgery, photodynamic therapy, shave excision (use of a blade to shave off the abnormal area), and dermabrasion (use of a tool or particles to rub away the top layer of skin).(1,2)

Strategies to Improve Treatment of Non-Melanoma Skin Cancer

The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Future progress in the treatment of non-melanoma skin cancer will result from the continued evaluation of new treatments in clinical trials.

Aldara® (imiquimod): Aldara was approved by the Food and Drug Administration (FDA) for the treatment of actinic keratoses, as well as the treatment of certain patients with small, superficial basal cell carcinoma. Researchers are exploring whether it is also effective against other types of basal cell carcinoma and squamous cell carcinoma.

Photodynamic therapy: Photodynamic therapy involves the use of a drug (generally one that is applied directly to the skin) that collects in cells and makes them sensitive to particular wavelengths of light.(6) Cancer cells tend to absorb more of the drug than normal cells. When light is then shined on the treated area, it leads to the destruction of the cancer cells.

Photodynamic therapy is approved in the US for treatment certain of types of actinic keratoses on the face or scalp. Although it has not been approved in the US for the treatment of basal cell carcinoma or squamous cell carcinoma, studies suggest that it can be effective in patients with an early stage of squamous cell carcinoma (particularly patients with large or multiple lesions, or with lesions in difficult-to-treat areas) or superficial basal cell carcinoma.(6)

Interferon-alfa: Interferon-alfa is a drug that stimulates the immune system to fight cancer cells. Though FDA approved for other uses, interferon alfa is still being evaluated in the treatment of basal cell carcinoma and squamous cell carcinoma.

References:

  1. National Cancer Institute. Skin Cancer (PDQ®): Treatment. Health Professional Version. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/skin/HealthProfessional (accessed December 4, 2007).
  2. National Cancer Institute. Skin Cancer (PDQ®): Treatment. Health Professional Version. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/skin/HealthProfessional (accessed November 28, 2007)
  3. Neville JA, Welch E, Leffell DJ. Management of nonmelanoma skin cancer in 2007. Nature Clinical Practice Oncology. 2007; 4:462-469.
  4. Rubin AI, Chen EH, Ratner D. Basal-Cell Carcinoma. New England Journal of Medicine. 2005;353:2262-2269.
  5. Alam M, Ratner D. Cutaneous Squamous-Cell Carcinoma. New England Journal of Medicine. 2001;344:975-983.
  6. Fien SM, Oseroff AR. Photodynamic therapy for non-melanoma skin cancer. Journal of the National Comprehensive Cancer Network. 2007;5:531-540.

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