Treatment Options for Nonmelanoma Skin Cancer

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Most skin cancers are nonmelanoma skin cancers, such as basal cell carcinomas (BCCs) or squamous cell carcinomas (SCCs). Although these skin cancers are quite common, with about 3.5 million diagnosed every year, the vast majority don't spread beyond the initial tumor site.

If you've been diagnosed with one of these nonmelanoma skin cancers and the cancer is still "localized" (meaning it hasn't spread to lymph nodes or other parts of the body), the good news is that treatment usually doesn't require chemotherapy or inpatient surgery. Instead, treatment of localized nonmelanoma skin cancer usually focuses on cutting the tumor out of the skin or otherwise destroying the skin cancer cells. (Note: Localized skin cancer is sometimes referred to as Stage I or II skin cancer.)

Which treatment your doctor recommends depends in part on whether the skin cancer seems to be low risk (small, unlikely to spread) or higher risk (larger or looking much different from regular skin cells). Here are the most common treatment options for localized nonmelanoma skin cancer:

Excisional surgery

What it is: The tumor is surgically removed, often in an outpatient clinic setting, under local anesthesia.

Pros: The edge of the removed tissue can be examined under a microscope to ensure that the tumor's edge has been successfully cut out. Cure rates are very good. Depending on the tumor location, cosmetic results are usually very good.

Cons: More complicated to perform than cryotherapy (see below).

Best for: Larger and higher-risk squamous cell carcinomas; low-risk and high-risk basal cell carcinomas.

Avoid if: Recurrent tumor or large and irregular in shape.

Mohs surgery

What it is: A specialized excisional surgery technique in which tissue is removed in a series of stages and examined microscopically by the surgeon at each stage.

Pros: Allows for precise removal of irregularly shaped tumors or tumors in cosmetically sensitive areas. Very high cure rates.

Cons: More expensive and much more time-consuming to perform than standard excisional surgery.

Best for: High-risk basal cell carcinomas, high-risk squamous cell carcinomas with irregular borders, or squamous cell carcinomas located in cosmetically important areas.

Avoid if: Patient is unable to tolerate a lengthy procedure under local anesthesia.

Electrosurgery (also known as electrodessication and curettage)

What it is: The tumor is scraped away with a small blunt instrument (a curette), and the wound is cauterized with an what's called an electrodessication device.

Pros: Relatively easy to do in a doctor's office, not very expensive, and can spare healthy tissue around the tumor.

Cons: Impossible to check the wound edges to confirm that all cancer is gone. Squamous cell carcinoma or basal cell carcinoma may recur in 10 percent of cases.

Best for: Low-risk superficial squamous cell carcinomas or low-risk basal cell carcinomas on the trunk or extremities.

Avoid if: Recurrent tumor or if minimal scarring is highly desired.

Cryotherapy

What it is: A freezing product such as liquid nitrogen is used to freeze both the tumor cells and a small amount of healthy surrounding tissue.

Pros: Easy to do in office, inexpensive, usually doesn't require anesthesia, good cure rates for low-risk cancers.

Cons: Impossible to check the wound edges to confirm that all cancer is gone. Expect swelling and pain shortly after cryotherapy. The affected area can take four to six weeks to fully heal and may result in a pale spot or a small scar.

Best for: Smaller squamous cell carcinomas that have developed from an actinic keratosis.

Avoid if: Skin cancer is on scalp, nose, lips, ears, eyelids, or near a major nerve. Also avoid if the squamous cell carcinoma seems to be invading deeper into the skin. Cryotherapy is only rarely used for basal cell carcinomas.

Radiation therapy

What it is: Focused radiation treatment is applied to the tumor over several weeks.

Pros: Spares nearby tissue and can be used on lips, nose, eyelids.

Cons: Relatively expensive and requires multiple treatments. Impossible to check the wound edges to confirm that all cancer is gone. Radiation treatment can cause short-term skin side effects and is also linked to delayed side effects that can appear months to years later. These delayed effects include dermatitis and new skin cancers.

Best for: Squamous cell carcinomas and basal cell carcinomas in older patients who can't undergo excision.

Avoid if: Tumor is on trunk or limbs, or if patient is younger than age 60.

Topical 5-fluorouracil

What it is: A cream containing a compound that interferes with cell growth, FDA-approved for treatment of actinic keratosis but also used off-label for smaller squamous cell carcinomas. Dying tumor cells usually cause inflammation in the skin, which eventually heals.

Pros: Topical therapy is considered easier and less invasive by some patients. For suitable squamous cell carcinomas, cure rate is about 85 percent.

Cons: Skin inflammation during treatment can be uncomfortable and unsightly. Requires twice-daily application over several weeks.

Best for: Older patients who are refusing surgery or have difficulty getting to a doctor's office.

Avoid if: Larger squamous cell carcinoma, or invasive squamous cell carcinoma.

Topical imiquimod

What it is: An immune-modifier compound that interferes with growth of some tumors; FDA-approved to treat actinic keratosis and basal cell carcinomas.

Pros: Topical therapy is considered easier and less invasive by some patients. Cure rates for suitable skin cancers are estimated at 75 to 85 percent.

Cons: Often requires a longer course of treatment than topical 5-fluorouracil. Can cause skin inflammation.

Best for: Older patients who are declining surgery or have difficulty getting to a doctor's office.

Avoid if: Larger or invasive skin tumor.

See also the FAQ What kind of follow-up should I have after treatment for skin cancer?


over 1 year ago, said...

my mom has middle stage alzeihmers and has developed 3 spots of skin cancer one lg spot on breast one on back of neck and one on hip she already had a spot 3 yrs ago removed from side of nose we would like to know if she would be a likely candidate to be hospitalized to have these removed she is scratching at them constantly all while they are a bloody mess