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.
The following is a general overview of treatment for non-melanoma skin cancer. Treatment may consist of surgery, radiation therapy, or topical therapy.
In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment. Treatments that may be available through clinical trials are discussed in the section titled Strategies to Improve Treatment.
Circumstances unique to each patient’s situation influence which treatment or treatments are utilized. 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.
Mohs micrographic surgery: This procedure is complicated and requires expertise, but is often recommended for the treatment of high-risk basal cell carcinoma or squamous cell carcinoma.1 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. The procedure generally requires less than four hours to complete, but can take longer if the cancer is extensive.
Surgical excision: Surgical excision involves the use of a scalpel to remove the cancerous area and a small margin of surrounding normal tissue.
Electrodesiccation and Curettage: This is a commonly used treatment for basal cell carcinoma. It may also be used for very small squamous cell carcinoma.1 Electrodesiccation and curettage involves scraping and cauterizing (burning) the abnormal area of skin.
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.1
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
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.2Radiation 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.3
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 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.
For squamous cell carcinoma that has spread to nearby lymph nodes, treatment may involve surgical removal of the lymph nodes, radiation therapy, or both.4 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.
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
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.
Patients may gain access to better treatments by participating in a clinical trial. Participation in a clinical trial also contributes to the cancer community’s understanding of optimal cancer care and may lead to better standard treatments. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. Areas of active investigation aimed at improving the treatment of non-melanoma skin cancer include the following:
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.5 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.5
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.
1National 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 Neville JA, Welch E, Leffell DJ. Management of nonmelanoma skin cancer in 2007. Nature Clinical Practice Oncology. 2007; 4:462-469.
3Rubin AI, Chen EH, Ratner D. Basal-Cell Carcinoma. New England Journal of Medicine. 2005;353:2262-2269.
4Alam M, Ratner D. Cutaneous Squamous-Cell Carcinoma. New England Journal of Medicine. 2001;344:975-983.
5 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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