Treating skin cancer (non-melanoma)

Saturday 1 March, 2014

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On this page: Surgery | Curettage and cautery | Cryotherapy | Immunotherapy | Chemotherapy | Photodynamic therapy | RadiotherapyKey points


Skin cancer is treated in different ways. This will depend on the type, size and location of the cancer; whether it has spread to other parts of your body; your general health; and any medications you are on (these can affect bleeding and healing time).

Surgery

Surgery is the most common treatment for skin cancer. The operation is usually a quick and simple procedure, but it can be more complicated if the skin cancer is on your face, scalp or lower legs.

The doctor – often a plastic surgeon or a dermatologist – will use a local anaestheticto numb the area, then cut out the skin cancer leaving an area of normal-looking tissue around it. This tissue is then checked for cancer cells to make sure the cancer has not spread.

The laboratory staff may be able to check the tissue at the time of the surgery if it is performed in a hospital. This is called a frozen section. If tests show the cancer has not been completely removed, sometimes further surgery is needed.

Skin flap and skin graft

A large skin cancer may need a larger area of skin removed. In this case, you may need a skin flap or skin graft to cover the wound. In a skin flap, nearby skin or tissue is taken from an area close to the wound and moved over the wound and stitched. A skin graft is when a shaving or piece of skin from another part of the body is used to cover the area where the skin cancer was removed.

Mohs' surgery

Mohs’ surgery is a type of surgery that is also known as microscopically controlled excision.

The cancer is removed little by little and the tissue is checked under the microscope before the wound is closed. The removal continues until only healthy tissue remains. This reduces the amount of healthy skin that is removed while making sure all the cancer has been taken out.

Mohs’ surgery is sometimes used to treat large skin cancers that have gone deep (penetrated) into the skin or have come back. It can also be used for cancers in areas that are difficult to treat, such as the skin near the eye.

Mohs’ surgery is not commonly used because it is a highly specialised surgery. It is only available at some hospitals and some private specialist practices. It costs more than other types of surgery.

Curettage and cautery

Curettage and cautery treatment is mainly used for superficial BCCs. A local anaesthetic is given and the cancer is scooped out with a small, sharp, spoon-shaped instrument called a curette. A low-level electric current is then applied (cautery) to stop bleeding and to destroy any remaining cancer. The wound is then covered. It should heal within a few weeks, leaving a pale white scar.

Cryotherapy

Sunspots and superficial BCCs may be treated using a freezing technique called cryotherapy (sometimes called cryosurgery). This technique is not usually used for skin spots close to the eye.

Liquid nitrogen is sprayed onto the abnormal skin spot and a small area of skin around it. It can feel like a stinging sensation when applied. The liquid nitrogen freezes and kills the abnormal skin cells and creates a wound. The wound will be slightly sore and red for a few days and may weep or develop a blister.

After about 10 days, a crust will form on the wound and the dead tissue will fall off. New, healthy skin cells will grow and a scar may develop. Healing can take a few weeks. The main side effect of cryotherapy is a change in skin pigmentation. The new, healed skin will probably look paler and whiter than the surrounding skin.

How cryotherapy treatment affects the skin

 Before treatment

A skin cancer before cryotherapy

 Immediately after treatment

A wound after cryotherapy

Immunotherapy

Immunotherapy is a treatment that stimulates the body’s immune system to destroy the cancer.

An immunotherapy cream called imiquimod (Aldara®) is used to treat sunspots and superficial BCCs. It is usually applied directly to the skin cancer. Imiquimod cream doesn’t work for some people. If it’s not effective, another type of treatment will be used.

For superficial BCCs the cream is applied, five days a week, for up to six weeks.

Side effects can include a lot of scabbing and crusting, which can be uncomfortable. The treated skin may become red and inflamed but it is usually not sore. It is important to ask your doctor or pharmacist about how much cream to apply, about potential side effects or if precautions are needed when using the cream.

It is not as common, but some people can have a more serious skin reaction. Side effects may include pain or itching in the affected area, spots on the skin, a high temperature (fever), feeling generally unwell, achy joints, eyesight changes, burning, painful or itchy eye and mouth sores.

If you experience any of these side effects, seek medical advice immediately. Do not use the cream without further advice from your doctor. 

Chemotherapy

If chemotherapy is given, it’s normally applied directly on the skin cancer as a cream or lotion. This is called topical chemotherapy. Usually a cream called fluorouracil (Efudix®), also known as 5FU, is used. This treatment is for skin cancers that affect the top layer of skin.

Your doctor or specialist nurse will explain how to apply the cream yourself at home and how often. It may help to place a waterproof dressing over the cream to keep it in place. The treated skin may become red and inflamed but it shouldn’t be painful and will usually wear off within a couple of weeks after treatment has finished.

Photodynamic therapy

Photodynamic therapy (PDT) uses a light source with a cream to treat sunspots and superficial BCCs. The area is gently scraped and a light-sensitive cream is applied to the spot. This is left on for about three hours, and then a light is shone on the area for 7–8 minutes. Afterwards, the treated area is covered with a bandage to protect it from light for 24 hours. You will need to keep the treated area covered and dry. PDT usually needs to be repeated after 1–2 weeks.

Some people experience pain during PDT, particularly if having treatment to the face. Your doctor may use a cold water spray, cold water pack, a cold air blower or give you a local anaesthetic during the PDT to cool the area and to help ease the pain.

Radiotherapy

Radiotherapy treats cancer by using x-rays to kill cancer cells. It is usually used in areas that are hard to treat with surgery, such as skin near the eyes, nose or forehead. It can also be used for skin cancers that have grown deeply into the skin.

You will lie on a table while the radiotherapy machine is positioned around you. This can take 10–30 minutes, but the treatment itself will probably only take a few minutes. Radiotherapy sessions are usually given over several weeks. Skin in the treatment area may become red and sore after 2–3 weeks of radiotherapy.

For more information, call Cancer Council 13 11 20 for a free copy of the Understanding Radiotherapy booklet.

Removing lymph nodes

Two skin cancer types (SCC and melanoma) can spread to the lymph nodes (also called lymph glands). Lymph nodes are roughly the size of kidney beans, and are located in the neck, groin, pelvis, stomach and underarms. They are involved in the body’s fight against infection and cancer. If the cancer has spread, the doctor may recommend a lymph node dissection. This means that the cancerous lymph nodes are cut out. This procedure will reduce the chance of the cancer spreading to other parts of the body or coming back. For more information, speak to your doctor.

Key points

  • Sometimes skin cancer can be removed with a biopsy and no further treatment is needed. If some skin cancer remains after the biopsy, you will need further treatment.
  • Surgery is the most common and successful treatment for skin cancer.
  • The doctor, who may be your GP, a dermatologist or plastic surgeon, will carefully cut out the skin cancer. You will have stitches or the doctor will use some skin from another part of your body (a skin flap or skin graft) to cover the wound.
  • Mohs’ surgery, also known as microscopically controlled excision, is a specialised surgery that is only available at a few hospitals in Australia. The surgeon removes layers of cells and checks them under a microscope immediately. The aim is to leave only healthy tissue.
  • The doctor may gently remove the cancer with a sharp tool called a curette, and then use a low-level electric current to stop bleeding and destroy any remaining cancer. This is called curettage and cautery.
  • Cryotherapy is also used to treat some skin cancers. The doctor sprays liquid nitrogen onto the skin, which freezes and kills the cancer cells.
  • Immunotherapy and chemotherapy are used, in the form of creams, to treat skin cancers that affect the top layer of skin.
  • Other treatments for skin cancer include light therapy (photodynamic therapy) and radiotherapy, which uses x-rays.
  • Sometimes, SCC or melanoma spreads to the lymph nodes and the doctor must remove the affected lymph nodes (lymph node dissection).

Reviewed by: Dr Richard Lewandowski, Plastic and Reconstructive Surgeon, Director of Surgery, Mater Adults Hospital, QLD; Prof H Peter Soyer, Chair, Dermatology Research Centre, The University of Queensland, School of Medicine, Acting Head, South-West Cluster & PA-Southside Clinical School, Deputy Head, School of Medicine, Director, Dermatology Department, Princess Alexandra Hospital, QLD; Carole Arbuckle, Helpline Consultant, Cancer Council Victoria; Irena Brozek, Research and Development Officer, Health Strategies, Cancer Council NSW; Julie Fraser, Consumer; Jenny Lawrence, Consumer; Dr Matheen Mohamed, Consultant Dermatologist, St Vincent’s Hospital Melbourne, VIC; Margaret Whitton, Clinical Nurse Consultant, Department of Dermatology, Royal Prince Alfred Hospital, NSW.

Updated: 01 Mar, 2014