Treating skin cancer (non-melanoma)

Monday 1 February, 2016

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On this page: Surgery | Curettage and cautery | Cryotherapy | Topical treatments | Photodynamic therapy | Radiotherapy | Key points


Skin cancer is treated in different ways. Treatment depends on:

  • the type, size and location of the cancer
  • your general health
  • any medicines you are taking (these can affect the amount of bleeding and the healing time)
  • whether the cancer has spread to other parts of your body (although this is uncommon for keratinocytic skin cancers).

For some people, a biopsy is the only treatment they need (see skin biopsy).

Many of the treatments described in this chapter are for sunspots as well as skin cancers. It is uncommon for sunspots to develop into cancer, but many people have them removed for cosmetic reasons.

Most common treatment options
Treatment  Type of skin spot
Surgery BCC, SCC
Curettage and cautery
BCC, Bowen disease
Cryotherapy
Sunspots, superficial BCC
Topical treatments
BCC, Bowen disease, sunspots
Photodynamic therapy
Bowen disease, sunspots, superficial BCC
Radiotherapy
BCC, SCC

Surgery

Surgery is the most common treatment for skin cancer. It is usually a quick and simple procedure that can be performed by a GP or a dermatologist. More complex cases may be treated by a surgeon.

The doctor uses a local anaesthetic to numb the affected area and cuts out the skin cancer and nearby normal-looking tissue (margin) before closing the wound with stitches. The margin is checked by a pathologist to make sure the cancer has been completely removed. The results will be available in about a week. If cancer cells are found in the margin, further surgery may be required.

Skin flap and skin graft

For large skin cancers, a bigger area of skin needs to be removed. In these cases, a skin flap or skin graft may be used to cover the wound.

Skin flap

Loose skin or tissue is taken from an area close to the wound and placed over it using stitches.

Skin graft

A shaving or thin piece of skin from another part of the body is stitched over the wound.

These procedures are often done as day surgery in hospital under a local or general anaesthetic.

Mohs’ surgery

Mohs’ surgery, or microscopically controlled excision, is usually done under local anaesthetic by a dermatologist to treat large skin cancers that have penetrated deep into the skin or come back (recurred). It can also be used for cancers in areas that are difficult to treat, such as near the eye and on the nose, lips and ears.

The doctor removes the cancer little by little, checking each section of tissue under a microscope. They keep removing tissue until they see only healthy tissue under the microscope, and then close the wound with stitches or, sometimes, a skin flap or graft.

This procedure reduces the amount of healthy skin that is removed while making sure all the cancer has been taken out.

Mohs’ surgery is not a common treatment because it is highly specialised surgery. It is only available at some private specialist practices and private hospitals. It costs more than other types of skin cancer surgery due to the time it takes and the equipment required.

Curettage and cautery

Curettage and cautery is usually done by a dermatologist. You will be given a local anaesthetic and the doctor will scoop out the cancer using a small, sharp, spoon-shaped instrument called a curette. They will then apply low-level heat (cautery) to stop bleeding and destroy any remaining cancer, and cover the wound with a dressing.

The wound should heal within a few weeks, leaving a small, round, white scar.

Cryotherapy

Cryotherapy, or cryosurgery, is a freezing technique to remove sunspots and some superficial BCCs.

The doctor, usually a dermatologist, sprays liquid nitrogen onto the sunspot or skin cancer and a small area of skin around it. This causes a burning or stinging sensation. The liquid nitrogen freezes and kills the abnormal skin cells and creates a wound, which will be sore and red for a few days and may weep or blister.

A crust will form on the wound and the dead tissue will fall off after 1–4 weeks, depending on the area treated. New, healthy skin cells will grow and a scar may develop.

Healing can take a few weeks, and the healed skin will probably look paler and whiter than the surrounding skin.

Topical treatments

Some skin spots and cancers can be treated using creams, lotions or gels prescribed by a doctor that you apply yourself.

Immunotherapy

Immunotherapy stimulates the body’s immune system to destroy cancer cells.

Sunspots, superficial BCCs and Bowen disease can be treated using a cream called imiquimod. You apply it directly to the affected area once a day at night, usually five days a week for six weeks.

Imiquimod can cause scabbing and crusting, which may be uncomfortable. The treated skin may become red and inflamed and may be tender to touch.

Some people have a more serious reaction to imiquimod, but this is uncommon. Symptoms include pain or itching in the affected area, fever, achy joints, headache and a rash. If you experience any of these more serious side effects, stop using the cream and see your doctor immediately.

Chemotherapy

A cream called 5-fluorouracil (5-FU) is used to treat superficial BCCs, sunspots and, sometimes, Bowen disease.

Your doctor (GP or dermatologist) will explain how to apply the cream and how often. Many people use it twice a day for four weeks.

The treated skin may become red, inflamed and tender, and often itchy or uncomfortable. These effects will usually settle within a few weeks after treatment has finished.

Ingenol mebutate

This newer treatment for sunspots is a gel that you apply to the affected skin once a day for two or three days.

Side effects include: skin reddening, flaking or scaling; mild swelling; crusting or scabbing; and blisters. These effects should disappear within two weeks after treatment has finished.

Photodynamic therapy

Photodynamic therapy (PDT) is the use of a light source and a cream to treat sunspots, superficial BCCs and Bowen disease. The doctor, usually a dermatologist, gently scrapes the area with a curette and applies a cream that is sensitive to light. After about three hours, they will shine a special light onto the area for 7–8 minutes and cover it with a bandage. For skin cancers, PDT usually needs to be repeated after two weeks. Side effects include redness and swelling, which usually ease after a few days.

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

Radiotherapy

Radiotherapy uses x-rays to kill cancer cells. It is usually used on skin cancers in areas that are hard to treat with surgery, such as on the face, and on 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 take only a few minutes. Radiotherapy is usually given five times a week for 4–8 weeks. Skin in the treatment area may become red and sore 2–3 weeks after treatment starts and may last for a few weeks after treatment has finished.

For more information see Understanding Radiotherapy or call Cancer Council 13 11 20.

Key points

  • Surgery is the most common and successful treatment for skin cancer.
  • During surgery, your doctor will carefully cut out the skin cancer. You will have stitches or the doctor will use skin from another part of your body (a flap or graft) to cover the wound.
  • Mohs’ surgery, also known as microscopically controlled excision, is a specialised procedure that is only available at some private clinics and private hospitals. The surgeon removes layers of cells and checks them under a microscope immediately. The aim is to remove the cancer cells and leave only healthy tissue.
  • Curettage and cautery is when the doctor gently removes the cancer with a sharp tool called a curette. They then use low-level heat (cautery) to stop the bleeding and destroy any remaining cancer cells.
  • Cryotherapy is used to treat sunspots and some skin cancers. The doctor will spray liquid nitrogen onto the skin to freeze and destroy the cancer cells.
  • Some skin spots and cancers can be treated using creams, lotions and gels. This is called topical treatment and it includes immunotherapy, chemotherapy and ingenol mebutate.
  • Photodynamic therapy is the use of a light source and a cream to treat sunspots and some skin cancers.
  • Cancers that are hard to treat with surgery may require treatment with radiotherapy.

Reviewed by: Prof H Peter Soyer, Chair in Dermatology, Director, Dermatology Research Centre, The University of Queensland School of Medicine, Head, South-West Cluster, Deputy Head, School of Medicine, Director, Dermatology Department, Princess Alexandra Hospital, QLD; Christine Archer, Melanoma and Skin Cancer Specialist Nurse, Canberra Region Cancer Centre, ACT; Irena Brozek, Research and Development Officer, Cancer Programs, Cancer Council NSW; A/Prof T Michael Hughes, Surgical Oncologist, Associate Professor of Surgery, Sydney Adventist Hospital Clinical School, The University of Sydney, NSW; Dr Simon Lee, Head of Surgery, The Skin Hospital, Dermatologist, Sydney Skin, NSW; A/Prof Jonathan Stretch, Plastic Surgeon, Melanoma Institute Australia; Mark Strickland, SunSmart Manager, Cancer Council Western Australia, WA; Dr Tony Tonks, Plastic and Reconstructive Surgeon, Canberra Plastic Surgery, ACT; Leslie Tortora, Cancer Information and Support Service, Cancer Council Victoria, VIC; Dr April Wong, Poche Fellow, Melanoma Institute Australia; Robert Wood, Consumer.

Updated: 01 Feb, 2016