Cancer care pathways
For an overview of what to expect during all stages of your cancer care, read or download the What To Expect guide for basal and squamous cell carcinoma (also available in Arabic, Chinese, Greek, Hindi, Italian, Tagalog and Vietnamese – see details on the site). The What To Expect guide is a short guide to what is recommended for the best cancer care across Australia, from diagnosis to treatment and beyond.
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.
If the biopsy has removed all the cancer (see skin biopsy), you may not need any further treatment. Many of the treatments described in this section are suitable for sunspots as well as skin cancers.
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, then cuts out the skin cancer and some nearby normal-looking tissue (margin) before closing the wound with stitches. A pathologist checks the margin 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.
Repairing the wound
For large skin cancers, a bigger area of skin needs to be removed, and the wound is covered with a skin flap or skin graft.
For a skin flap, nearby loose skin or fatty tissue is moved over the wound and stitched. For a skin graft, a thin piece of skin from another part of the body is stitched over the wound. These procedures may be performed in the doctor's office but are sometimes done as day surgery in hospital under a local or general anaesthetic.
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 or on the nose, lips and ears.
This procedure is done in stages. The doctor removes the cancer little by little and checks 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.
Mohs surgery reduces the amount of healthy skin that is removed while making sure all the cancer is taken out.
Mohs surgery is available only at some private specialist dermatology practices and private hospitals. The procedure costs more than other types of skin cancer surgery because of the time it takes and the equipment required.
Curettage and cautery
Curettage and cautery is used to treat some BCCs and squamous cell carcinoma in situ. It 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 the bleeding and destroy any remaining cancer, and cover the wound with a dressing. The wound should heal within a few weeks, leaving a small, flat, round, white scar.
Cryotherapy, or cryosurgery, is a freezing technique used 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, which lasts a few minutes. 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. The area may also swell for a few days. In some cases, the procedure may need to be repeated.
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.
Some skin spots and cancers can be treated using creams or gels prescribed by a doctor that you apply directly on the skin. These are called topical treatments. They may contain immunotherapy or chemotherapy drugs as their active ingredient.
Sunspots, superficial BCCs and squamous cell carcinoma in situ (Bowen disease) can be treated using a cream called imiquimod (brand name, Aldara). This is a type of immunotherapy drug that causes the body's immune system to destroy the cancer cells. You apply imiquimod 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.
This cream is used to treat superficial BCCs, sunspots and, sometimes, squamous cell carcinoma in situ (Bowen disease). It works best on the face and scalp.
Your GP or dermatologist will explain how to apply the cream and how often. Many people use it twice a day for three to four weeks.
While using the cream, you will be more sensitive to the sun and will need to stay out of the sun. The treated skin may become red, blister, peel and crack, and often feel uncomfortable. These effects will usually settle within a few weeks after treatment has finished.
This new type of topical chemotherapy for sunspots is a gel that you apply to the affected skin once a day for two or three days. Side effects can include skin reddening, flaking or scaling, mild swelling, crusting or scabbing, and blisters. These side effects should disappear within a couple of weeks after treatment has finished.
Vismodegib is a new treatment for people with BCC that has spread and who aren't suitable for surgery and radiation therapy. It is taken as a tablet once a day. Common side effects include muscle spasms, taste changes and upset stomach.
Photodynamic therapy (PDT) uses a cream and a light source to treat sunspots, superficial BCCs and squamous cell carcinoma in situ (Bowen disease).
The GP or dermatologist gently scrapes the area with a curette and applies a cream that is sensitive to light. After three hours, they will shine a special light onto the area for about 8 minutes and cover it with a bandage. For skin cancers, PDT is usually repeated after two weeks.
Side effects can include redness and swelling, which usually ease after a few days. Some people experience a burning or stinging sensation during PDT, particularly for treatment to the face. Your doctor may use a cold water spray or pack, or give you a local anaesthetic to help ease the discomfort.
Radiation therapy (also called radiotherapy) uses radiation such as x-rays or electron beams to damage or kill cancer cells. It is used for BCC or SCC in areas that are difficult to treat with surgery, such as the face, and for cancers that have spread or come back.
You will lie on a table while the radiation therapy machine is positioned around you. This can take 10–30 minutes, but the treatment itself will take only a few minutes. Radiation therapy is usually given five times a week for several 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 Radiation Therapy or call Cancer Council 13 11 20.
Removing lymph nodes
If the cancer has spread, the doctor may recommend a lymph node dissection. This means that the cancerous lymph nodes are cut out to reduce the chance of the cancer spreading to other parts of the body or coming back. For more information, speak to your doctor.
- Surgery is the most common and successful treatment for skin cancer.
- During surgery, your doctor will carefully cut out the skin cancer and close the wound with stitches. Sometimes the doctor will use skin from another part of the body (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. Then low-level heat (cautery) is used 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, 5-FU chemotherapy, ingenol mebutate and vismodegib.
- 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 radiation therapy.
Expert content reviewers:
Dr Judy Cole, Consultant Dermatologist, St John of God Dermatology, WA; Irena Brozek, Research and Development Officer, Cancer Council NSW; Shannon Jones, SunSmart Health Professionals Coordinator, Cancer Council Victoria, VIC; David Lemon, Consumer; Dr Margaret Oziemski, Dermatologist, QLD; Megan Trewhella, Nurse Coordinator, Melanoma and Skin Service, Peter MacCallum Cancer Centre, VIC; Chelsey Upston, 13 11 20 Clinical Nurse Specialist, Cancer Council Victoria, VIC.