This information represents the views of the doctors and nurses serving on the American Cancer Society's
Cancer Information Database Editorial Board. These views are based on their interpretation of studies
published in medical journals, as well as their own professional experience.
The treatment information in this document is not official policy of the Society and is not intended as
medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you
and your family make informed decisions, together with your doctor.
Your doctor may have reasons for suggesting a treatment plan different from these general treatment
options. Don't hesitate to ask him or her questions about your treatment options.
General treatment information
The next few sections describe the types of treatments used for non-melanoma skin
cancers. This is followed by a discussion of the typical treatment options based on the
type of skin cancer.
The treatments described in these sections are those used for actinic keratosis, squamous
cell carcinoma, basal cell carcinoma, and/or Merkel cell carcinoma. Other skin cancers,
such as melanoma, lymphoma of the skin, Kaposi sarcoma, and other sarcomas are
treated differently and are discussed in separate documents.
Fortunately, most basal cell and squamous cell carcinomas can be cured with fairly minor
surgery or other types of local treatments.
Surgery
There are many different kinds of surgery for basal cell and squamous cell skin cancers.
The options for surgery depend on how large the cancer is, where it is on the body, and
the specific type of skin cancer. In most cases the surgery can be done in a doctor's office
or hospital clinic. For certain skin cancers with a high risk of spreading, surgery may
sometimes be followed by other treatments, such as radiation or chemotherapy.
Simple excision
This is similar to an excisional biopsy (described in the section called "How are basal and
squamous cell skin cancers diagnosed?"), but in this case the diagnosis is already known.
For this procedure, the skin is first numbed with a local anesthetic. The tumor is then cut
out with a surgical knife, along with some surrounding normal skin. The remaining skin
is carefully stitched back together, leaving a small scar
Curettage and electrodesiccation
This treatment removes the cancer by scraping it with a curette (a long, thin instrument
with a sharp edge on one end), then treating the area where the tumor was located with an
electric needle (electrode) to destroy any remaining cancer cells. This process is often
repeated. Curettage and electrodesiccation is a good treatment for small basal cell and
squamous cell cancers. It will leave a small scar.
Mohs surgery (microscopically-controlled surgery)
Using the Mohs technique, the surgeon removes a thin layer of the skin that the tumor
may have invaded and then checks the sample under a microscope. If cancer cells are
seen, the next layer is removed and examined. This is repeated until the skin samples are
found to be free of cancer cells. This process is slow, but it means that more normal skin
near the tumor can be saved. This creates a better appearance after surgery. This is a
highly specialized technique that should be used only by doctors who have been trained
in its use.
Lymph node surgery
If lymph nodes near a non-melanoma skin cancer (especially a squamous cell or Merkel
cell carcinoma) are growing larger, doctors will be concerned that the cancer may have
spread to these lymph nodes. The nodes may be biopsied (see the section, “How are basal
and squamous cell skin cancers diagnosed?”) or removed by an operation called a lymph
node dissection and looked at under a microscope for signs of cancer. This operation is
more involved than surgery on the skin, and usually requires general anesthesia (where
you are asleep).
Lymphedema, a complication where excess fuid collects in the legs or arms, is a possible
long-term side effect of a lymph node dissection. Lymph nodes in the groin or under the
arm normally help drain fluid from the legs and arms. If the lymph nodes are removed,
fluid may build up, leading to swelling in these limbs. If severe enough, it can cause skin
problems and an increased risk of infections in the limb. Elastic stockings or compression
sleeves can help some people with this condition. For more information, see our
document, Understanding Lymphedema (For Cancers Other Than Breast Cancer).
Skin grafting and reconstructive surgery
After removing large non-melanoma skin cancers, it may not be possible to stretch the
nearby skin enough to sew the edges of the wound together. In these cases, healthy skin
may be taken from another part of the body and grafted over the wound to help it heal
and to restore the appearance of the affected area. Other reconstructive surgical
procedures can also be helpful in some cases.
Other forms of local therapy
Several other techniques can be used to treat basal and squamous cell skin cancers that
have not spread to lymph nodes or other parts of the body. Some of these treatments are
described as types of surgery since they destroy a targeted area of body tissue. But these
techniques don't involve using scalpels or cutting into the skin.
Cryosurgery (cryotherapy)
For this treatment, liquid nitrogen is applied to the tumor to freeze and kill abnormal
cells. After the dead area of skin thaws, it may swell, blister and crust over. The wound
may take a month or 2 to heal and will leave a scar. The treated area may have less color
after treatment.
Cryosurgery is often used for pre-cancerous conditions such as actinic keratosis and for
small basal cell and squamous cell carcinomas.
Photodynamic therapy (PDT)
This treatment uses a special drug that is either applied to the skin or injected into the
blood. It collects in the tumor cells over the course of several hours or days and makes
the cells sensitive to certain types/colors of light. A light source is then focused on the
tumor(s), which causes the cells to die. A possible side effect of PDT is that it can make a
person's skin very sensitive to sunlight for a period of time (often several weeks), so
precautions may be needed to avoid severe burns.
PDT can be used to treat actinic keratoses. But its exact role in treating non-melanoma
skin cancers, if any, still needs to be determined. For more information on this technique,
see our document called Photodynamic Therapy.
Topical chemotherapy
Chemotherapy uses drugs that kill cancer cells. Topical chemotherapy means that an anticancer medicine is placed directly on the skin (usually in a cream or ointment) rather than
being given by mouth or injected into a vein. The drug most often used in topical
treatment of basal and squamous cell skin cancers is 5-fluorouracil (5-FU).
When applied directly on the skin in the form of a cream, 5-FU reaches cancer cells near
the skin surface, but it cannot reach cancer cells that may have invaded deeply into the
skin or spread to other organs. For this reason, treatment with 5-FU generally is used only
for pre-cancerous conditions such as actinic keratosis and for some very superficial skin
cancers.
Because it is only applied to the skin, the drug does not spread throughout the body, so it
doesn't cause the same side effects that can occur with systemic chemotherapy (treatment
that affects the whole body). But it can cause the treated skin to become red and very
sensitive for a few weeks, which can be quite bothersome for some people. Other topical
medicines can be used to help relieve this. Fluorouracil also increases the skin's
sensitivity to sunlight, so treated areas must be protected from the sun for a few weeks
after use of this cream to prevent sunburn.
A gel containing the drug diclofenac is sometimes used to treat actinic keratoses. This
drug belongs to the non-steroidal anti-inflammatory drugs (NSAIDs), a group that
includes pain relievers such as aspirin and ibuprofen.
Immune response modifiers
Certain drugs can boost the body's immune system response against the cancer, causing it
to shrink and go away.
Imiquimod is a cream that can be applied to actinic keratoses and some basal cell cancers.
It is not a chemotherapy drug. Instead, it causes the immune system to react to the skin
lesion and cause its destruction.
Interferon is a man-made version of an immune system protein. It can be injected directly
into the tumor to boost the immune response against it. It may be used occasionally when
surgery is not possible, but it may not be as effective as other treatments.
Laser surgery
This relatively new approach uses a beam of laser light to vaporize cancer cells. It is
sometimes used for squamous cell carcinoma in situ (involving only the epidermis) and
for very superficial basal cell carcinomas (those only on the surface of the skin). It is not
yet known if this type of treatment is as effective as standard methods of treatment, and it
is not widely used.
Radiation therapy
Radiation therapy uses high-energy rays (such as x-rays) or particles (such as photons,
electrons, or protons) to kill cancer cells. External beam radiation therapy focuses
radiation from outside the body on the skin tumor. The treatment is much like getting an
x-ray, but the radiation is more intense. The procedure itself is painless. Each treatment
lasts only a few minutes, although the setup time – getting you into place for treatment –
takes longer.
If a tumor is very large or is on an area of the skin that makes surgery difficult, radiation
may be used as the primary (main) treatment instead of surgery. Primary radiation
therapy is often useful for some elderly patients who, because of poor general health,
cannot tolerate surgery. Radiation therapy can cure small non-melanoma skin cancers and
can delay the growth of more advanced cancers. Radiation is also useful in combination
with other therapies. It is particularly useful for Merkel cell carcinoma.
In some cases, radiation can be used after surgery as adjuvant (additional) therapy to kill
any small deposits of remaining cancer cells that may not have been visible during
surgery. This lowers the risk of cancer coming back after surgery. Radiation may also be
used to help treat non-melanoma skin cancer that has spread to lymph nodes or other
organs.
Side effects of radiation can include skin irritation, redness, drying, and hair loss in the
area being treated. With longer treatments, these side effects may get worse. After many
years, new skin cancers sometimes arise in areas previously treated by radiation. For this
reason, radiation usually is not used to treat skin cancer in young people. Radiation is
also not recommended for people with certain inherited conditions (such as basal cell
nevus syndrome or xeroderma pigmentosum), who may be at higher risk for new cancers,
or for people with connective tissue diseases (such as lupus or scleroderma), which
radiation might make worse.
For more general information about radiation therapy, please see our document called
Understanding Radiation Therapy: A Guide for Patients and Families.
Systemic chemotherapy
Systemic chemotherapy uses anti-cancer drugs that are injected into a vein or given by
mouth. These drugs travel through the bloodstream to all parts of the body. In contrast to
topical chemotherapy, systemic chemotherapy can attack cancer cells that have spread to
lymph nodes and other organs.
One or more chemotherapy drugs may be used to treat squamous cell carcinoma or
Merkel cell carcinoma that has spread to other organs. Chemotherapy drugs such as
cisplatin, doxorubicin, 5-fluorouracil (5-FU), topotecan, and etoposide are given
intravenously (into a vein), usually once every few weeks. They can often delay the
spread of these cancers and relieve some symptoms. In some cases, they may shrink
tumors enough so that other treatments such as surgery or radiation therapy can be used.
Chemotherapy drugs attack cells that are dividing quickly, which is why they work
against cancer cells. But other cells in the body, such as those in the bone marrow, the
lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells
are also likely to be affected by chemotherapy, which can lead to side effects.
The side effects of chemotherapy depend on the type and dose of drugs given and the
length of time they are taken. These side effects may include:
• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea
• Increased risk of infection (due to low white blood cell counts)
• Easy bruising or bleeding (due to low blood platelets)
• Fatigue (due to low red blood cells)
These side effects are usually short-term and go away once treatment is finished. Some
drugs may have specific effects that are not listed above, so be sure to talk with your
cancer care team about what you might expect in terms of side effects.
There are often ways to lessen these side effects. For example, drugs can be given to help
prevent or reduce nausea and vomiting. Do not hesitate to discuss any questions about
side effects with the cancer care team.
You should tell your medical team about any side effects or changes you notice while
getting chemotherapy so that they can be treated promptly.
For more general information about chemotherapy, please see our document called
Understanding Chemotherapy: A Guide for Patients and Families.
Clinical trials
You may have had to make a lot of decisions since you've been told you have cancer.
One of the most important decisions you will make is choosing which treatment is best
for you. You may have heard about clinical trials being done for your type of cancer. Or
maybe someone on your health care team has mentioned a clinical trial to you.
Clinical trials are carefully controlled research studies that are done with patients who
volunteer for them. They are done to get a closer look at promising new treatments or
procedures.
If you would like to take part in a clinical trial, you should start by asking your doctor if
your clinic or hospital conducts clinical trials. You can also call our clinical trials
matching service for a list of clinical trials that meet your medical needs. You can reach
this service at 1-800-303-5691 or on our Web site at www.cancer.org/clinicaltrials. You
can also get a list of current clinical trials by calling the National Cancer Institute's
Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) or by
visiting the NCI clinical trials Web site at www.cancer.gov/clinicaltrials.
There are requirements you must meet to take part in any clinical trial. If you do qualify
for a clinical trial, it is up to you whether or not to enter (enroll in) it.
Clinical trials are one way to get state-of-the art cancer treatment. They are the only way
for doctors to learn better methods to treat cancer. Still, they are not right for everyone.
You can get a lot more information on clinical trials in our document called Clinical
Trials: What You Need to Know. You can read it on our Web site or call our toll-free
number (1-800-227-2345) and have it sent to you.
Complementary and alternative therapies
When you have cancer you are likely to hear about ways to treat your cancer or relieve
symptoms that your doctor hasn't mentioned. Everyone from friends and family to
Internet groups and Web sites may offer ideas for what might help you. These methods
can include vitamins, herbs, and special diets, or other methods such as acupuncture or
massage, to name a few.
What exactly are complementary and alternative therapies?
Not everyone uses these terms the same way, and they are used to refer to many different
methods, so it can be confusing. We use complementary to refer to treatments that are
used along with your regular medical care. Alternative treatments are used instead of a
doctor's medical treatment.
Complementary methods: Most complementary treatment methods are not offered as
cures for cancer. Mainly, they are used to help you feel better. Some methods that are
used along with regular treatment are meditation to reduce stress, acupuncture to help
relieve pain, or peppermint tea to relieve nausea. Some complementary methods are
known to help, while others have not been tested. Some have been proven not to be
helpful, and a few have even been found harmful.
Alternative treatments: Alternative treatments may be offered as cancer cures. These
treatments have not been proven safe and effective in clinical trials. Some of these
methods may pose danger, or have life-threatening side effects. But the biggest danger in
most cases is that you may lose the chance to be helped by standard medical treatment.
Delays or interruptions in your medical treatments may give the cancer more time to
grow and make it less likely that treatment will help.
Finding out more
It is easy to see why people with cancer think about alternative methods. You want to do
all you can to fight the cancer, and the idea of a treatment with few or no side effects
sounds great. Sometimes medical treatments like chemotherapy can be hard to take, or
they may no longer be working. But the truth is that most of these alternative methods
have not been tested and proven to work in treating cancer.
As you consider your options, here are 3 important steps you can take:
• Look for "red flags" that suggest fraud. Does the method promise to cure all or most
cancers? Are you told not to have regular medical treatments? Is the treatment a
"secret" that requires you to visit certain providers or travel to another country?
• Talk to your doctor or nurse about any method you are thinking about using.
• Contact us at 1-800-227-2345 to learn more about complementary and alternative
methods in general and to find out about the specific methods you are looking at.
