There are many different treatment options for skin cancer. Which treatment, or combination of treatments you end up getting will depend on various factors, including which type of skin cancer you have been diagnosed with and how far your skin cancer has progressed.
Your doctor and care team will make a decision about which is the most appropriate treatment for your skin cancer. Read on to get a better understanding of what the different treatment options entail and how you can prepare for them.
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The following different types of local treatment can only be used for precancerous lesions or when your doctor is certain that the skin cancer has not spread beyond the skin.
Used in the treatment of actinic keratosis, early basal cell carcinomas (BCC), and early squamous cell carcinomas (SCC).
Liquid nitrogen or, less commonly, other agents are used to freeze off abnormal cells. This is a quick, simple, and largely painless procedure. You may need to have more than one episode of cryotherapy to get rid of the lesion completely.
Cryotherapy should not be used in the treatment of aggressive subtypes of BCCs, invasive SCCs, or melanoma.
Photodynamic therapy (PTD)
There is ample evidence that this is effective for the treatment of precancerous lesions, such as actinic keratosis, but its role in the treatment of BCC and SCC is not as clear.
PTD makes use of a drug that is applied topically to the lesion. The area is then exposed to a special light that causes a change in the chemical structure of the drug, activating it to kill off abnormal cells.
This is a chemotherapy drug that is applied topically in a cream or gel form to the affected site. Imiquimod and 5-fluorouracil (5-FU) are the most commonly used agents. There is a small risk of absorption of 5-FU into the body, and this may cause significant side effects.
This treatment type is used only in select patients and is not recommended for the treatment of invasive cancers, where surgery may offer better outcomes.
A laser is used to cut the lesion off. The laser functions in the same way as a very sharp blade.
Deep chemical peel
A chemical agent, such as trichloroacetic acid, is applied topically to the affected area, causing the surface layers of the skin to peel off. This is really only effective for actinic keratosis.
You may have heard this term in relation to beauty treatments, but it can also be used to treat very superficial cancers and precancers. Dermabrasion uses small particles or a rough, tiny wheel to rub away skin cells.
All of these local treatments have very little downtime, and you can usually resume normal life immediately after the treatment. It should, however, be noted that these treatments only have a role in very early cancers and precancerous lesions.
Can be used in the treatment of:
Actinic keratosis (precancerous lesions)
There are different types of surgery:
This is when the lesion is simply shaved off the surface of the skin. This is only really suitable for very early, superficial tumors and is not suitable for melanomas or aggressive tumors.
Wide excision surgery
The skin cancer is cut from the skin along with some of the normal surrounding tissue. The pathologist will examine the lesion and make sure that all of the margins are clear of cancer cells. This means that the cancer has not spread beyond the area that was cut out.
If the skin cancer is able to be removed completely, it is cured. If a large skin cancer has been removed, it may be necessary for you to have a skin transplant at the site from which the cancer was removed.
Mohs micrographic surgery
During this type of surgery, the skin cancer lesion is removed in fine layers of cells. As each layer is removed, a pathologist studies the cells in real-time to see if there are any cancerous cells present. Once a layer is clear of cancer cells, the lesion is deemed to have been completely removed.
This type of surgery removes as little unnecessary tissue as possible, so it is good for cancers on the face.
Electrosurgery (also called curettage and electrodessication)
The skin cancer is removed using a sharp curette (spoon-shaped blade), and then the remaining base is cauterized with an electric current. This destroys any remaining cancer cells and also helps to staunch bleeding.
If your doctor is worried that your skin cancer may have spread or wants more information about it, they will send the removed lesion to the pathologists for examination.
The pathologist will look at the removed cancer under a microscope to ensure that the margins of the lesion are free from cancer cells.
If the margins are free from cancer cells, it means that that cancer has not spread and is cured. It should be noted, however, that melanoma of certain thicknesses may require confirmation that it has not spread to lymph nodes.
If the margins are not free of cancer cells, you may need to go back for further surgery or have another treatment, such as radiation, at the cancer site to kill off the remaining cancer cells.
Can be used in the treatment of:
Radiation therapy is used when surgery isn’t possible to remove skin cancer. More commonly, it is used as an adjuvant (add-on) therapy to surgery.
Radiation to the surgery site after removal of the skin cancer can ensure that any remaining cancer cells are killed off.
Radiation therapy uses a beam of low-energy x-rays. This ensures that the radiation is very superficial and the effects don’t go deeper than the skin.
Radiation is painless and similar to getting an x-ray. Side effects of radiation can be:
Skin irritation, redness, or blistering in the area being treated
Hair loss in the area being treated
Change in skin color in the area being treated
Skin that has been irradiated for skin cancer is more prone to developing cancer in the future; so radiation is not usually used in young people.
Systemic therapy comprises immunotherapy, targeted therapy, or chemotherapy. It is either injected into the bloodstream (not just applied topically) or administered in a tablet form. It is used in cases where cancer has spread to distant organs.
Used to treat:
BCC (BCC seldom metastasizes to distant organs. However, it can be treated with targeted therapy, immunotherapy, or chemotherapy when it does).
Immunotherapy utilizes the body’s own immune system to kill off cancer cells. Normally, the immune system recognizes a germ or foreign body and mounts a response to kill it off. Immunotherapy uses this principle against cancer cells.
An important part of the immune system is its ability to keep itself from attacking normal cells. To do this, it uses “checkpoints,” which are proteins on immune cells that need to be turned on (or off) to start an immune response.
Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. Immunotherapy that targets checkpoint proteins can help restore the immune response against cancer cells.
Used to treat:
Some of the side effects of immunotherapy include:
Bone or joint pain
Loss of appetite
Autoimmune reactions, affecting the skin, thyroid, and other endocrine organs, gut, lungs, heart, liver, nerves/brain, or any other part of the body
Possible allergic reaction
These drugs work in complex ways. In many cancer types, cell signaling may be turned on indefinitely, causing uncontrolled signaling and cell growth. These drugs target these pathways.
Side effects may occur because normal non-cancerous cells also utilize these pathways. Your doctor can advise you regarding the frequency and type of side effects depending on the drug used.
Used to treat:
Since the availability of immunotherapy and targeted therapy, the use of chemotherapy in skin cancers often occurs when these therapies no longer work.
Chemotherapy can have side effects, such as nausea and suppression of the immune system. If chemotherapy is required, you will need to have a discussion with your doctor and oncology team about all of the possible side effects and the ways to manage them.
Whenever new drugs are developed, they undergo clinical trials to evaluate safety and efficacy before they are brought to market. These trials are performed in very safe and strict clinical conditions. Often the drugs being tested are cutting edge and not otherwise available.
If your doctor thinks you are a good candidate for a new drug that is being trialed, you may be eligible to join a drug trial. Sometimes drug trials are the only hope when all other known treatments have failed. Other times, being part of a drug trial can mean that you get a drug that is more effective and has fewer side effects than you might otherwise be prescribed.
Most skin cancers are curable if they are caught early. If they are only detected at a later stage, there are still multiple effective treatment options that can be used. In consultation with your doctor, you will be able to decide on the best treatment option to manage your specific cancer.