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Skin cancer treatments

This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on March 17, 2022.

Most cases of skin cancers are basal cell or squamous carcinomas and may be treated in a dermatologist's office or with outpatient surgery. But more aggressive skin cancers, such as melanoma or Merkel cell carcinoma, usually require more extensive treatments, such as surgery, chemotherapy or immunotherapy. Your multidisciplinary team of doctors and clinicians at Cancer Treatment Centers of America® (CTCA) will answer your questions and recommend treatment options based on your unique diagnosis. The most common treatments for skin cancer include:

Surgery

Surgery is the primary treatment for most skin cancers. For patients with basal cell or squamous cell carcinomas, a dermatologist or other qualified doctor may perform an outpatient procedure using a local anesthetic. In these procedures, like with most skin cancer surgeries, the cancer cells are removed, along with surrounding skin, known as the margin.

Surgical procedures for skin cancer include:

  • Excision: Types of excisions include:
  • Simple excision: removes the skin tumor and a small amount of surrounding tissue.
  • Wide excision: removes the skin tumor and a larger margin of healthy tissue. This is a more common treatment for melanoma.
  • Shave excision: removes the skin tumor by shaving it off with a razor-like device.

Mohs surgery: Layers of skin are removed individually and analyzed until no cancer cells are found.

Curettage and electrodessication: In this two-phase procedure, a physician uses a surgical tool called a curette to scrape off cancer cells. The area is then treated with an electric current to kill remaining cancer cells and control bleeding.

Cryosurgery: Cancer cells are frozen with liquid nitrogen.

Laser surgery: A powerful laser light beam kills cancer cells on the surface of the skin.

Lymph node biopsy: In some cases, lymph nodes near the skin cancer may need to be removed to determine whether the cancer has spread.

Reconstructive surgery: This may be an option for some patients in cases where extensive skin cancer surgery may have caused scarring or disfigurement.

Learn more about surgery for skin cancer

Topical treatments

In some cases, nonsurgical forms of therapy may be used to remove or destroy localized skin cancer cells. These techniques may be used, either alone or in combination with other treatments, to treat early-stage basal cell or squamous cell carcinomas or noncancerous or pre-cancerous lesions. Topical treatments include those below.

Photodynamic therapy: This technique uses photosensitive medication combined with light in an effort to kill cancer cells. In this technique, a light-sensitive substance, usually aminolevulinic acid (Levulan®), is applied directly to the tumor. Up to 18 hours later, the treated area is exposed to a special blue light that activates the medication, targeting cancer cells on the skin. This type of treatment is most often used on actinic keratoses, precancerous growths that may develop into squamous cell carcinomas if not treated.

The most common side effect of photodynamic therapy is sensitivity to bright light. Patients should talk to their doctor about how long light sensitivity may last. 

Exposure to light for a period of time after therapy may cause a reaction to the treated area, including: 

  • Burning
  • Itching or tingling
  • Rash or redness 

As a precaution, patients should:

  • Avoid direct light.
  • Stay indoors or wear protective clothing when outdoors. • Avoid areas where the sun may reflect off bright surfaces, such as the beach or areas where snow has accumulated. 

Topical chemotherapy: This therapy applies a chemotherapy cream, usually fluorouracil (Efudex®), directly to the skin tumor. Application may be prescribed twice daily for as little as three weeks or as long 12 weeks. Topical chemotherapy may be used to treat basal cell carcinoma or actinic keratoses. The drug, also known as 5-FU, typically only affects the cells it reaches, and cannot penetrate deeply into the skin. It is generally used only for very superficial skin cancers.

Common side effects of topical skin cancer treatments include:

  • Burning or itching
  • Rash or redness
  • Sore or tender skin

In rare cases, a patient may have an allergic reaction to fluorouracil. Patients should seek medical care immediately if they have severe side effects, such as fever, difficulty swallowing, digestive issues, watery eyes or eye pain.

Immune response modifier: The topical cream imiquimod (Zyclara®, Aldara®) may be used to treat actinic keratoses or superficial basal cell carcinomas. Application may be prescribed for several times a day for two to eight weeks. Imiquimod, which is designed to activate the immune system to attack cancer cells, works by stimulating the body to produce interferon, a natural protein that fights foreign invaders and cancer cells.

Side effects of an immune response modifier may include:

  • Redness, itching, bleeding or flaking skin
  • Swelling, blisters, stinging or pain
  • Fatigue or tiredness
  • Headache or back pain
  • Diarrhea

Chemotherapy

In most cases, systemic chemotherapy is recommended for patients with advanced skin cancer, especially Merkel cell carcinoma that has spread to distant parts of the body. Topical chemotherapy may be an option for localized basal cell carcinoma. If chemotherapy is an option for you, your care team at Cancer Treatment Centers of America® (CTCA) will work together to select an appropriate type of chemotherapy and develop an individualized treatment plan tailored to your needs.

Side effects to chemotherapy are common and may include digestive issues, hair loss and immune suppression. Side effects are usually temporary and subside over time after treatment has ended.

Radiation therapy

Skin cancer radiation therapy may be used following surgery in the area where lymph nodes were removed, to kill any remaining cancer cells. It may also be used if the cancer comes back, to reduce the size of the metastases and to relieve symptoms, particularly if the cancer has spread to the brain or bones.

Radiation therapy techniques used to treat skin cancer include those below.

External beam radiation therapy (EBRT)

External beam radiation therapy (EBRT) directs a beam of radiation from outside the body at cancerous tissues inside the body. It is a cancer treatment option that uses doses of radiation to destroy cancerous cells and shrink tumors. Advantages of using EBRT to treat skin cancer may include:

  • EBRT is an outpatient procedure. This technique does not carry the standard risks or complications associated with major surgery for skin cancer, which can include surgical bleeding, post-operative pain or the risk of stroke, heart attack or blood clot.
  • The procedure itself is painless.
  • EBRT poses no risk of radioactivity to you or others with whom you have contact. As you undergo EBRT, you may continue normal activities with family and friends.

Intensity modulated radiation therapy (IMRT)

If you have previously had radiation therapy for skin cancer and are experiencing recurrent tumors in the treated area, IMRT may be an option for you. Compared to standard radiotherapy, IMRT allows our radiation oncologists to use higher radiation doses than traditional therapies would allow in these areas. At the same time, IMRT helps to spare more of the surrounding healthy skin tissue from harmful doses of radiation.

TomoTherapy®

This technology combines a form of intensity modulated radiation therapy (IMRT), with the accuracy of computed tomography (CT) scanning technology, in one machine. TomoTherapy may have may offer the following advantages for skin cancer patients:

  • Uses built-in CT scanning to confirm the exact shape and location of a skin tumor seconds before your treatment begins
  • Targets hard-to-reach skin tumors by sculpting small, powerful and more precise radiation beams at the tumors from a full 360 degrees.
  • Limits treatment-related side effects by reducing damage to nearby healthy tissue.
  • Reduces radiation exposure to muscle tissue, the spine, lungs and other sensitive organs

Radiation therapy for skin cancer may cause side effects that are usually limited to the treated area. They may include:

  • Skin irritation, blistering, redness or peeling
  • Hair loss
  • Changes in skin color

In rare cases, radiation therapy for skin cancer may result in new skin cancer lesions developing years later.

Targeted therapy

Targeted therapy works by seeking out specific characteristics in cancer cells, such as gene mutations or proteins. Targeted therapy drugs are designed to attach themselves to those cells, to kill them or help other therapies, such as chemotherapy, work better.

A certain type of targeted therapy drug approved to treat rare cases of advanced basal cell carcinoma are called hedgehog pathway inhibitors because they target the hedgehog pathway, a signaling mechanism critical to healthy cell growth in the fetus. The pathway typically goes dormant by adulthood, but cancer cells may re-activate the hedgehog pathways in adults, promoting tumor growth in some cases. Because of the pathway’s importance to developing fetuses, these drugs should not be taken by women who are pregnant or who may become pregnant.

Other targeted therapy drugs have been approved to treat melanoma, a potentially aggressive form of skin cancer.

Potential side effects of targeted therapy for skin cancer vary depending on the drug used. Side effects for targeted therapy drugs to treat basal cell carcinoma that has spread may include:

  • Muscle spasms
  • Digestive issues, such as diarrhea, constipation and vomiting
  • Itchy skin
  • Hair loss

Side effects of targeted therapy drugs used to treat squamous cell skin cancers may include:

  • Mouth sores
  • Diarrhea and loss of appetite
  • Skin reactions, such as breakouts, rashes and dryness

Immunotherapy

Immunotherapy, which is designed to help the immune system identify and attack cancer cells, may be an option to treat Merkel cell carcinoma and melanoma.

Checkpoint inhibitors are immunotherapy drugs that work by targeting signaling proteins that allow cancer cells to disguise themselves as healthy cells.

Cytokines are immunotherapy drugs that use molecules to help regulate immune activity. The drugs alpha-interferon (IFN-alpha) and interleukin-2 (IL-2) are cytokines that may be used to treat some cases of advanced melanoma. These drugs stimulate the rapid growth and activity of immune cells so that they quickly attack the cancer cells. Immunotherapy may not be recommended for all patients. Because they stimulate the immune system, immunotherapy treatments may also lead to side effects, such as skin rashes or gastrointestinal problems.

Common side effects of immunotherapy include:

  • Fatigue
  • Digestive issues, such as constipation and/or diarrhea
  • Skin rashes
  • Joint and bone pain
  • Loss of appetite

In some cases, immunotherapy drugs may cause the immune system to attack healthy cells. Some patients may also develop a reaction during infusion or if they’ve developed an allergy to the drugs. Patients should seek immediate medical attention if they develop a fever, have difficulty breathing or experience other severe symptoms or side effects.

Next topic: How is skin cancer treated with surgery?

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