Skin Cancers

Treatment Options

Skin cancer is commonly treated with more than one type of therapy. Treatments will be either local or systemic or a combination. Local treatments target specific areas of the body and include surgery and sometimes radiation therapy. Some can also be injected into a lesion or applied topically to the skin.

Skin cancer treatment options include the following.

Surgery is frequently the primary treatment option for BCC, CSCC and MCC. Most surgeries for skin cancer are outpatient procedures that are done with local anesthesia in a doctor’s office. Most procedures take less than one hour, and patients are able to go home the same day. Possible types of surgery include the following.

• Curettage and electrodessication involves removing tissue with a surgical instrument. The area is then treated with an electric current to control bleeding and kill any remaining cancer cells. This type of surgery may be used for BCC, CSCC and actinic keratosis.
• Mohs micrographic surgery removes a visible lesion in individual layers, which are examined by a doctor under a microscope one at a time until all cancer tissue has been removed. It is also called Mohs surgery and may be used for BCC and CSCC.
• Wide and simple excisions remove the tumor and healthy skin and tissue surrounding it, called a margin. These may be used for BCC, CSCC and MCC.
• Shave excision shaves off the surface of the skin abnormality and a thin layer of surrounding skin, and it is examined under a microscope.
• Sentinel lymph node biopsy is used to determine if the cancer has spread to the lymph nodes. It removes the lymph node to which cancer cells are likely to spread first from a primary tumor. A radioactive dye is used to determine the sentinel node, and the surgeon removes it to check for the presence of cancer cells. This is used for MCC.
• Lymph node dissection is the removal of lymph nodes. A regional lymph node dissection removes lymph nodes near the tumor, and a radical lymph node dissection removes most or all the lymph nodes in the tumor area. This is used for MCC.
• Laser surgery uses a laser beam to destroy a lesion. It is used primarily to treat actinic keratosis.

After the surgery, caring for your wound is important and recommendations will be given by your doctor’s office. It is important to call your doctor’s office if you feel any of the warning signs of infection, such as redness, swelling, pain, odor, fever or discharge of yellow pus. Reconstructive surgery may be an option in some cases when the cancer develops on or near the face. Before treatment begins, talk with your doctor about whether you will need to consider this option.

Cryosurgery, also called cryoablation and cryotherapy, kills cancer cells by freezing them with a probe or another instrument that is super-cooled with liquid nitrogen or similar substances. It may be used to treat precancerous skin conditions, BCC and CSCC. Following cryosurgery, a blister and then a crust will form. Once this falls off, the skin may have some changes in color.

Immunotherapy works with your immune system to help it identify and fight cancer. Immune checkpoint inhibitors may be used to treat metastatic, locally advanced or recurrent CSCC in people who could not be cured by surgery or radiation therapy, or for recurrent locally advanced or metastatic MCC. Immunotherapy is also approved for locally advanced and metastatic BCC that was previously treated with a targeted therapy known as a hedgehog pathway inhibitor. Side effects from immunotherapy should be discussed with your medical team so they can assist you in managing them.

Targeted therapy may be an option for locally advanced and metastatic BCC if it cannot be treated with surgery or radiation therapy. Approved therapies are hedgehog pathway inhibitors that block the PTCH1 genetic mutation. Others may be used for CSCC to block the epidermal growth factor receptor (EGFR) pathways. Side effects from these therapies include hair loss, taste changes and rash.

Photodynamic therapy is treatment with drugs that become active and kill cancer cells when exposed to light. It is used mainly to treat tumors on or just under the skin. It may be used for CSCC that is Stage 0, for actinic keratosis and for BCC when surgery is not an option.

Chemotherapy in the form of creams or ointments may be used as topical therapy for CSCC, actinic keratosis and very superficial BCC. It is applied to the skin and is primarily used to treat the earliest stage of CSCC in situ or Stage 0. Systemic chemotherapy may also be used for metastatic or unresectable CSCC.

Radiation therapy may be used for skin cancers near the eyelid, tip of the nose, the ear or other hard-to-reach areas when surgery may not be a good option. It may be recommended after surgery to prevent a recurrence or avoid scarring from surgery. The most common type of radiation treatment is called external-beam radiation therapy (EBRT), which is delivered from a machine outside of the body. Radiation therapy may be used to treat recurrent CSCC that is not metastatic and Stages I and II of MCC.

Clinical trials are ongoing and may be an option to consider, especially if the skin cancer is advanced or metastatic.