Treatment - Skin cancer (non-melanoma)

Surgery is the main treatment for non-melanoma skin cancer. It involves removing the cancerous tumour and some of the surrounding skin.

Other treatments for non-melanoma skin cancer include freezing (cryotherapy and, anti-cancer creams). Radiotherapy and a form of light treatment called photodynamic therapy (PDT) may also be used.

The treatment used will depend on the type, size and location of the non-melanoma skin cancer you have.

When deciding which treatment is best for you, your doctors will consider:

• the type of cancer you have
• the stage of your cancer (its size and if it has spread)
• your general health

Your doctor will recommend what they think is the best treatment option. But the final decision will be yours.

Success rate

Treatment for non-melanoma skin cancer is usually successful. At least 9 out of 10 (90%) non-melanoma skin cancer cases are cured. Unlike most other types of cancer, there's a lower risk that the cancer will spread to other parts of the body.

Basal cell carcinoma doesn't usually spread to other parts of the body. There's a small risk of squamous cell carcinoma spreading to other parts of the body. This is usually to the lymph nodes (small glands found throughout your body).

For both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) there can sometimes be considerable skin damage if the tumour isn't treated.

Surgical excision

Surgical excision is an operation to cut out the cancer. The surgeon will also remove the surrounding healthy tissue to ensure the cancer is removed.

It may be carried out in combination with a skin graft. This involves removing a patch of healthy skin, usually from a part of the body where any scarring can't be seen. This could be from your neck, abdomen or upper thigh. It's then connected (grafted) to the affected area.

In most cases, surgery is enough to cure non-melanoma skin cancer

Mohs micrographic surgery

Mohs micrographic surgery (MMS) is a specialist form of surgery used to treat non-melanoma skin cancers when:

• it's felt there's a high risk of the cancer spreading or returning
• the cancer is in an area where it would be important to remove as little skin as possible. This could be the nose or close to the eyes

MMS involves surgical excision of the tumour and a small area of surrounding skin.

The edges are immediately checked under a microscope to make sure all the tumour has been completely removed.

If it hasn't, further surgery is carried out, usually on the same day. This minimises the removal of healthy tissue. It also reduces scarring while ensuring that the tumour has been completely removed.

Curettage and electrocautery

Curettage and electrocautery is a similar technique to surgical excision. But it's only suitable in cases where the cancer is quite small.

The surgeon will use a small spoon-shaped or circular blade to scrape off the cancer. Burning (cauterising) of the skin will then take place to remove any remaining cancer cells and seal the wound.

They may need to repeat the procedure 2 or 3 times to ensure the cancer is completely removed.

Cryotherapy

Cryotherapy uses cold treatment to destroy the cancer. It's sometimes used for non-melanoma skin cancers in their early stages.

Cryotherapy uses liquid nitrogen to freeze the cancer, and this causes the area to scab over.

After about a month, the scab containing the cancer will fall off your skin. Cryotherapy may leave a small white scar on your skin.

Anti-cancer creams

Anti-cancer creams are also used for certain types of non-melanoma skin cancers. But these are only recommended when the tumour is within the top layer of the skin, such as early basal cell carcinoma and Bowen's disease.

There are two main types of anti-cancer cream:

• chemotherapy creams – these contain a medication called 5-fluorouracil
• immune stimulating creams – these contain a medication called imiquimod

For non-melanoma skin cancer, chemotherapy creams containing 5-fluorouracil are used.

The cream is applied to the affected area for some weeks.

The cream only affects the surface of the skin. This means you won't experience the side effects associated with other forms of chemotherapy, such as vomiting or hair loss. But your skin may feel sore for several weeks afterwards.

Imiquimod cream is used to treat basal cell carcinomas with a diameter of less than 2cm (0.8 inches). It's also used to treat actinic keratoses and Bowen's disease.

Imiquimod encourages your immune system to attack the cancer in the skin and is used over many weeks.

Common side effects of 5-fluorouracil cream and imiquimod include redness, flaking or peeling skin and itchiness. Less common and more serious side effects include blistering or skin ulceration.

Photodynamic therapy (PDT)

Photodynamic therapy (PDT) is used to treat basal cell carcinoma, Bowen's disease and actinic keratoses. It involves using a cream that makes the skin sensitive to light.

After the cream has been applied, a strong light source is shone on to the affected area of your skin. This kills the cancer.

PDT may cause a burning sensation. It may also leave scarring, although this is usually less than for surgery.

Radiotherapy

Radiotherapy involves using low doses of radiation to destroy the cancer. The level of radiation involved is safe. But your skin may feel sore for a few weeks after radiotherapy.

Radiotherapy is sometimes used to treat basal cell and squamous cell carcinomas if:

• surgery would be unsuitable
• the cancer covers a large area
• the area is difficult to operate on

Radiotherapy is sometimes used after surgical excision to try to prevent the cancer coming back. This is called adjuvant radiotherapy.

Complications

If you've had non-melanoma skin cancer in the past, there's a chance the condition may return.

The chance of non-melanoma skin cancer returning is increased if your previous cancer was large in size and high grade (severe).

You'll probably need regular check-ups to check your health.

If you've had a non-melanoma skin cancer, your risk of developing another one in the future is increased. This is because these cancers are often multiple.

This means it's important to regularly examine your skin to check for new tumours.