Types of treatment for skin cancer

The main treatments

The main treatment for skin cancer is surgery. For most people this will be all the treatment you need.
Radiotherapy can also be used to treat and cure skin cancers. You may have this instead of surgery if an operation is not suitable for you. Radiotherapy can also be given after surgery to reduce the chances of the cancer coming back.
Another alternative to an operation for basal cell skin cancer is treatment with a drug to make your skin sensitive to light. This is followed by treatment with a bright light to the affected area. This treatment is called photodynamic therapy (PDT).
Chemotherapy is only occasionally used for skin cancer.

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Surgery

Most basal cell and squamous cell skin cancers can be successfully treated with surgery. In most cases the surgery is minor. The affected area is completely removed, usually under local anaesthetic. There are several different types of surgical techniques that can be used. What is done will depend on

• The type of skin cancer you have
• The size of the cancer
• Where the cancer is
• The stage of the cancer (if relevant)

You are usually referred to a dermatologist for skin cancer diagnosis and treatment. But some basal cell skin cancers can be removed by GPs, if they have had specialist training. If you have a skin cancer that covers a wide area or is awkward to remove, you may be operated on by a plastic surgeon.
Small cancers are often operated on under local anaesthetic. You may have a general anaesthetic for a larger cancer. If the cancer covers a large area you may need to have a skin graft. Or you may need to have the skin replaced by a skin flap. A flap is a thicker piece of skin tissue taken from an area of skin nearby. But it will still be connected to its own blood supply. It is then stitched in place over your wound.
If your cancer has spread to nearby lymph nodes your surgeon will need to remove them. You have this operation under general anaesthetic.
If your doctor thinks there is a high chance of cancer spread you may have the lymph nodes removed. Even though there may be no sign of actual spread, a few cancer cells can be missed. If they are not removed they can go on to develop into new tumours and spread further to other parts of the body.

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Radiotherapy

Radiotherapy can be used to treat basal cell or squamous cell skin cancers. You are most likely to have this if

• The cancer covers a wide area
• It is in an area that is difficult to operate on
• Surgery is not suitable for you – for example, you may be elderly or have other health problems

In some situations radiotherapy may be used as well as surgery. If there is a risk that cancer cells may have been left behind, radiotherapy may be used after surgery. This is called adjuvant treatment. It reduces the risk of the cancer coming back in the future.
Radiotherapy can also be used to treat cancer that has spread to lymph nodes. In advanced cancer which has spread to another part of the body, radiotherapy can be used to relieve symptoms. It is also used to treat cancers that have come back (recurred) after they were first treated with surgery.

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Chemotherapy

Chemotherapy tablets or injections are only used in certain circumstances for skin cancer. More often, chemotherapy creams are used

• To treat actinic keratosis
• For skin cancers that are only on the top layer of the skin

Solar or actinic keratosis may develop into squamous cell skin cancer, though this is very uncommon. You may have treatment to try to prevent this. A chemotherapy cream containing fluorouracil (5FU) is commonly used. Bowen's disease is also sometimes treated with 5FU cream.
Chemotherapy tablets or injections are only used for skin cancers that have spread. This treatment is mostly used to relieve symptoms in cancers that cannot be cured. This is still experimental treatment and you may be asked to take part in a clinical trial.

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Immunotherapy

Interferon stimulates your body’s immune system to pick out and fight cancer cells. Interferon is sometimes used to treat advanced squamous cell cancers that started in the nose, mouth or elsewhere inside the head and neck area. We have information about the specific side effects of interferon on this website.

Imiquimod cream (Aldara) is a new type of immunotherapy treatment. It is used for

• Actinic keratoses
• Basal cell carcinoma (BCC) in the top layer of skin

Imiquimod cream uses the immune system to attack cancers. This means it uses the body’s natural defences to kill the cancer cells in the skin. Imiquimod makes cells produce more chemicals such as interferon and these destroy the skin cancer cells.

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Photodynamic therapy (PDT)

This is a relatively new type of treatment. It is another alternative to surgery. PDT uses a drug that makes skin cells sensitive to light. The area of skin that needs treating is exposed to a special type of light, and the cancer cells are destroyed. PDT is used to treat basal cell skin cancers, Bowen's disease and actinic keratosis (also called solar keratosis).
PDT is best used in cases where you would need a lot of surgery. So you generally have this treatment for large basal cell skin cancers that are not too deep, or where there are several cancers in an area. PDT is not suitable for deeper basal cell cancers or squamous cell skin cancers because the light cannot penetrate far enough into the skin. The appearance of the treated area (the cosmetic outcome) after PDT is generally better than after surgery. There is more information about PDT in this section.