Types of treatment for skin cancer

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. This is sometimes used instead of surgery if an operation is not suitable for you. It can also be given after surgery to reduce the chances of the cancer coming back.

Another alternative to an operation 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 also sometimes used for skin cancer.

Most basal cell and squamous cell 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 should be referred to a dermatologist for skin cancer diagnosis and treatment. 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 done 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.

Radiotherapy can be used to treat basal cell or squamous cell cancers. It is most likely to be used if

• The cancer covers a wide area
• It is in an area that is difficult to operate on
• Surgery is not suitable for you – 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.

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 can sometimes develop into squamous cell skin cancer. It is possible that treatment may prevent this, and chemotherapy cream containing 5FU is a 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.

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. There is information about the specific side effects of interferon in CancerHelp UK.

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.

This is a relatively new type of treatment. It is another alternative to surgery. In February 2006, the National Institute of Health and Clinical Excellence (NICE) issued guidance on PDT for skin cancers. They support its use for several types of skin cancer. NICE said there is not much information on how well PDT works for people with squamous cell skin cancers. They felt there was a high risk of the cancer coming back or spreading. PDT is now available on the NHS for Bowen's disease, basal cell skin cancers and actinic keratosis (also called solar keratosis).

NICE say that PDT is best used in cases where you would need a lot of surgery. So it is best for large skin cancers that are not too deep, or where there are several cancers in an area. PDT is not suitable for deeper skin cancers because the light cannot penetrate far enough into the skin. In the trials NICE looked at, the appearance of the treated area after PDT was better than after surgery. Generally, PDT was as good as surgery at controlling basal cell cancers, actinic keratosis and Bowen's disease. There is more information about PDT in this section of CancerHelp UK.

Retinoids are chemicals similar to vitamin A. Tretinoin is a type of retinoid that is rarely used to treat basal cell and squamous cell cancers and solar keratosis. It can be taken as tablets or applied to the area in a cream. Tretinoin works by encouraging the cancerous cells to mature into normal cells. It is unclear how well it works.

Retinoid treatment can cause redness and skin peeling. This usually settles down within a couple of days. You should keep the treated skin out of the sun.

You can read more about retinoid treatment in the skin cancer research section.

Please remember that cannot have retinoid treatment if you are pregnant. You are not allowed to give blood while you are having retinoid treatment.