Treatment

Surgery
Chemotherapy
Photodynamic Therapy
Biological Therapy
Radiation Therapy

Treatment for skin cancer depends on the type and stage of the disease, the size and place of the tumor, and your general health and medical history. In most cases, the goal of treatment is to remove or destroy the cancer completely. Most skin cancers can be cured if found and treated early.

Sometimes all of the skin cancer is removed during the biopsy. In such cases, no more treatment is needed.

If you do need more treatment, your doctor can describe your treatment choices and what to expect. You and your doctor can work together to develop a treatment plan that meets your needs.

Surgery is the usual treatment for people with skin cancer. In some cases, the doctor may suggest chemotherapy, photodynamic therapy, or radiation therapy. People with melanoma may also have biological therapy.

You may have a team of specialists to help plan your treatment. Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat skin cancer include dermatologists and surgeons. Some people may also need a reconstructive or plastic surgeon.

People with advanced skin cancer may be referred to a medical oncologist or radiation oncologist. Your health care team may also include an oncology nurse, a social worker, and a registered dietitian.

Because skin cancer treatment may damage healthy cells and tissues, unwanted side effects sometimes occur. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each person. Before treatment starts, your health care team will tell you about possible side effects and suggest ways to help you manage them.

Many skin cancers can be removed quickly and easily. But some people may need supportive care to control pain and other symptoms, to relieve the side effects of treatment, and to help them cope with the feelings that a diagnosis of cancer can bring. Information about such care is available on NCI's Web site at http://www.cancer.gov/cancertopics/coping and from NCI's Cancer Information Service at 1–800–4–CANCER (1–800–422–6237) and at LiveHelp (http://www.cancer.gov/livehelp).

You may want to talk with your doctor about taking part in a clinical trial, a research study of new treatment methods. See the Taking Part in Cancer Research ¹ section.

Surgery

In general, the surgeon will remove the cancerous growth and some normal tissue around it. This reduces the chance that cancer cells will be left in the area.

There are several methods of surgery for skin cancer. The method your doctor uses depends mainly on the type of skin cancer, the size of the cancer, and where it was found on your body.

Your doctor can further describe these methods of surgery:

• Excisional skin surgery: This is a common treatment to remove any type of skin cancer. After numbing the area of skin, the surgeon removes the growth (tumor) with a scalpel. The surgeon also removes a border (a margin) of normal skin around the growth. The margin of skin is examined under a microscope to be certain that all the cancer cells have been removed. The thickness of the margin depends on the size of the tumor.
• Mohs surgery (also called Mohs micrographic surgery): This method is often used for basal cell and squamous cell skin cancers. After numbing the area of skin, a specially trained surgeon shaves away thin layers of the tumor. Each layer is examined under a microscope. The surgeon continues to shave away tissue until no cancer cells can be seen under the microscope. In this way, the surgeon can remove all the cancer and only a small bit of healthy tissue.
  
  Some people will have radiation therapy after Mohs surgery to make sure all of the cancer cells are destroyed.
• Electrodesiccation and curettage: This method is often used to remove a small basal cell or squamous cell skin cancer. After the doctor numbs the area to be treated, the cancer is removed with a sharp tool shaped like a spoon (called a curette). The doctor then uses a needle-shaped electrode to send an electric current into the treated area to control bleeding and kill any cancer cells that may be left. This method is usually fast and simple. It may be performed up to three times to remove all of the cancer.
• Cryosurgery: This method is an option for an early-stage or a very thin basal cell or squamous cell skin cancer. Cryosurgery is often used for people who are not able to have other types of surgery. The doctor applies liquid nitrogen (which is extremely cold) directly to the skin growth to freeze and kill the cancer cells. This treatment may cause swelling. It also may damage nerves, which can cause a loss of feeling in the damaged area. The NCI fact sheet Cryosurgery in Cancer Treatment ² has more information.

For people with cancer that has spread to the lymph nodes, the surgeon may remove some or all of the nearby lymph nodes. Additional treatment may be needed after surgery. See the Staging ³ section for information about finding cancer in lymph nodes.

If a large area of tissue is removed, the surgeon may do a skin graft. The doctor uses skin from another part of the body to replace the skin that was removed. After numbing the area, the surgeon removes a patch of healthy skin from another part of the body, such as the upper thigh. The patch is then used to cover the area where skin cancer was removed. If you have a skin graft, you may have to take special care of the area until it heals.

The time it takes to heal after surgery is different for each person. You may have pain for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.

Surgery nearly always leaves some type of scar. The size and color of the scar depend on the size of the cancer, the type of surgery, the color of your skin, and how your skin heals.

For any type of surgery, including skin grafts or reconstructive surgery, follow your doctor's advice on bathing, shaving, exercise, or other activities.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Drugs for skin cancer can be given in many ways.

Put directly on the skin

A cream or lotion form of chemotherapy may be used to treat very thin, early-stage basal cell or squamous cell skin cancer (Bowen disease). It may also be used if there are several small skin cancers. The doctor will show you how to apply the cream or lotion to the skin one or two times a day for several weeks.

The cream or lotion contains a drug that kills cancer cells only in the top layer of the skin:

• Fluorouracil (another name is 5-FU): This drug is used to treat early-stage basal cell and squamous cell cancers.
• Imiquimod: This drug is used to treat early-stage basal cell cancer.

These drugs may cause your skin to turn red or swell. Your skin also may itch, ooze, or develop a rash. Your skin may be sore or sensitive to the sun after treatment. These skin changes usually go away after treatment is over.

A cream or lotion form of chemotherapy usually does not leave a scar. If healthy skin becomes too red or raw when the skin cancer is treated, your doctor may stop treatment.

Swallowed or injected

People with melanoma may receive chemotherapy by mouth or through a vein (intravenous). You may receive one or more drugs. The drugs enter the bloodstream and travel throughout the body.

If you have melanoma on an arm or leg, you may receive drugs directly into the bloodstream of that limb. The flow of blood to and from the limb is stopped for a while. This allows a high dose of drugs in the area with the melanoma. Most of the chemotherapy remains in that limb.

You may receive chemotherapy in an outpatient part of the hospital, at the doctor's office, or at home. Some people need to stay in the hospital during treatment.

The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:

• Blood cells: When drugs lower the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. There are also medicines that can help your body make new blood cells.
• Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.
• Cells that line the digestive tract: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems. They usually go away when treatment ends.

You may want to read the NCI booklet Chemotherapy and You ⁴.

Photodynamic Therapy

Photodynamic therapy (PDT) uses a drug along with a special light source, such as a laser light, to kill cancer cells. PDT may be used to treat very thin, early-stage basal cell or squamous cell skin cancer (Bowen disease).

The drug is either rubbed into the skin or injected intravenously. The drug is absorbed by cancer cells. It stays in cancer cells longer than in normal cells. Several hours or days later, a special light is focused on the cancer. The drug becomes active and destroys the cancer cells.

The side effects of PDT are usually not serious. PDT may cause burning or stinging pain. It also may cause burns, swelling, or redness. It may scar healthy tissue near the growth. If you have PDT, you will need to avoid direct sunlight and bright indoor light for at least 6 weeks after treatment.

The NCI fact sheet Photodynamic Therapy for Cancer ⁵ has more information.

Biological Therapy

Some people with advanced melanoma receive a drug called biological therapy. Biological therapy for melanoma is treatment that may improve the body's natural defense (immune system response) against cancer.

One drug for melanoma is interferon. It's injected intravenously (usually at a hospital or clinic) or injected under the skin (at home or in a doctor's office). Interferon can slow the growth of melanoma cells.

Another drug used for melanoma is interleukin-2. It's given intravenously. It can help the body destroy cancer cells. Interleukin-2 is usually given at the hospital.

Other drugs may be given at the same time to prevent side effects. The side effects differ with the drug used, and from person to person. Biological therapies commonly cause a rash or swelling. You may feel very tired during treatment. These drugs may also cause a headache, muscle aches, a fever, or weakness.

You may find it helpful to read the NCI booklet Biological Therapy ⁶. You may also wish to read the NCI fact sheet Biological Therapies for Cancer ⁷.

Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells. The radiation comes from a large machine outside the body. It affects cells only in the treated area. You will go to a hospital or clinic several times for this treatment.

Radiation therapy is not a common treatment for skin cancer. But it may be used for skin cancer in areas where surgery could be difficult or leave a bad scar. For example, you may have radiation therapy if you have a growth on your eyelid, ear, or nose. Radiation therapy may also be used after surgery for squamous cell carcinoma that can't be completely removed or that has spread to the lymph nodes. And it may be used for melanoma that has spread to the lymph nodes, brain, bones, or other parts of the body.

Although radiation therapy is painless, it may cause other side effects. The side effects depend mainly on the dose of radiation and the part of your body that is treated. It's common for the skin in the treated area to become red, dry, tender, and itchy. Your health care team can suggest ways to relieve the side effects of radiation therapy.

You may find it helpful to read the NCI booklet Radiation Therapy and You ⁸.