Non-Melanoma Skin Cancer Treatment

What are the treatment options for non-melanoma skin cancers?

The primary treatment options for non-melanoma skin cancers such as squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) include surgery, radiotherapy, cryotherapy, photodynamic therapy, laser surgery, targeted therapy, chemotherapy and immunotherapy. The type of treatment you receive will depend on a number of different considerations, such as the type of non-melanoma skin cancer you have, its stage, your overall health and your treatment preferences. This page aims to give you a comprehensive overview of how non-melanoma skin cancer treatment works.

Surgery for non-melanoma skin cancer

Surgery is the most common treatment for non-melanoma skin cancer. In many cases, surgery may be the only treatment you need.

Radiotherapy for non-melanoma skin cancer

Radiotherapy is a non-invasive treatment option for basal cell carcinoma and squamous cell carcinoma and is particularly effective for older patients, for those who would prefer to avoid surgery, or if the cancer is in a location where surgery isn’t medically or cosmetically recommended. In some cases, radiotherapy may also be given after surgery to prevent the cancer from coming back or if the cancer is advanced.

Types of radiotherapy commonly used for people with non-melanoma skin cancer include:

• External beam radiotherapy (EBRT)

• Superficial radiotherapy

Cryotherapy for non-melanoma skin cancer

Cryotherapy involves applying liquid nitrogen onto the non-melanoma skin cancer to freeze and kill non-melanoma skin cancers such as small basal cell carcinomas. This might be repeated multiple times depending on your treatment plan, and you may feel a burning or stinging sensation in the area being treated. Once the cancer is destroyed, new healthy skin will grow over the wound.

Photodynamic therapy for non-melanoma skin cancer

Photodynamic therapy involves applying a gel which makes your non-melanoma cancer sensitive to light. A special light is then directed onto the non-melanoma skin cancer for around eight minutes to destroy it. This may also help to damage blood vessels in the tumour. Photodynamic therapy is commonly used to treat superficial basal cell carcinoma and squamous cell carcinoma in situ.

Laser surgery for non-melanoma skin cancer

Laser surgery is a less common treatment for non-melanoma skin cancer that uses the heat from a laser beam to destroy skin cancer cells. The treatment is typically effective for very superficial basal cell carcinomas and squamous cell carcinoma in situ (Bowen disease).

Chemotherapy for non-melanoma skin cancer

Topical chemotherapy is a common treatment option for non-melanoma skin cancer which involves applying an anti-cancer drug (normally a cream or gel) directly onto the affected area. Because it is only applied to the top layer of the skin, topical chemotherapy is not effective for non-melanoma skin cancer that has spread to areas such as the lymph nodes and surrounding organs.

Immunotherapy for non-melanoma skin cancer

Immunotherapy trains your body’s own immune system to recognise and fight non-melanoma skin cancer cells.

A common type of immunotherapy treatment for non-melanoma skin cancer is called imiquimod. This is a cream which is typically applied directly onto the non-melanoma skin cancer daily for several weeks. It can increase the number of cancer-destroying proteins your skin makes to treat sunspots, superficial basal cell carcinoma and squamous cell carcinoma in situ (Bowen’s disease).

For advanced basal or squamous cell skin cancer, cancer cells may hide from your immune system using checkpoints – proteins that are turned on or off to tell your body what cells needs to be protected or attacked. Checkpoint inhibitors are drugs that can help the immune system to recognise non-melanoma cancer cells and destroy them. This is typically used to treat advanced squamous cell carcinoma.

Targeted therapy for non-melanoma skin cancer

Like other cells, non-melanoma cancer cells are made up of a number of different parts including proteins. Targeted therapies use drugs to destroy specific proteins or gene mutations in advanced non-melanoma cancer cells. Advanced basal cell carcinoma cells can have mutations that are part of a cell signalling pathway (how cells pass instructions to each other) called hedgehog. When the hedgehog pathway is activated, this causes the cancer cells to grow in an uncontrolled, rapid way.

Hedgehog pathway inhibitors are drugs that target this pathway, slowing down the cancer’s growth and spread. They are typically used to treat advanced (metastatic) non-melanoma skin cancers and some advanced basal cell carcinomas when surgery and radiation therapy are not appropriate.

Treatment by stage of non-melanoma skin cancer

When you are diagnosed with non-melanoma skin cancer, your oncologist will develop your treatment plan as part of a multidisciplinary team based on the size and spread of your cancer.