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Treatment

Most basal cell and squamous cell carcinomas can be completely cured by fairly minor surgery.

The type of treatment chosen depends on:

  • how large the cancer is
  • where it is found on the body
  • what type of cancer it is

Certain squamous cell cancers have a higher risk of spreading. With these cancers, surgery may be followed by radiation or chemotherapy.

Surgery | Chemotherapy | Radiation

Surgery

Simple excision
The tumour is cut out, along with some surrounding normal (non-cancerous) skin, and the remaining skin is stitched back together.

Simple excision is most often used to treat squamous cell carcinomas. It is sometimes used to remove basal cell carcinomas, along with a margin of normal skin. After this kind of surgery is used to remove smaller basal cell tumours, cancerous tumours return in about 12 percent of cases; when this surgery is used to remove larger tumours, they return in about 23 percent of cases.

Electrodesiccation and curettage
The doctor removes the cancer by scraping it away with a long, thin instrument, called a curette. Then an electric needle is used to destroy any remaining cancer cells in the area where the tumour was. This process is repeated one to three times.

Electrodesiccation and curettage is the treatment most often used for basal cell carcinomas. Following this treatment, about five percent of small tumours (those less than 5 mm in diameter) will reappear within five years.

Electodessication and curettage is also useful for treating small squamous cell carcinomas, but this procedure is not recommended for larger tumours.

Cryosurgery
Cryosurgery (also sometimes called cryotherapy) uses liquid nitrogen to freeze and kill abnormal cells. After the dead tissue thaws, blistering and crusting may occur. The wound may take several weeks to heal and the treated area may have less colour after treatment.

Cryosurgery is used for some small basal cell and squamous cell carcinomas but it is not recommended for large, invasive tumours or those on certain parts of the body, including the nose, ears, eyelids, scalp or legs.

Mohs surgery (microscopically controlled surgery)
A specially trained Mohs surgeon removes the skin cancer one thin layer of skin at a time. After each sample is removed, it is checked under a microscope. If it contains cancer, more pieces will be removed and examined until the skin samples are found to be free of cancer cells. This process is slow, but it preserves much of the normal skin next to the tumour. Mohs surgery successfully cures 95-99 percent of basal cell skin cancers and 92-95 percent of squamous cell skin cancers. Mohs surgery is used on tumours that are growing quickly, on tumours that have recurred after previous treatment, on cancers in particularly visible areas, and on tumours near important structures such as the eye, ear, lip or nose.

Mohs surgery has the best cure rate for basal cell carcinoma. It is often used to treat:

  • large tumours
  • tumours that have recurred after treatment
  • tumours found on or near the nose, lip, eyes, ears, forehead, scalp, fingers and genital area

Mohs surgery may be used when basal cell carcinoma has reoccurred following a different form of treatment. The cure rate for basal cell carcinomas in this situation is about 96 percent. For reoccurring cancers, the cure rate is about 50 percent for most other types of treatment.

Mohs surgery also has the highest cure rate for squamous cell carcinoma. It is best for:

  • large tumours
  • tumours that have come back after other treatments
  • cancers that are spreading along nerves under the skin
  • cancers on delicate areas, such as the face or genitals

Shave excision
A small sterile blade is used to shave off the abnormal area of the skin.

Laser surgery and photodynamic therapy (PDT)
This relatively new approach uses a beam of laser light to kill cancer cells. It is useful for squamous cell carcinoma in situ and for some basal cell carcinomas. It's not yet known whether laser surgery works as well as other standard methods of treatment. It is not commonly used to treat nonmelanoma skin cancers. Follow-up is essential for this treatment because it does not destroy any cancer cells that are deep under the skin's surface. This treatment still requires more testing before it can be offered for general use in the treatment of skin cancers.

Lymph node surgery
If lymph nodes near the cancer are growing larger, it may be a sign that the cancer has spread to these nodes. In this case, the nodes will be removed using an operation called a lymph node dissection. Patients are usually given a general anesthetic. Tissue from the removed nodes is examined under a microscope to see if cancer cells are present. Because lymph nodes help drain fluid, a possible long-term side effect of this surgery is the build-up of fluid and swelling in the area.

Skin grafting and reconstructive surgery
After removing a large nonmelanoma skin cancer, it may not be possible to stretch the nearby skin enough to sew it back together. In these cases, skin grafts or reconstructive surgery can be used to help the wound heal, to replace tissue, and to restore a more natural appearance.

 

Chemotherapy

Chemotherapy involves using drugs to kill cancer cells. The chemotherapy used to treat nonmelanoma skin cancer may be either topical (applied directly to the skin) or systemic (injected or taken orally).

Topical Chemotherapy
With topical chemotherapy, the drugs used to kill the cancer cells are placed directly onto the skin (rather than being given orally or by injection).

The topical medications currently available in Canada include 5-fluorouracil (5-FU) and imiquimod. These creams are more commonly used to treat pre-cancerous (not yet cancer) skin lesions such as actinic keratosis. These rough, red, scaly spots, which may itch or sting, indicate excess exposure to sun over many years. This condition increases a person's risk of developing skin cancer.

5-FU is applied directly onto the skin in the form of a cream. This treatment only reaches cancer cells near the skin's surface. It cannot reach cancer cells that have gone deeper into the skin or spread to other organs.

Side effects from 5-FU treatment are common. The cream may make your skin red and sensitive for a few weeks. It can cause burning, oozing, pain, itchiness and skin colour changes. 5-FU also increases the skin's sensitivity to sunlight. Sunlight on the treated area can cause intense pain and burning, so treated areas must be protected from the sun for a few weeks afterwards.

The second drug, imiquimod, belongs to a new group of medications called immune response modifiers. These stimulate a person’s immune system to produce substances which interfere with the growth of cancer cells. Imiquimod has been approved by Health Canada to treat actinic keratoses and basal cell carcinomas. This treatment is recommended only for low-risk, superficial basal cell carcinomas.

Systemic Chemotherapy
Systemic chemotherapy involves taking chemotherapy drugs in the form of a pill or by injection. These drugs travel through the bloodstream and attack cancer cells that have spread beyond the skin to the lymph nodes or other organs.

One or more drugs may be used to treat squamous cell carcinoma that has spread to other organs. Some chemotherapy drugs, such as cisplatin, doxorubicin, 5-FU or mitomycin, can temporarily delay the spread of these cancers and relieve some symptoms. However, systemic chemotherapy (taken alone or together with radiation therapy) is usually not able to cure nonmelanoma skin cancer after it has spread.

Chemotherapy drugs damage not only cancer cells but also some normal cells, which, in turn, can cause side effects. Side effects from chemotherapy will depend on the type of drugs you are taking, your dosage and the length of time you are on the medication. Side effects may include:

  • nausea and vomiting (You will be given anti-nausea drugs that may help.)
  • loss of appetite
  • temporary loss of hair
  • mouth or vaginal sores
  • increased chance of infection
  • fatigue
  • bleeding and bruising after minor cuts and injuries
  • hearing loss

Most of the side effects, with the possible exception of hearing loss, will go away when the treatment is over.

 

Radiation Therapy

Radiation therapy may be used as the main treatment, or in combination with other treatments, to shrink or kill cancer cells. Radiation therapy aims high-energy rays from outside the body to damage the cells in the path of the beam.

When Is it Used?

Primary radiation therapy may be used for

  • older patients with large cancers
  • patients with health problems who cannot have surgery
  • tumours in areas which are hard to remove surgically, for example, on the eyelids, ears, or nose
  • cancers that have come back after surgery and have become too large or too invasive to be removed with more surgery
  • relieving symptoms (palliative care)

Primary radiation therapy can cure small nonmelanoma skin cancers and can delay the growth of more advanced cancers.

In some cases, radiation therapy is used after surgery as additional (adjuvant) therapy to kill small deposits of cancer cells that may not have been removed during surgery, or to lower the risk of cancer recurring after surgery. Radiation may also be used to treat nonmelanoma skin cancer that has spread to the lymph nodes or other organs.

A patient receiving radiation therapy will likely visit a medical facility with special x-ray equipment between 15 and 30 times. Recovery times vary depending on the location of the cancer and the amount of radiation used.

Side Effects

The side effects of radiation therapy include

  • fatigue
  • nausea and vomiting
  • hair loss in the treated area
  • irritated, red skin in the treated area
  • diarrhea if the skin radiated is in the area of the abdomen or pelvis

With longer treatments, these side effects may get worse.

Risks

After many years, new skin cancers may develop in the areas that were treated earlier with radiation. For this reason, radiation is not usually used to treat skin cancer in younger people. Additional risks include:

  • the skin becoming dry, hairless and discoloured
  • the skin becoming easily infected
  • skin atrophy
  • healthy skin being destroyed by the radiation

 

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Nonmelanoma Skin Cancer

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  • A publication of:
  • Women's College Hospital