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Skin Cancer

Skin Cancer Treatment Options

There are several ways to approach skin cancer treatment. You typically will not need all of the treatment types described in this section. Your skin cancer specialist will determine what types of treatment may be needed given the type of skin cancer, stage of cancer, and your overall health.

The most common skin cancer treatments for both nonmelanoma skin cancers and melanoma are:

Other skin cancer treatments may be available, including clinical research trials, depending on each patient’s specific situation.

Surgeries for Skin Cancers

Surgery is the primary treatment for most skin cancers. The type of surgery and the combination of other treatments may vary by patient, depending on the type of skin cancer, where the cancer is located, and its stage.

Types of skin cancer surgeries

Here are the most common types of skin cancer surgeries:

  • Simple excision is most commonly used to remove nonmelanoma skin cancers. In many cases cases, no further treatment is needed.
  • A wide-local excision (WLE) is a common treatment to remove skin cancer. It’s the most common type of surgery for melanoma removal. After numbing the area, the surgeon removes the growth with a scalpel. The surgeon also removes a border of skin around the growth. This skin is the margin. The margin is examined under a microscope to be certain that all the cancer cells have been removed. The size of the margin depends on the size of the growth.
  • Mohs surgery (also called Mohs micrographic surgery) is often used for skin cancer. The area of the growth is numbed. A specially trained surgeon shaves away thin layers of the growth. Each layer is immediately 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.
  • Electrodesiccation and curettage is often used to remove small basal cell skin cancers. The doctor numbs the area to be treated. The cancer is removed with a sharp tool shaped like a spoon. This tool is a curette. An electric current is sent into the treated area to control bleeding and kill any cancer cells that may be left. Electrodesiccation and curettage is usually a fast and simple procedure.
  • Cryosurgery is used for people who are not able to have other types of surgery. It uses extreme cold to treat early stage or very thin skin cancer. Liquid nitrogen creates the cold. The doctor applies liquid nitrogen directly to the skin growth. 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: Questions and Answers” has more information.
  • Laser surgery uses a narrow beam of light to remove or destroy cancer cells. It is most often used for growths that are on the outer layer of skin only. The NCI fact sheet “Lasers in Cancer Treatment: Questions and Answers” has more information.

In addition to removing the cancer itself, there may be other surgeries needed to determine whether melanoma has spread to the nearby lymph nodes. If it has, the options for treatment are adjusted.

Grafts are sometimes needed to close an opening in the skin left by surgery. The surgeon first numbs and then 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.

Radiation Therapy

Radiation therapy, which uses high-energy beams of radiation to kill cancer cells, is used for skin cancer patients in a few different ways:

  • To kill any left over cancer cells around the area where the surgery was done.
  • When surgery would be difficult or leave a bad scar such as on the eyelid, ear, or nose.
  • If the cancer comes back after surgery.

External beam radiation therapy is offered as an outpatient treatment at our office in Sebastian, Florida.

Chemotherapy Options for Skin Cancer

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.

Topical Chemotherapy for Nonmelanoma Skin Cancers

When a cancer fighting drug is put directly on the skin in the form of a lotion or cream, the treatment is called topical chemotherapy. It is recommended most often for nonmelanoma patients and can be helpful in treating new skin cancers as they appear.

Chemotherapy for Melanoma

If the doctor feels that your lymph nodes have been affected by the cancer, chemotherapy can be used to kill those cells throughout the body. When given after surgery, chemotherapy can lower the risk that the cancer will come back.

Chemotherapy can be given through an IV in order to attack cancer cells that may be floating throughout the lymph system and possibly attaching to other organs.

For melanoma, there is sometimes an option for using regional chemotherapy. The chemotherapy is injected directly to the region of the body where cancer has been found. The flow of blood to and from the limb is temporarily stopped with a tourniquet. A warm solution with the anticancer drugs is put directly into the blood of the limb. This gives a high dose of drugs to the area where the cancer is.

Photodynamic Therapy for Nonmelanoma Skin Cancers

Photodynamic therapy (PDT) uses a chemical along with a special light source, such as a laser light, to kill cancer cells. The chemical is a photosensitizing agent. A cream is applied to the skin or the chemical is injected. It stays in cancer cells longer than in normal cells. Several hours or days later, the special light is focused on the growth. The chemical becomes active and destroys nearby cancer cells.

PDT is used to treat cancer on or very near the surface of the skin. It’s not typically used for treating melanoma.

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.

Immunotherapy for Skin Cancers

Immunotherapy, also known as biologic therapy, has become more common in recent years, especially for the treatment of melanoma. Immunotherapy uses the patient’s own immune system to fight the cancer cells. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer.

It may be used as an additional treatment, after skin cancer surgery, especially for patients who have a higher likelihood of recurrence.

Interferon and imiquimod are immunotherapy drugs used to treat nonmelanoma skin cancers:

  • Interferon (by injection) may be used to treat squamous cell carcinoma of the skin.
  • Topical imiquimod (a cream applied to the skin) may be used to treat some basal cell carcinomas.

Melanoma can be treated with several different immunotherapies, including the most recent research study of T-cells for fighting cancer.

  • Checkpoint inhibitor therapy helps the immune system to recognize melanoma is present and stimulates the immune cells — specifically T cells — to kill the cancer cells. Checkpoint inhibitors may be used alone or in combination with other cancer treatments to achieve more successful outcomes.
  • Interferon: Interferon affects the division of cancer cells and can slow tumor growth.
  • Interleukin-2 (IL-2): IL-2 boosts the growth and activity of many immune cells, especially lymphocytes (a type of white blood cell). Lymphocytes can attack and kill cancer cells.
  • Tumor necrosis factor (TNF) therapy: TNF is a protein made by white blood cells in response to an antigen or infection. TNF is made in the laboratory and used as a treatment to kill cancer cells. It is being studied in the treatment of melanoma.

Skin Cancer Targeted Therapy

Targeted therapy is a type of skin cancer treatment that identifies cells with certain genetic changes (defects) and targets them for destruction.

Some of the targeted therapies used for melanoma include:

  • BRAF inhibitors - limiting the growth of a changed (mutated) BRAF gene can slow the growth of melanoma.
  • MEK inhibitors - limiting the growth of the MEK gene that works with the BRAF gene. Blocking the MEK gene can slow the BRAF gene growth.
  • C-KIT inhibitors - This gene is responsible for melanomas in certain areas of the body including:
    • The palms of the hands, soles of the feet and under the nails.
    • Inside the mouth or other mucosal areas
    • In areas that get consistent sun exposure

Basal cell carcinoma may also be treated with a targeted therapy called Signal transduction inhibitors therapy. This treatment blocks signals that are passed from one molecule to another inside a cell. Blocking these signals can kill cancer cells.

Your oncologist will run a test to determine if the melanoma has any of these gene mutations before starting targeted therapy.