Other forms of local therapy for basal and squamous cell skin cancers

Several techniques other than surgery can be used to treat basal and squamous cell skin cancers that have not spread to lymph nodes or other parts of the body. Some of these treatments are described as types of surgery since they destroy a targeted area of body tissue. But these techniques don’t use scalpels or cut into the skin.

Cryosurgery (cryotherapy)

For this treatment, the doctor applies liquid nitrogen to the tumor to freeze and kill the cells. After the dead area of skin thaws, it may swell, blister and crust over. The wound may take a month or two to heal and will leave a scar. The treated area may have less color after treatment.

Cryosurgery is used most often for pre-cancerous conditions such as actinic keratosis and for small basal cell and squamous cell carcinomas.

Photodynamic therapy (PDT)

This treatment uses a special liquid drug that is applied to the skin. The drug collects in the tumor cells over the course of several hours or days and makes the cells sensitive to certain types of light. A special light source is then focused on the tumor(s), which makes the cells die. A possible side effect of PDT is that it can make a person’s skin very sensitive to sunlight for some time, so precautions may be needed to avoid severe burns.

PDT can be used to treat actinic keratoses. But its exact role in treating non-melanoma skin cancers, if any, still needs to be determined. For more information on this technique, see our document, Photodynamic Therapy.

Topical chemotherapy

Chemotherapy uses drugs that kill cancer cells. Topical chemotherapy means that an anti-cancer medicine is placed directly on the skin (usually in a cream or ointment) rather than being given by mouth or injected into a vein.

The drug most often used in topical treatment of actinic keratoses, as well as some basal and squamous cell skin cancers, is 5-fluorouracil, or 5-FU (Efudex^®, Carac^®, others). It is typically applied to the skin once or twice a day for several weeks.

When applied directly on the skin, 5-FU kills tumor cells near the skin’s surface, but it cannot reach cancer cells that may have grown deeply into the skin or spread to other organs. For this reason, treatment with 5-FU generally is used only for pre-cancerous conditions such as actinic keratosis and for some very superficial skin cancers.

Because it is only applied to the skin, the drug does not spread throughout the body, so it doesn’t cause the same side effects that can occur with systemic chemotherapy (treatment that affects the whole body). But it can make the treated skin red and very sensitive for a few weeks, which can be quite bothersome for some people. Other topical medicines can be used to help relieve this. 5-FU also increases the skin’s sensitivity to sunlight, so treated areas must be protected from the sun to prevent sunburn for a few weeks after use of this cream.

A gel containing the drug diclofenac (Solaraze^®) is sometimes used to treat actinic keratoses. This drug belongs to the non-steroidal anti-inflammatory drugs (NSAIDs), a group that includes pain relievers such as aspirin and ibuprofen. The gel is usually applied twice daily for 2 or 3 months. It may cause less severe skin reactions than 5-FU, but it also may take longer to work.

A newer gel used to treat actinic keratosis, ingenol mebutate (Picato^®), might work more quickly than other topical gels. It is applied to the skin daily for 2 or 3 days. The gel can cause bothersome skin reactions, but these usually begin to go away within a week of starting treatment.

Immune response modifiers

Certain drugs can boost the body’s immune system response against the cancer, causing it to shrink and go away.

Imiquimod (Zyclara^®, others) is a cream that can be applied to actinic keratoses and some very early basal cell cancers. It is not a chemotherapy drug. Instead, it causes the immune system to react to the skin lesion and destroy it. It is typically applied at least a few times a week for several weeks, although schedules can vary. Like other topical gels, it can cause severe skin reactions in some people. It can also cause flu-like symptoms.

Interferon is a man-made version of an immune system protein. It can be injected directly into the tumor to boost the immune response against it. It may be used occasionally when surgery is not possible, but it may not be as effective as other treatments.

Laser surgery

This relatively new approach uses a beam of laser light to vaporize cancer cells. It is sometimes used for actinic keratosis, squamous cell carcinoma in situ (involving only the epidermis) and for very superficial basal cell carcinomas (those only on the surface of the skin). It is not yet known if this type of treatment is as effective as standard methods of treatment, and it is not widely used.

Chemical peeling

For this technique, the doctor applies a small amount of trichloracetic acid (TCA) or a similar chemical to the skin tumor, killing the tumor cells over the course of several days. This approach is sometimes used to treat actinic keratosis.