This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

Surgery

Often basal cell and squamous cell cancers can be completely cured by minor surgery. Some can be cured by using medicine on the skin. There are many different kinds of treatment for these cancers. The type of treatment that's best for you depends on how large the cancer is, where it is on the body, and sometimes on other factors such as the exact type of skin cancer it is. For certain squamous cell cancers with a high risk of spreading, surgery might be followed by radiation or chemotherapy.

Simple excision (this is like an excisional biopsy)

The skin is numbed to do this. The tumor is cut out, along with some normal skin around it. The remaining skin is carefully stitched back together. This surgery will leave a small scar.

Curettage and electrodesiccation

In this treatment the cancer is removed by scraping it with a long, thin tool called a curette. The curette looks something like a vegetable peeler. The area is then treated with an electric needle to destroy any remaining cancer cells. The process is often done more than once. This treatment will also leave a scar.

Mohs surgery

In this surgery, the doctor removes a layer of skin that the tumor may have spread to and then checks the sample under a microscope. If cancer cells are seen, more layers of skin will be removed and looked at until the samples do not show cancer cells. This process is slow, but it means that normal skin next to the tumor can be saved. This means the skin will look better after surgery. Only doctors who have had special training should perform this type of surgery.

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 that case, the nodes will be removed by an operation called a lymph node dissection. The removed tissue will be looked at under a microscope to see if there are cancer cells in it. This operation is more involved than surgery on the skin. You would most likely have general anesthesia (where you are given drugs to put you into a deep sleep).

A possible long-term side effect is lymphedema. Lymph nodes in the groin or under the arm normally help drain fluid from the limbs. If they are removed, fluid may build up, leading to limb swelling. This swelling is called lymphedema. Elastic stockings or compression sleeves can help some people with this problem. For more information, see the separate American Cancer Society document, Understanding Lymphedema (For Cancers Other Than Breast Cancer).

Skin grafting and reconstructive surgery

If a large skin cancer has been removed, it may not be possible to stretch the nearby skin enough to sew the edges of the wound together. In these cases, skin grafts or some other methods can help the wound heal and replace tissue. These can also help the treated skin look as normal as possible.

Other forms of local treatment

Other methods can be used to treat non-melanoma 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 tissue. But these methods don't involve cutting into the skin.

Cryosurgery

In this treatment liquid nitrogen is used to freeze and kill cancer cells. After the dead tissue thaws it may blister and crust. The wound may take a month or 2 to heal and will leave a scar. The treated area may have less color after treatment.

Photodynamic therapy (PDT)

This treatment involves giving patients a drug that collects in the cancer cells over the course of many hours or days. The drug is either put right on the skin or injected into the blood. It makes the cancer cells sensitive to certain types of light. A light source is then focused on the cancer. It activates the drug so it kills the cells. A possible side effect of PDT is that it can make a person's skin very sensitive to sunlight for a period of time, so patients may need to be careful to avoid sunlight and severe burns.

Topical chemotherapy

Chemotherapy (often called "chemo") is the use of drugs to kill cancer cells. Topical chemo means that a medicine is placed right on the skin (usually in a cream or ointment) rather than being given by mouth or injected into a vein.

When put directly on the skin in the form of a cream, the drug reaches cancer cells near the skin surface. But it does not reach cancer cells that have gone deeply into the skin or spread to other organs. For this reason, this kind of treatment is most often used only for certain types of skin cancer or skin conditions that could cause become cancer.

This treatment can cause the treated skin to be red and sensitive for a few weeks, which can be quite bothersome for some people.

Immune response modifiers

Certain drugs can cause an immune response to the cancer, causing it to get smaller or go away.

These drugs do not kill the cancer cells and are not chemo. Instead, they cause the body's immune system to react to the skin problem and make it go away.

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

Laser surgery

This newer treatment uses a beam of light to kill cancer cells. It is useful for squamous cell cancer that hasn’t spread and for some basal cell cancers. It's not yet known whether laser surgery works as well as standard methods of treatment.

Radiation therapy

Radiation therapy is treatment with high-energy rays (such as x-rays) to kill cancer cells and shrink tumors. External beam radiation focuses radiation from outside the body on the skin tumor.

Radiation may be used as the main (primary) treatment instead of surgery if the tumor is very large, or if it is in an area that makes surgery hard to do. It might also be used for older people who, because of poor health, cannot have surgery. In some cases, radiation can be used after surgery as additional (adjuvant) therapy to kill small deposits of cancer cells that may not be seen during surgery. This lowers the risk of cancer coming back after surgery. Radiation may also be used to treat non-melanoma skin cancer that has spread to lymph nodes or other organs.

Side effects of radiation include skin irritation, redness, and dryness. With longer treatments, these side effects may get worse. After many years, new skin cancers may start in areas that had been treated with radiation. Because of this, radiation is not usually used to treat skin cancer in young people.

Systemic chemotherapy

Systemic chemotherapy (or chemo) uses drugs that are injected into a vein or given by mouth. These drugs travel through the bloodstream to all parts of the body. In contrast to topical chemo, systemic chemo can attack cancer cells that have spread to lymph nodes and other organs.

Chemo drugs work by attacking cells that are dividing quickly. This is why they work against cancer cells. But other cells in the body divide quickly, too. These cells are also likely to be affected by chemo, which can lead to side effects.

The side effects of chemo depend on the type and dose of drugs given and the length of time they are taken. These side effects may include:

• hair loss
• mouth sores
• loss of appetite
• nausea and vomiting
• higher chance of infection (due to low white blood cell counts)
• easy bruising or bleeding (due to low blood platelets)
• fatigue (due to low red blood cells)

These side effects are usually short-term and go away once treatment is finished.

Be sure to talk with your doctor or nurse about any side effects you have because there are often ways to help. For instance, there are drugs to help prevent or reduce nausea and vomiting.