Local Treatments Other than Surgery for Basal and Squamous Cell Skin Cancers

Several techniques other than surgery can be used to treat basal and squamous cell skin cancers (or pre-cancers) that haven't spread beyond the skin. These include:

• Cryotherapy
• Photodynamic therapy (PDT)
• Topical chemotherapy
• Immune response modifiers
• Laser surgery
• Chemical peeling

These are called local treatments, and some are even described as types of surgery, because they destroy a targeted area of body tissue. But these techniques are different from surgery because they don’t use scalpels or cut into the skin. (Radiation therapy is also a type of local treatment.)

Cryotherapy (cryosurgery)

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

For this treatment, the doctor applies liquid nitrogen to the tumor to freeze and kill the cells. This is often repeated a couple of times in the same office visit. After the dead area of skin thaws, it will swell, blister and crust over.

The wound may have fluid draining from it for a while and take a month or two to heal. It will leave a scar, and the treated area may have less color after treatment.

Photodynamic therapy (PDT)

PDT can be used to treat actinic keratoses. But its exact role in treating basal and squamous cell skin cancers still needs to be determined.

This treatment uses a drug that is applied to the skin as a gel or liquid. The drug collects in the tumor cells over several hours or days, where it is converted to a different chemical that makes the cells very sensitive to certain types of light. A special light source is then focused on the tumor(s), which kills the cells. Another option to activate the drug, especially when large areas need to be treated, is to have the person go out into the sunlight for a specific amount of time (known as daylight PDT).

PDT can cause redness and swelling on the skin where it is used. Another 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.

To learn more about this technique, see Photodynamic Therapy.

Topical chemotherapy

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

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

When put directly on the skin, 5-FU kills tumor cells on or near the skin’s surface, but it can’t reach cancer cells deeper in the skin or those that have spread to other organs. For this reason, 5-FU is generally used only for pre-cancerous conditions such as actinic keratosis and for some very superficial skin cancers.

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

A very small portion of people have a condition called DPD deficiency, which makes it hard for their bodies to break down and get rid of 5-FU. This can result in serious or even life-threatening side effects. If you are applying 5-FU and have any reactions beyond those you were told to expect on your skin, call your doctor or nurse right away.

Diclofenac (Solaraze): A gel containing the drug diclofenac is sometimes used to treat actinic keratoses. This drug is part of a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs), which includes 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 can also take longer to work.

Immune response modifiers

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

Imiquimod (Zyclara) is a cream that can be applied to actinic keratoses and some very early basal cell cancers. It causes the immune system to react to the skin lesion and destroy it. It’s typically applied at least a few times a week for several weeks, although schedules can vary. Like other topical products, 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 might be an option when surgery isn’t possible, but it may not be as effective as other treatments.

Laser surgery

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

Chemical peeling

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