Learning about your treatment choices

You may have questions and concerns about your treatment choices. You may also want to know how you’ll feel and function during and after treatment, and if you’ll have to change your normal activities.

Your healthcare provider is the best person to answer your questions. They can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your healthcare provider may advise a specific treatment. Or they may offer more than one and ask you to decide which one you’d like to use.

You may have just one treatment or a combination of treatments.

In some cases, you may elect to have no treatment. This may be a reasonable choice in elderly or frail patients with no symptoms. Be sure to discuss the risks of this choice with your healthcare provider before declining treatment.

Types of treatment for nonmelanoma skin cancer

Surgery

Surgery is a common treatment for nonmelanoma skin cancer. It' s used in most cases when the cancer is still at an early stage. Many skin cancers can be removed easily and need only very minor surgery. Others may need a more extensive surgery. The surgery choices include:

• Simple excision. This is done to cut the cancer from the skin using a scalpel blade, along with some of the healthy tissue around it (edges of tissue are called the surgical margin).

• Curettage and electrodesiccation. The surgeon scrapes the tumor from the skin using a sharp, spoon-shaped instrument called a curette. Then they use a needle-shaped electrode to stop bleeding and kill any cancer cells that may have been left behind in the edges of the wound.

• Mohs surgery. This procedure removes the cancer and as little normal tissue as possible. It’s done in sensitive areas, such as the head, face, and hands. During this surgery, the surgeon removes a thin layer of skin including the cancer and then uses a microscope to make sure no cancer cells remain. If cancer cells are seen, another layer of skin is removed. This is repeated until all of the cancer has been removed.

• Cryosurgery. This procedure uses extremely cold liquid, like liquid nitrogen or a tool called a cryroprobe, to freeze the tissue and kill cancer cells.

• Laser therapy. The surgeon uses a narrow beam of intense light to burn away cancer cells.

Chemotherapy

Chemotherapy is done with medicines. With nonmelanoma skin cancer, chemotherapy is most often done by applying a topical strong medicine to the skin to kill cancer cells. Basal cell cancer rarely spreads, and IV or oral medicine is not often used for it. Squamous cell cancer can sometimes spread. If this happens, medicines may be given through an IV or by mouth. Chemotherapy may be given with radiation therapy or alone.

Targeted therapy

Targeted therapy is also done with medicine, but it works differently than chemotherapy. It also can have different side effects. The medicine targets specific parts of cancer cells. In rare cases of locally advanced basal cell cancer, or where surgery or radiation can’t be used, a basal cell cancer may be treated with a targeted medicine, such as oral medicines called vismodegib or sonidegib. Squamous cell skin cancer can be treated with targeted therapy, such as an EGFR (epidermal growth factor receptor) medicine to keep cancer cells from growing.

Radiation therapy

Radiation therapy uses high energy X-rays or other types of radiation sources. The goal of this treatment is to kill cancer cells. In some cases, this treatment is used instead of surgery. It can also be used to get rid of any cancer cells that may be left after surgery. Radiation treatment is noninvasive (it does not need cutting the skin) but usually needs many treatments and may not be as reliable as other treatment choices. Chemotherapy may be used with radiation for some squamous cell skin cancers.

Photodynamic therapy

The goal of this treatment is to kill cells at the cancer site by using a medicine to make the cells more sensitive to a special laser light. This limits damage to healthy tissue. This therapy is occasionally used for nonmelanoma skin cancer or precancers. For more information, ask your healthcare provider about this therapy.

Immunotherapy

This type of therapy is done with medicines. The medicines use chemicals that stimulate the immune system. .The medicine uses your body’s immune defense to attack the cancer cells. The treatments can be given as a topical cream that is applied on the tumor, such as imiquimod for superficial basal cell skin cancers. Medicines that target PD-1 receptors on cancer cells are a type of immune checkpoint inhibitor, and may be used for some squamous or basal cell skin cancers.

Clinical trials for new treatments

Researchers are always finding new ways to treat cancer. These new methods are tested in clinical trials. Talk with your healthcare provider to find out if there are any clinical trials you should consider.

Talking with your healthcare provider

At first, thinking about treatment choices may seem overwhelming. Talk with your healthcare providers, nurses, and loved ones. Make a list of questions. Consider the benefits and possible side effects of each choice. Discuss your concerns with your healthcare provider before making a decision.