Skin Cancer Treatment By Type
Reviewed by: HU Medical Review Board | Last reviewed: January, 2022. | Last updated: March 2022
The goals of skin cancer treatment are: (1) remove the tumor and (2) kill any additional cancer cells that may cause the cancer to recur or spread. Treatment is selected based on cancer type, stage, your overall health, and other factors. Options can generally be categorized:
- Surgery
- Other local treatments
- Radiation therapy
- Topical medications
- Systemic medications
Some people use complementary medicine together with conventional treatment. These approaches include:
- Mind-body practices
- Natural products and supplements
- Alternative healing practices
Some of these practices can be used safely. They may reduce stress or side effects and improve well-being. Others may have harmful interactions with medications. If you are considering complementary treatments, it is important to discuss with your doctor any complementary practices you may take part in to ensure that nothing interferes negatively with your treatment, or causes unsafe side effects.
Evaluate claims about home remedies that cure cancer with skepticism, as they do not. Effective treatments should be supported by good science and you should develop a plan with your physician. Delaying effective treatment for skin cancer can lead to worse outcomes.
Non-melanoma skin cancer
Non-melanoma skin cancer includes basal cell carcinoma and squamous cell carcinoma. These lesions are often treated in the doctor’s office with relatively minor surgery.1 The specific type of surgery depends on the location of the tumor and likelihood of recurrence. More details on non-melanoma treatment:
Excision. Your doctor will cut out (excise) the tumor using a surgical knife. When an elliptical (football shaped) incision is made, the scar will be a flat, thin line. Narrower margins are used for tumors that are unlikely to recur. Wider margins are used for tumors that are more likely to recur.2,3 However, for tumors at high risk of recurrence, Mohs surgery is preferred.
Mohs surgery. A specially trained surgeon performs Mohs surgery. The surgeon removes one layer of skin at a time until all the cancer cells have been removed. This surgical procedure has the highest cure rates: the 5-year recurrence rate is approximately 1%.4 It also saves the most healthy skin. Mohs surgery can be a good option for large, invasive, or prominent tumors.
Other local treatment procedures. Local procedures that may be used to remove some thin, low-risk non-melanoma skin cancers include curettage and electrodesiccation, cryotherapy, and photodynamic therapy.
Topical medications. Fluorouracil and imiquimod may be used to treat some non-melanoma skin cancers that affect only the very top layers of skin. However, it is more common to use topical medications to treat precancers.1,4
Radiation therapy.Radiation therapy is a treatment option when surgery is not possible. It may be used as adjuvant therapy when the risk of recurrence is high. Adjuvant therapy is a second treatment given after the primary (main treatment, such as surgery). Adjuvant therapy may help reduce the risk of recurrence.
Systemic medications. Two targeted therapies are available for people with certain forms of advanced basal cell carcinoma: Erivedge® (vismodegib) and Odomzo® (sonidegib). These are oral medications taken by mouth. Cemiplimab-rwlc (Libtayo®) and pembrolizumab (Keytruda®) may be used to treat people with certain forms of advanced cutaneous squamous cell carcinoma. Cemiplimab-rwlc (Libtayo®) may also be used to treat people with certain forms of advanced basal cell carcinoma.
Melanoma
Melanoma varies considerably in type, stage, genetic alterations, and location. Treatment selection depends on all these factors. The main treatment options are summarized here.
Excision. The first choice of treatment for local melanoma is wide excision.5,6 Margin width depends on the thickness of the tumor.
Lymph node dissection. If the cancer has spread to the lymph nodes, your doctor may recommend additional surgery. Removal of the lymph nodes is called lymph node dissection.
Topical medication. Topical imiquimod may be used to treat certain forms of early stage melanoma or melanoma that is only found in the skin.6
Systemic medications. Medications administered to the whole body (systemic medication) may be used for primary or adjuvant treatment if the cancer has spread. Several different types of medication are available. Immunotherapy turns your immune system against the cancer. Targeted therapy aims at the abnormal mutations that lead to uncontrolled cell growth. Chemotherapy is often less effective than newer medications, but remains an option in some circumstances.
Intralesional medication.Talimogene laherparepvec is a medication injected into the tumor. It is an oncolytic virus that makes copies of itself in cancer cells.7 It is used to treat certain forms of melanoma in the skin and lymph nodes. Another intralesional therapy, the Bacillus Calmette-Guerin vaccine, is used less often.
Radiation therapy.Radiation therapy is sometimes used to treat the lymph node region after the lymph nodes are removed. Radiation therapy kills cancer cells that remain. In some circumstances, radiation therapy is a primary treatment for melanoma. It is also used to relieve symptoms of cancer metastasis (spread).
Merkel cell carcinoma
Merkel cell carcinoma is a rare, aggressive cancer. Treatment options and outcome data are somewhat limited.
Excision. The first choice of treatment for early stage Merkel cell carcinoma is wide excision.8
Lymph node dissection. If the cancer has spread to the lymph nodes, your doctor may recommend removing them.
Radiation therapy.Radiation therapy may be used as adjuvant treatment. It may be used to treat the tumor site after excision or to treat the area where lymph nodes were removed. In some cases, radiation therapy is the primary treatment if surgery is not possible.8
Systemic medications. If Merkel cell carcinoma is advanced or spreads to distant parts of the body, systemic medications may be an option. Bavencio® (avelumab) is the first drug specifically approved for metastatic Merkel cell carcinoma.9 It is a type of immunotherapy. Chemotherapy also may be used to treat Merkel cell carcinoma.8 Keytruda® (pembrolizumab) is another immunotherapy medication that may be used to treat recurrent (has come back after treatment) locally advanced or metastatic Merkel cell carcinoma.
Kaposi sarcoma
Treatment of Kaposi sarcoma is different from treatment of other skin cancers. Part of treatment for AIDS-related Kaposi sarcoma is treatment for HIV infection. Improving immune function with antiretroviral therapy may reduce the size of Kaposi sarcoma lesions.10
The treatment goals for Kaposi sarcoma are also different from other skin cancers. The goal of treating Kaposi sarcoma is to reduce symptoms. The aim is not to remove all the cancer cells or to prolong survival.11 Treatment is selected based on the type of Kaposi sarcoma, how many lesions you have, and your overall health.
Local treatment procedures. Local procedures used to shrink or eliminate lesions include curettage and electrodesiccation, cryotherapy, and photodynamic therapy.
Topical medication.Topical retinoid gel (brand name: Panretin; generic name: alitretinoin) can be used to treat Kaposi sarcoma skin lesions. It is only used if systemic therapy is not needed. More than one-third of patients have an improvement in lesions.12
Excision. For a person with a only a few small lesions, cutting (excising) the lesion may be an option.
Radiation therapy. Radiation therapy treats lesions on the skin and in the mouth.
Chemotherapy.Chemotherapy may be injected into the lesion. In other cases, it is used carefully for systemic (whole-body) treatment.
Immunotherapy.
Cytokine immunotherapy with interferon-alfa is occasionally used for patients with no systemic symptoms, limited lymph node disease, and fairly good immune function.13 Pomalidomide (Pomalyst®) may be used to treat Kaposi sarcoma in certain patients who are HIV negative, or certain patients with Kaposi sarcoma related to having AIDS where highly active antiretroviral therapy (HAART) is not working anymore.
