Treatment

Surgery is the main treatment for non-melanoma skin cancer, although it may depend on your individual circumstances.

Non-surgical treatments, such as cryotherapy, anti-cancer creams, photodynamic therapy (PDT) , Radiotherapy and electrochemotherapy, are also used in certain circumstances.

Overall, treatment is successful for at least9 out of 10 people with non-melanoma skin cancer.

If you have skin cancer, yourspecialist care team may include a dermatologist, a plastic surgeon, aradiotherapy and chemotherapy specialist (an oncologist), a pathologist and a specialist nurse.

If you have non-melanoma skin cancer, you may see several (or all) of these specialists as part of your treatment.

When deciding which treatment is best for you, your doctors will consider:

• the type ofcancer you have
• the stage of your cancer (its size and how far it's spread)
• your general health

Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.

Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions you'd like to ask the specialist.

For example, you may want to find out what the advantages and disadvantages areof particular treatments.

Surgical excision

Surgical excision is anoperation tocut out the cancer along with surrounding healthy tissue to ensure the cancer is completely removed.

It may be carried out in combination with a skin graft , which involves removing a patch of healthy skin, usually from a part of the body where any scarring can't be seen, such as your neck, abdomen or upper thigh. It's then connected (grafted) to the affected area.

In most cases, surgery is enough to cure non-melanoma skin cancer.

Mohs micrographic surgery

Mohs micrographic surgery (MMS) is a specialist form of surgery used to treat non-melanoma skin cancers when:

• it's felt there's a high risk of the cancer spreading or returning
• the cancer is in an area where it would be important to remove as little skin as possible, such as the nose or close to the eyes

MMS involves surgical excision of the tumour and a small area of surrounding skin.

The edges are immediately checked under a microscope to make sure all the tumour has been completely removed.

If it hasn't, further surgery is carried out, usually on the same day. This minimises the removal of healthy tissue and reduces scarring while ensuring that the tumour has been completely removed.

Curettage and electrocautery

Curettage and electrocautery is a similar technique to surgical excision, but it's only suitable in cases where the cancer is quite small.

The surgeon will use a small spoon-shaped or circular blade to scrape off the cancer before burning (cauterising) the skin to remove any remaining cancer cells and seal the wound.

The procedure may need to be repeated two or three times to ensure the cancer is completely removed.

Cryotherapy

Cryotherapy uses cold treatment to destroy the cancer. It's sometimes used for non-melanoma skin cancers in their early stages.

Liquid nitrogen is used to freeze the cancer, and this causes the area to scab over.

After about a month, the scab containing the cancer will fall off your skin. Cryotherapy may leave a small white scar on your skin.

Anti-cancer creams

Anti-cancer creams are also used for certain types of non-melanoma skin cancers, but are only recommended when the tumour is contained within the top layer of the skin, such as early basal cell carcinoma and Bowen's disease .

There are two main types of anti-cancer cream:

• chemotherapy creams these contain a medication called 5-fluorouracil
• immune stimulating creams these contain a medication called imiquimod

For non-melanoma skin cancer, chemotherapy creams containing 5-fluorouracil are used.

The cream isapplied to the affected area for a number of weeks.

As only the surface of the skin is affected, you won't experience the side effects associated with other forms of chemotherapy, such as vomiting or hair loss. However, your skin may feel sore for several weeks afterwards.

Imiquimod cream is used to treat basal cell carcinomas with a diameter of less than 2cm (0.8 inches). It's also used to treat actinic keratoses and Bowen's disease.

Imiquimod encourages your immune system to attack the cancer in the skinand is used over a number of weeks.

Common side effects of 5-fluorouracil cream and imiquimod include redness, flaking or peeling skin and itchiness. Less common and more serious side effects include blistering or skin ulceration.

Photodynamic therapy (PDT)

Photodynamic therapy (PDT) is used to treat basal cell carcinoma, Bowen's disease and actinic keratoses. It involves using a cream that makes the skin highly sensitive to light.

After the cream has been applied, a strong light source is shone on to the affected area of your skin, which kills the cancer.

PDT may cause a burning sensation and may leave scarring, although this is usually less than for surgery.

Radiotherapy

Radiotherapy involves using low doses of radiation to destroy the cancer. The level of radiation involved is perfectly safe. However, your skin may feel sore for a few weeks after radiotherapy.

Radiotherapy is sometimes used to treat basal cell and squamous cell carcinomas if:

• surgery would be unsuitable
• the cancer covers a large area
• the area is difficult to operate on

Radiotherapy is sometimes used after surgical excision to try to prevent the cancer coming back. This is called adjuvant radiotherapy.

Electrochemotherapy

Electrochemotherapy is a possible treatment for non-melanoma skin cancer.

It may be considered if:

• surgery isn't suitable or hasn't worked
• radiotherapy and chemotherapy haven't worked

The procedure involves giving chemotherapy into the tumour or sometimes directly into a vein (intravenously).Short, powerful pulses of electricity are then directed to the tumour using electrodes.

The electrical pulses allow the medicine to enter the tumour cells more effectively and cause more damage to the tumour.

The procedureis usuallycarried out using general anaesthetic , where you're unconscious, but some people maybe able to havelocal anaesthetic,where you're conscious but the area is numbed.

Depending on how many tumours need to be treated, the procedure can take up to an hour to complete.

The main side effect is pain where the electrode was used, which can last for a few days and may require painkillers.

Ittakes around six weeks for results to appearand the procedure usually needs to be repeated.

Your specialist can give you more detailed information about electrochemotherapy.

You can also read the 2013 National Institute for Health and Care Excellence (NICE) guidance about electrochemotherapy for metastases in the skin .