Treating Nonmelanoma Skin Cancer
Basal cell carcinoma and
squamous cell carcinoma, which are classified as nonmelanoma
skin cancers, account for approximately 96% of all diagnosed skin
cancers. Usually these cancers can be cured with minor surgery that
is safely performed in a medical office or outpatient setting under
The treatment method(s) used depends on the location, size, and
microscopic characteristics of the tumor as well as the patient’s
overall health, medical history, and age. When the diagnosis is
squamous cell carcinoma, whether or not the cancer has spread must
also be considered. Large tumors may require more extensive
treatment since the cancer tends to envelop much of the tissue as it
grows. Some squamous cell carcinomas, especially those on the lips
and ears, have a high risk of spreading. In these cases, surgery may
be followed by radiation or chemotherapy.
Cure rates range from 85% to 96% if the cancer has not spread. The
prognosis is poor once the cancer has spread.
Surgical and non-surgical methods used to treat these two skin
Curettage and electrodesiccation: Often used to treat small
basal cell and squamous cell tumors, this surgical procedure
involves scraping the tumor with a curette (a surgical instrument
shaped like a long spoon) and then using an electric needle to
gently burn or “cauterize” the remaining cancer cells and a margin
of normal-looking tissue. This scraping and cauterizing process is
typically repeated 3 times, and the wound tends to heal without
Curettage may be used alone or as the first part of a treatment plan
that uses two or more procedures. Curettage and electrodesiccation
is best suited for treating a primary lesion. It also may be useful
in treating some recurrent lesions; however, it is not very
effective in curing recurrent lesions found within scar tissue.
Cryosurgery: Used to treat some small primary basal cell and
squamous cell tumors as well as a few recurrent lesions, cryosurgery
involves freezing the tumor with liquid nitrogen or another cryogen
to a temperature of at least -50 degrees Celsius, which equals -58
degrees Fahrenheit. The frozen cancer cells are destroyed by the
freezing and slough off, allowing the underlying normal skin to
heal. Local anesthesia is usually required because this freezing is
much more intense than when cryosurgery is used to treat actinic
keratoses (lesions that can form after many years of sun exposure
and have the potential to progress to squamous cell carcinoma).
Cryosurgery is often recommended when a patient has a bleeding
disorder or another form of surgery is not advisable. However,
cryosurgery is not appropriate for all skin cancers. When a tumor is
large or freezing could cause a nearby area to become deformed,
cryosurgery is not recommended.
The cure rate when performed by a dermatologist who is trained and
experienced in cryosurgery is generally very good.
Excision: Also known as simple surgical excision, this
surgical procedure is used to treat both primary and recurrent
tumors. It consists of surgically removing the tumor and an area of
healthy looking skin (margin) around the tumor. In some cases, the
wound does not require treatment and is allowed to heal on its own.
When closure is necessary, the wound may be closed with stitches,
skin from another area of the body (skin graft), or healthy skin
moved from a nearby area (skin flap). After surgery, the excised
tissue is examined under a microscope to see if any cancer cells
were present in the skin that appeared cancer free. This is the same
procedure used to perform an excisional biopsy; however, a
wider area of tissue is removed during simple surgical excision.
Laser surgery: Laser surgery may be used in certain cases to
vaporize superficial and multiple basal cell carcinomas and to
excise or destroy squamous cell carcinoma. Laser surgery does not
destroy cancer cells found deeper in the skin so close follow-up
with a dermatologist is important.
Mohs micrographic surgery: This highly specialized surgical
technique involves first removing the visible tumor and then
successive layers of skin one at a time until microscopic
examination no longer reveals cancer cells. This surgery is
performed while the patient is under local anesthesia. Removing and
examining each layer takes about one hour, with much of this time
spent looking at the removed skin. Once skin cancer is no longer
visible, the surgical wound is treated as needed. Methods include
allowing the wound to heal naturally, closing the wound with
stitches, covering the surgical site with skin from another area of
the body (skin graft), and moving healthy skin from a nearby area to
cover the surgical wound (skin flap).
Mohs surgery may be an effective treatment for most skin cancers.
However, the length and intensity of this surgical procedure
typically limit its use to treating recurring skin cancer; larger
tumors; areas where it is essential to preserve as much skin as
possible, such as an ear, eyelid, nose, lip, or hand; tumors in
which it is difficult to determine where the cancer ends; and sites
prone to recurrence. Mohs surgery has the highest reported five-year
cure rate for both basal cell and squamous cell carcinoma.
When one of the above surgical methods is not appropriate due to the
location of the tumor, patient’s medical history, or another factor,
the following treatment methods are considered. Some of these
methods, such as chemotherapy and radiation, may be used after
surgery to attack cancer cells that may not be removed with surgery.
Chemotherapy: If squamous cell carcinoma spreads beyond the
skin to the lymph nodes or to other organs, systemic (affects
entire body) chemotherapy may be used to kill the cancer
cells. In systemic chemotherapy, a cancer medication is taken orally
(by mouth), injected, or infused so that it can travel through the
body and kill the cancer cells. Chemotherapy also destroys normal
cells, and this can lead to side effects, such as nausea and hair
loss. Once chemotherapy stops, the side effects usually disappear.
Immunotherapy: Immunotherapy uses the patient’s own immune
system to fight the cancer. In mid-2004, a topical (applied to the
skin) medication called imiquimod was approved by the U.S.
Food and Drug Administration (FDA) for patients who have superficial
basal cell carcinoma (one of the four types of basal cell carcinoma)
and a normal immune system.
Imiquimod comes in cream form and is approved for treating
superficial basal cell carcinoma (sBCC) tumors with a maximum
diameter of 2.0 centimeters. Use is limited to certain areas of the
body. Patients typically apply the cream once a day for
approximately 5 to 7 weeks. If imiquimod is an option, your
dermatologist will determine how often imiquimod should be applied.
As the medication works, local skin reactions, such as redness,
swelling, erosion, scabbing, scaling, and crusting occur. These are
a normal and expected part of treatment. In a recent research study,
a few patients with sBCC experienced headache, upper respiratory
tract infection, or back pain. Patients must be willing to apply the
medication as instructed and return for follow-up visits. The
dermatologist will need to examine the area to see if the tumor has
been destroyed. This determination should not be made by the
patient, patient’s family, or friends.
It is important to know that imiquimod does not work for every
patient, and another form of therapy may be necessary. The ability
of imiquimod to sustain long-term clearance is still not known, and
ongoing studies are evaluating the long-term effectiveness of this
Radiation therapy: Radiation may be used to treat an older
adult who has a large tumor; tumors that cover a large area; or a
tumor that is difficult to surgically remove because of location,
such as one on an eyelid, nose, or ear. Radiation therapy gradually
destroys the cancer cells through repeated exposure to radiation.
Usually, 15 to 30 treatments are needed.
Treatment is typically reserved for older adults because radiation
has been shown to cause skin cancer years after exposure. Side
effects can include the skin becoming dry, red and itchy;
hairlessness near the treated area; and greater susceptibility to
infection. Nausea, diarrhea, or vomiting may be seen when the
treated area is near the abdomen. After treatment, fatigue can
The purpose of palliative care is to relieve symptoms and improve a
patient’s quality of life, not cure the cancer. Patients with all
stages of cancer may receive palliative care. For example, a
medication used to control nausea during chemotherapy is a form of
palliative care because it is treating a symptom not the cancer.
Patients with advanced cancer and those who chose not to fight the
cancer often receive palliative care to help control the symptoms
Researchers continue to look for more effective and safe methods for
treating basal cell and squamous cell carcinoma. While many new
treatments are being explored, the following methods are currently
being studied in large clinical trials or have some clinical use:
Immunotherapy: Imiquimod, which is currently FDA approved for
the treatment of superficial basal cell carcinoma and actinic
keratoses, is being evaluated for its effectiveness in treating
squamous cell carcinoma and nodular basal cell carcinoma (one of the
four types of basal cell carcinoma). The ability of imiquimod to
sustain long-term clearance also is being studied.
Photodynamic therapy: This form of therapy treats the tumor
with a photosensitizing chemical. Treatment consists of two phases.
First, the photosensitizing chemical, which is allowed to interact
with the tumor for several hours, is applied. During the second
phase, the treated area is then exposed to light of a certain
wavelength. This may be useful for treating superficial basal cell
and squamous cell carcinomas.
Follow up and Prevention: Key Part of Treatment
While both basal cell and squamous cell carcinoma have high cure
rates when the cancer is detected and treated early, these skin
cancers can recur. Those who have had one or more skin cancer lesion
are at increased risk of developing another one within the next year
or so. For these reasons, skin cancer patients should:
If you notice a new lesion or believe
that the removed tumor has recurred, see a dermatologist
immediately. Early detection and removal offer the best chance for a
American Academy of Dermatology’s Guidelines of Care for Basal
American Academy of Dermatology’s Guidelines of Care for Cutaneous
Squamous Cell Carcinoma
Geisse, J et al. “Imiquimod 5% cream for the treatment of
superficial basal cell carcinoma: Results from two phase III,
randomized, vehicle-controlled studies.” Journal of the American
Academy of Dermatology. 2004 May;50(5):722-33.
content solely developed by the American Academy of Dermatology
Both basal cell
carcinoma and squamous cell carcinoma have a better
than 95% cure rate if detected and treated early.
2004 Facts & Figures