About a million people in the United States are diagnosed with skin cancer every year. It is the most common type of cancer in the U.S. According to current estimates, 40 to 50 percent of Americans who live to age 65 will have skin cancer at least once. Although anyone can get skin cancer, the risk is higher if you have fair skin that freckles easily, often with red or blond hair and blue or light-colored eyes.
Types of skin cancer include melanoma, basal cell carcinoma and squamous cell carcinoma.
The risk of developing skin cancer is affected by where you live. People who live in areas that get high levels of UV radiation from the sun are more likely to get skin cancer. In the United States, for example, skin cancer is more common in Texas than it is in Minnesota, where the sun is not as strong. Worldwide, the highest rates of skin cancer are found in South Africa and Australia, areas that receive high amounts of UV radiation.
The Main Treatments
The main treatment for skin cancer is surgery. For most people, this will be all the treatment you need.
Radiotherapy can also be used to treat and cure skin cancers. This is sometimes used instead of surgery if an operation is not suitable for any reason. It can also be given after surgery to reduce the risk of the cancer coming back.
Another alternative to an operation is treatment with a drug to make your skin light sensitive, followed by treatment with bright light. This is photodynamic therapy (PDT).
Most basal cell and squamous cell cancers can be successfully treated with surgery. And in most cases, the surgery is minor. The area is completely removed, often under local anaesthetic. For other situations, there are several different types of surgical technique that can be used. What is done will depend on
- The type of cancer you have
- The size of the cancer
- Where the cancer is
- The stage of the cancer (if relevant)
For skin cancer diagnosis and treatment, you should be referred to a dermatologist. If you have a skin cancer that covers a wide area or is awkward to remove, you may be operated on by a plastic surgeon.
Small cancers are often operated on under local anaesthetic. For a larger cancer, you may have a general anaesthetic. If the cancer covers a large area, you may need to have a skin graft or a more complicated repair called a skin flap. A flap is a thicker piece of skin tissue that is removed together with its own blood supply.
If there is definite cancer spread to nearby lymph nodes, your surgeon will need to remove them. You will have this done under general anaesthetic. In some cases, if your doctor thinks there is a high chance of cancer spread, you may have the lymph nodes removed even though there is no sign of actual spread. A few cancer cells can be missed. But they can still go on to develop into new tumours and spread further to other parts of the body.
Radiotherapy can be used to treat basal cell or squamous cell cancers. It is most likely to be used if
- The cancer covers a wide area
- It is in an area that is difficult to operate on
- There are other reasons why surgery is a problem, for example very elderly or unfit patients
In some situations, radiotherapy may be used as well as surgery. It may be used after surgery if there is a risk that cancer cells may have been left behind. This is called adjuvant treatment. It reduces the risk of the cancer coming back in the future.
Radiotherapy can also be used to treat cancer that has spread to lymph nodes. In advanced cancers, which have spread to another part of the body, radiotherapy can be used to relieve symptoms. It is also used to treat cancers that have come back (recurred) after they were first treated with surgery.
Chemotherapy tablets or injections are only used in certain circumstances for skin cancer. More often, chemotherapy creams are used
- To treat actinic keratosis
- For skin cancers that are only on the top layer of the skin
Solar or actinic keratosis can sometimes develop into squamous cell skin cancer if it is not treated. Chemotherapy cream containing 5FU is a common treatment. Bowen’s disease is also sometimes treated with chemotherapy cream.
Chemotherapy tablets or injections are only used for skin cancers that have spread. This treatment is mostly used to relieve symptoms in cancers that cannot be cured. This is still experimental treatment and you may be asked to take part in a clinical trial.
Photodynamic therapy (PDT)
This is a relatively new type of treatment. It is another alternative to surgery. In February 2006, the National Institute of Health and Clinical Excellence (NICE) issued guidance on PDT for skin cancers. They say there is good enough evidence to use it for several types of skin cancer. They don’t recommend it for squamous cell skin cancers because there is not enough good evidence that it can control the spread of the disease and too high a risk of the cancer coming back. PDT using a cream is now available on the NHS for Bowen’s disease, basal cell skin cancers and actinic keratosis (also called solar keratosis).
NICE say that PDT is best used in cases where you would need a lot of surgery. So it is best for large skin cancers that are not too deep, or where there are several cancers in an area. PDT is not suitable for deeper skin cancers because the light cannot penetrate far enough into the skin. In the trials NICE looked at, the appearance of the treated area after PDT was better than after surgery.
Retinoids are chemicals similar to vitamin A. Tretinoin is a type of retinoid that is rarely used to treat basal cell and squamous cell cancers and solar keratosis. It can be taken in tablet form or applied to the area in a cream. It works by encouraging the cancerous cells to change back into normal cells. It is unclear how effective it is.
Retinoid treatment can cause redness and skin peeling. This usually settles down within a couple of days. You should keep the treated skin out of the sun.
You can read more about retinoid treatment in the skin cancer research section.
Note: You cannot have retinoid treatment if you are pregnant. You are not allowed to give blood while you are having retinoid treatment.
Interferon is a type of immunotherapy. These treatments are designed to stimulate the body’s immune system so that it can pick out and fight cancer cells more effectively. Interferon is sometimes used to treat advanced squamous cell cancers that started inside the nose, mouth or elsewhere in body tissues inside the head and neck. There is information about the specific side effects of interferon in CancerHelp UK.
Imiquimod cream (Aldara) is a new type of treatment for the most common form of skin cancer, basal cell carcinoma (BCC). Imiquimod cream uses the immune system to attack cancers. This means it uses the body’s natural defences to kill the cancer cells in the skin. It does this by releasing interferon. The idea is that the imiquimod makes cells produce more interferon, and this then destroys the skin cancer cells.