Treatment of Non Melanoma

Treating skin cancer

The treatment of non melanoma depends on the type and seriousness of the cancer.

It is important to remember that both basal cell cancer (BCC) and squamous cell cancer (SCC) are very curable and in the majority of cases (around 95%) need no more than the offending area scraped or cut away.

Surgery is certainly the most common form of treatment. This is usually done under local anaesthetic and the tumour and some of the surrounding tissue is removed. The wound is then stitched up.

When the skin cancer is larger and stitching is not an option, a skin graft may be needed. This usually involves taking skin from the thigh area.

Sometimes with a SCC, surgeons remove surrounding lymph nodes as this type of cancer can, in rare cases, spread to surrounding body tissue if left untreated.

Radiotherapy is another common treatment for non melanomas which cover a large area of the skin - in particular BCCs. It's a very specific treatment, targeting the affected area with X-rays aimed specifically at destroying the cancer cells and leaving the healthy ones alone. It is often a preferred option for elderly patients, who might find surgery distressing. But because of its tendency to burn and sensitise the skin it's not suitable for certain parts of the body such as small surface areas like ears or areas which have already been treated with radiotherapy.

One of the newest forms of treatment is photodynamic therapy (PDT). This involves the use of laser light treatment and light sensitive drugs on the specific area to burn away and destroy the cancer cells. Often only one treatment lasting about 40 minutes is needed, although sometimes a further two or three treatments may be necessary. Like radiotherapy it is an ideal treatment for non melanomas on areas such as the face where surgery could be disfiguring. It is most commonly used for BCCs.

A technique known as Mohs' Surgery is highly specialised and not widely available. Named after its founder Fred Mohs it involves cutting away the cancer in stages and analysing the samples under a microscope. This is continued until the surgeon can be sure all the cancer has been cut away. This can be done over the course of a day or sometimes several days and the wound is usually repaired by stitching or using a skin graft. It can be used for both basal cell cancer and squamous cell cancer.

Some very small non melanomas which affect only the top layer of the skin can be removed through freezing with a technique called cryotherapy. Liquid nitrogen is sprayed onto the affected area to freeze away any cancer cells during a period of about a month. Sometimes more than one treatment is necessary. Cryotherapy has been successful for both BCCs and SCCs.

Chemotherapy is not usually used to treat non melanomas but in some cases it's applied as a topical cream to small superficial cancers. The most common drug used is 5 fluoro-uracil - a strong combination of chemicals which kill off the cancer cells lying in the top layer of the skin.

For some small BCCs, cautery and curettage is performed. The doctor uses a spoon like instrument (curette) to scrape away the lesion and then the base of the wound is cauterised to destroy any remaining cells.


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