The skin is the largest organ in the body and comprises different types and layers of cells. Skin cancer can originate in any of these layers. Based on where skin cancer begins, there can be different types of cancer. The three most common types include basal cell carcinoma, squamous cell carcinoma and melanoma. Skin cancers usually begin on sun-exposed surfaces of the body, including hands, legs, feet and face.
This cancer is also common in people with lighter skin colour. Other less-common skin cancers are Merkel Cell Carcinoma and Kaposi’s Sarcoma. Skin cancer treatment options depend upon the type, location, and cancer stage. Skin cancer life expectancy is higher when diagnosed early and treated promptly.
Most non-melanoma and early-stage skin cancers can be treated in outpatient settings, while those with advanced-stage cancers may require newer treatments like immunotherapy.
Skin Cancer Treatment Options
Early-stage skin cancers can be successfully treated with less chance of recurrence. Treating advanced-stage skin cancers is challenging. Standard treatment options used for skin cancer include:
Surgery is a standard treatment option for skin cancers and aims to remove the cancerous cells. The type and extent of surgery depend upon the type of skin cancer, its size and location. Early-stage skin cancers are be easily removed by surgery and may not require any additional treatments.
Surgery is the treatment of choice for basal cell and squamous cell carcinomas. There are different types of surgical procedures available for skin cancer treatments, and these include– Mohs surgery, cryosurgery, curettage and electrodissection, and laser surgery.
External radiation therapy (uses an external radiation source) is used in treating basal cell and squamous cell carcinomas of the skin. This treatment uses high-energy radiation to stop the progression of cancer cells or kill them. When the skin cancer is in highly-aesthetic areas like the tip of the nose, eyelid or the outer ear that are hard-to-treat, surgery may not be recommended as it causes scars. So, these cases are treated by radiation therapy.
This therapy may also be used after surgery, especially when lymph nodes are involved or there is a high chance of cancer recurrence. This therapy is also used as adjuvant therapy in Stage I and Stage II Merkel cell cancers.
After radiation therapy, you may experience some side effects like skin rash, itching, inflammation, or skin colour changes. Ask your doctor about the same before beginning treatment to prepare yourself better. However, radiation therapy is not recommended for people with nevoid basal cell carcinoma syndrome.
Chemotherapy for skin cancers uses potent anti-cancer drugs that can be applied topically (for localised cancers) or injected into a vein for squamous cell carcinomas that have spread to other body parts. Usually, a combination of drugs is given during chemotherapy.
Topical chemotherapy drugs like fluorouracil may be used in early-stage squamous cell carcinomas that affect only the upper layers of the skin. It may also be effective in treating actinic keratosis and basal cell carcinomas. Your doctor will instruct you about the frequency of topical application of this chemotherapeutic drug.
Intravenous chemotherapy may be given in advanced, metastatic squamous cell carcinomas of the skin to slow down disease progression, relieve your symptoms and improve your quality of life.
Chemotherapy and skin cancer can cause a host of side effects. It is best to speak to your doctor about the same and know what to expect during your treatment.
Immunotherapy is a new-age biological treatment that uses your immune system to kill cancer cells. The drugs used to stimulate the immune system cells are called immunomodulators.
This is a new-age therapy that uses a combination of a light-sensitive drug and a bright light to kill cancer cells. Photodynamic therapy is also called photoradiation, phototherapy or photochemotherapy. There are different types of photosensitive medications used in this treatment. When these drugs are exposed to a particular wavelength of light, they produce oxygen, killing nearby cells.
While this therapy kills cancer cells, it may also damage blood vessels within the tumour. Research has also stated that photodynamic therapy may stimulate the immune system to attack cancer cells.
During photodynamic therapy, your doctor will apply a drug-containing topical cream on the affected area and use a special light to initiate the process. A tablet or injection containing the drug may also be given in some cases.
Photodynamic therapy is recommended in some basal cell carcinomas, squamous cell carcinoma in-situ and actinic keratosis. It may also be recommended if skin cancer surgery can cause scarring or if your skin cancer is superficial. Some recent studies have shown promising results for photodynamic therapy in treating skin cancers. However, this treatment is not recommended in the deep basal cell, and squamous cell carcinomas as the light does not penetrate the deeper skin layers.
Treating Different Types of Skin Cancers
From the several available treatments for skin cancer, your doctor and multidisciplinary health care team will select the most suitable plan for you. Your symptoms, signs and diagnostic test results will guide them about how to treat your skin cancer. Localised and early-stage cancers are easy to treat, but stage 4 skin cancer can be challenging.
The treatment options for different types of skin cancers vary and may include:
- Basal Cell Carcinoma
Very early-stage basal cell carcinomas are treated by surgery. In some patients, freezing or light therapy may be used as an alternative to surgery. In some people, radiation therapy may be the only treatment for basal cell carcinoma or may be used after surgery.
It is best to treat basal cell carcinomas early to prevent their spread into the deeper layers of the skin. The treatment for advanced basal cell carcinomas that have spread to other body parts includes surgery, followed by radiation therapy. Clinical trials may be recommended to some patients.
- Squamous Cell Carcinoma
Most people with squamous cell carcinoma of the skin require surgery and radiation therapy in the early stages. Radiation therapy is recommended when the squamous cell carcinoma is considered high-risk for metastasis (spread to other parts of the body). Advanced stage squamous cell carcinoma requires a combination of surgery, radiation therapy, and immunotherapy. Your doctor may also recommend you sign up for a clinical trial for newer, more effective treatment.
Melanoma is rare skin cancer but has a high chance of spreading (metastasising). The standard treatment options for melanomas include surgery, chemotherapy, radiation therapy, immunotherapy and targeted therapy. Newer treatments that are being used to treat melanoma include vaccine therapy.
Stages 0, 1 and 2 are usually treated with surgery. Stage 3 melanoma may require additional treatment like immunotherapy, targeted therapy or vaccine therapy after surgery. Stage 3 melanomas that cannot be surgically treated may require chemotherapy, radiation therapy, or oncolytic virus therapy.
In stage 4 melanoma, treatment aims to eliminate as much cancerous tissue as possible, improving symptoms and prolonging life. This stage of melanoma may require a combination of one or more treatments that can be most effective for your condition.