Skin Cancers

Treatment Options

It is common to have more than one type of treatment for skin cancer. Your treatments will be either local or systemic or a combination. Local treatments target specific areas of the body and include surgery and sometimes radiation therapy. Some can also be injected into a lesion or applied topically to the skin.

Systemic treatments, including drug therapies, such as immunotherapy, targeted therapy and chemotherapy, travel throughout your body. An important goal of systemic therapy is to destroy cancer cells that may be hiding in other organs of the body, such as the liver, lungs, bones or brain. These hidden cancer cells, called micrometastases, are usually too small to detect with laboratory testing or imaging studies.

Drug therapies can be given orally, subcutaneously or intravenously (IV) through a vein in your arm or through an implanted infusion port, which is surgically inserted under the skin in the upper chest area or arm to gain easy access to veins.

Treatment may be considered as standard of care, first line or second line. Standard of care refers to the best treatment known. First-line therapy is the first treatment given. Second-line therapy is given when the first-line therapy doesn’t work or is no longer effective.

Skin cancer treatment options include the following.

Surgery is frequently the primary treatment option for BCC, CSCC and MCC. Possible types of surgery include curettage and electrodessication, Mohs micrographic surgery, wide and simple excisions, shave excision, reconstructive surgery and sentinel lymph node biopsy.

Cryosurgery, also called cryoablation and cryotherapy, kills cancer cells by freezing them with a probe or another instrument that is super-cooled with liquid nitrogen or similar substances. It is used to treat precancerous skin conditions.

Radiation therapy may be used for skin cancers near the eyelid, tip of the nose, the ear or other hard-to-reach areas. It may be recommended after surgery to prevent a recurrence or avoid scarring from surgery. It may be used to treat recurrent CSCC that is not metastatic and Stages I and II of MCC.

Immunotherapy in the form of immune checkpoint inhibitors may be used to treat metastatic, locally advanced or recurrent CSCC in people who could not be cured by surgery or radiation therapy, or for recurrent locally advanced or metastatic MCC.

Targeted therapy may be an option for metastatic BCC if it cannot be treated with surgery or radiation therapy. Approved therapies are hedgehog pathway inhibitors that block the PTCH1 genetic mutation. Others may be used for CSCC to block the epidermal growth factor receptor (EGFR) pathways.

Photodynamic therapy is treatment with drugs that become active and kill cancer cells when exposed to light. It is used mainly to treat tumors on or just under the skin. It may be used for CSCC that is Stage 0, for actinic keratosis and for BCC when surgery isn’t an option.

Chemotherapy in the form of creams or ointments may be used as topical therapy for CSCC, actinic keratosis and very superficial BCC. It is applied to the skin and is primarily used to treat the earliest stage of CSCC in situ or Stage 0. Systemic chemotherapy may also be used for metastatic or unresectable CSCC.

Clinical trials are underway to find other effective treatments and may be an option to consider especially if the skin cancer is advanced or metastatic.

 

Common Drug Therapies for Basal Cell Carcinoma
As of 11/6/20
fluorouracil (Efudex)
imiquimod (Aldara)
sonidegib (Odomzo)
vismodegib (Erivedge)

 

Common Drug Therapies for Cutaneous Squamous Cell Carcinoma As of 11/6/20
cemiplimab-rwlc (Libtayo)
pembrolizumab (Keytruda)

 

Common Drug Therapies for Actinic Keratosis As of 11/6/20
aminolevulinic acid HCl (Levulan Kerastick)
diclofenac sodium (Solaraze)
fluorouracil (Efudex)
imiquimod (Aldara, Zyclara)
ingenol mebutate (Picato)

 

Common Drug Therapies for Merkel Cell Carcinoma
As of 11/6/20
avelumab (Bavencio)
pembrolizumab (Keytruda)

 

Follow-up Care

After being treated for skin cancer, watching for recurrence is vital. Knowing your risks and what to watch for are key to early detection and a potentially better prognosis. Your doctor will provide a follow-up schedule based on your unique diagnosis and treatment. Between appointments, perform regular self-checks on your body and tell your doctor about any symptoms or concerns you have.

Protecting your skin from harmful ultraviolet (UV) rays can reduce your risk of skin cancer returning. Though darker skin contains more melanin, the pigment that gives color to the skin, every skin tone is still vulnerable.

  1. Wear protective clothing.
  2. Wear a broad-brimmed hat and sunglasses that protect against UV rays.
  3. Limit sun exposure from 10 a.m. to 4 p.m.
  4. Choose a sunscreen and a lip balm with an SPF of at least 15 to 30 that protects against both UVA and UVB rays.
  5. Apply sunscreen liberally on all exposed skin. Reapply every two hours (sooner if swimming or sweating). Don’t forget ears, the back of your neck and exposed parts of your scalp.

 

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