Skin Cancer (Non-Melanoma): Treatment Options

Approved by the Cancer.Net Editorial Board, 01/2018

ON THIS PAGE: You will learn about the different treatments doctors use for people with these types of skin cancer. Use the menu to see other pages.

This section tells you the treatments that are the standard of care for this type of cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurses, social workers, pharmacists, counselors, dietitians, and others.

Descriptions of the most common treatment options for basal cell carcinoma, squamous cell carcinoma, and Merkel cell cancer are listed below. Treatment options and recommendations depend on several factors, including the size and location of the skin cancer, possible side effects, and the patient’s preferences and overall health.

Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Surgery and other procedures

Surgery is the removal of the tumor and surrounding tissue during a medical procedure. Many skin cancers can be removed from the skin quickly and easily during a simple surgical procedure. Often no other treatment is needed.

Which type of surgical procedure is used depends on the size and location of the lesion. Most of these procedures use a local anesthetic to numb the skin first. They can be done outside of a hospital by a dermatologist, surgical oncologist, general surgeon, plastic surgeon, nurse practitioner, or physician assistant.

Surgeries and other procedures for skin cancer include: 

  • Curettage and electrodessication. During this common procedure, the skin lesion is removed with a curette, which is a sharp, spoon-shaped instrument. The area is then treated with an electric current that helps control bleeding and destroys any remaining cancer cells. This is called electrodessication. Many people have a flat, pale scar after this procedure.

  • Mohs surgery. This technique, also known as complete margin assessment surgery, involves removing the visible tumor, in addition to small fragments around the edge of the area where the tumor was located. Each small fragment is examined under a microscope until all of the cancer is removed. This is typically used for larger tumors, for those located in the head-and-neck region, and for cancers that have come back in the same place.

  • Wide excision. This involves the removal of the tumor and some surrounding healthy skin and soft tissue, called a margin. When a large tumor is removed, the incision may be too large to close, so surgeons may use skin from another part of the body to close the wound, which is called a skin graft. This helps with healing and reduces scarring.

  • Reconstructive surgery. Since skin cancer often develops on a person’s face, a reconstructive (plastic) surgeon or facial specialist may be part of the health care team. When doctors plan treatment, they consider how treatment might affect a person’s quality of life, such as how the person feels, looks, talks, and eats. Before any surgery for skin cancer, talk with your doctor about whether changes to your appearance are possible and whether there may be functional aspects that need to be considered when developing a treatment plan.

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. In general, surgery may be associated with side effects such as pain, scarring, numbness, skin stretching, wound problems, infection, and appearance changes where surgery was performed.  Learn more about the basics of cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. Radiation therapy may be used instead of surgery for skin cancer that is located in a hard-to-treat place, such as on the eyelid, the tip of the nose, or the ear. It is also used in some people who would like to avoid scarring from surgery. Sometimes radiation therapy may be recommended after surgery to help prevent the skin cancer from coming back.

For Merkel cell cancer, radiation therapy is often given after surgery for stage I and II disease. This is called adjuvant therapy.

The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. Several treatments may be needed to eliminate the cancer. A less common type of radiation treatment for skin cancer is brachytherapy. This involves placing the radiation source very close to or inside of the skin cancer.

Radiation therapy is not recommended for people with nevoid basal cell carcinoma syndrome.

The side effects from radiation therapy may include a rash, skin infections, itchy or red skin, or a change in the color of the skin. However, these side effects can usually be prevented by applying a corticosteroid or antibiotic on the skin. If side effects develop, most go away a few weeks after treatment has finished. Learn more about the basics of radiation therapy.

Topical treatments

To treat precancerous skin conditions or a cancerous lesion located only in the top layer of the skin, doctors may prescribe topical treatments. These may include chemotherapy as a cream or lotion, photodynamic therapy, cryotherapy, or laser therapy. 

  • Chemotherapy. Chemotherapy is the use of drugs to destroy cancer cells, usually by ending the cancer cells’ ability to grow and divide. These drugs are usually applied to the skin every day for several weeks. They may cause skin inflammation or irritation, which will go away after treatment is finished. 

    Topical diclofenac (Solaraze), fluorouracil (Efudex), and ingenol mebutate (Picato) are approved for the treatment of precancerous actinic keratosis. All of these creams can cause irritation, burning, redness, and stinging during treatment. These symptoms usually go away soon after treatment has been completed. These creams do not cause scars, which is why many doctors use them to treat the face or other areas where cosmetic results are important. 

    For small basal cell cancers not located on the face, topical imiquimod (Aldara), which stimulates the immune system, may be recommended. The cream must be applied once a day, 5 days a week, for 6 to 12 weeks. Topical fluorouracil is also approved by the U.S. Food and Drug Administration (FDA) to treat superficial (very thin) basal cell carcinomas. It should be applied 2 times a day for 3 to 6 weeks. Some irritation and redness in the area of the basal cell carcinoma is expected with this treatment. 

    The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

  • Photodynamic therapy. This is a combination treatment for actinic keratosis. First, a topical medication called aminolevulinic acid (Levulan) is applied over areas with many actinic keratoses. Then this area is exposed to a special light-emitting device for several minutes to a few hours. The aminolevulinic acid makes the skin very sensitive, so the procedure can be painful. Your doctor may recommend taking pain medication before the procedure. In addition, the chemical makes the skin very sensitive to the sun, so it is important to avoid sun exposure and wear protective glasses, clothing, and sunscreen for a few days after the procedure. The skin will remain very red and irritated for a few days, but the actinic keratoses quickly disappear once the redness goes away.

  • Freezing. This procedure, which is also called cryotherapy, uses liquid nitrogen to freeze and destroy abnormal cells. It is usually used to treat precancerous skin conditions. The liquid nitrogen will sting when it is first applied to the skin, and then the skin will blister and shed off. More than 1 freezing may be needed. Sometimes this procedure leaves a pale scar.

  • Laser therapy. A narrow beam of high-intensity light can destroy precancerous skin conditions that are located only in the outer layer of the skin.  

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

The U.S. Food and Drug Administration (FDA) has approved avelumab (Bavencio) to treat patients 12 and older with Merkel cell cancer that has spread to another part of the body. This is called metastatic cancer. Avelumab blocks the programmed death-ligand 1 (PD-L1) pathway. By blocking this pathway, the body’s immune system may be able to more effectively fight cancer cells.

Learn more about the basics of targeted treatments.

Immunotherapy (updated 10/2018)

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. There is 1 immunotherapy drug approved by the FDA for the treatment of metastatic or locally advanced squamous cell carcinoma. It is an immune checkpoint inhibitor called cemiplimab-rwlc (Libtayo) that targets the PD-1 pathway.  

Different types of immunotherapy can cause different side effects. The common side effects of cemiplimab-rwlc include fatigue, rash, and diarrhea. It can also cause severe and possibly life-threatening side effects, including problems in the lung, intestines, liver, hormone gland, skin, and kidneys. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatments intended to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. People often receive treatment for the cancer at the same time that they receive treatment to ease side effects. In fact, patients who receive both at the same time often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as topical medications, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan. 

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. During and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.

Metastatic skin cancer

In rare cases, non-melanoma skin cancer spreads to another part in the body from where it started. In these situations, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Surgery alone cannot always eliminate skin cancer that has metastasized. If cancer cannot be removed with surgery, it is called unresectable. To control distant spread, a person’s treatment plan may include chemotherapy, radiation therapy, and/or targeted therapy. Palliative care will also be important to help relieve symptoms and side effects.

Metastatic or unresectable squamous cell carcinoma of the skin is rare, so treatment plans often use the same treatments that have been demonstrated to work in patients with squamous cell carcinoma of the head and neck that may not have originated from the skin. Chemotherapy usually includes taxanes, such as docetaxel (Taxotere) or paclitaxel (Taxol, Onxal), and platinums, such as carboplatin (Paraplatin) or cisplatin (Platinol).

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. The main side effects of these drugs include fatigue, low blood cell counts, rashes, diarrhea, and changes in sensation in the tips of the fingers or toes. Learn more about the basics of chemotherapy and preparing for treatment.

Targeted therapies may be used for some patients with squamous cell carcinoma, including cetuximab (Erbitux), panitumumab (Vectibix), and erlotinib (Tarceva). These drugs are usually delivered through an intravenous (IV) tube placed into a vein using a needle.

For people with metastatic basal cell carcinoma that cannot be treated with surgery or radiation therapy, targeted therapy may be an option. Vismodegib (Erivedge) and sonidegib (Odomzo) are FDA-approved drugs known as hedgehog pathway inhibitors. They block the PTCH1 genetic mutation, which seems to drive the growth of basal cell carcinoma. This treatment shrinks tumors in many patients. The main side effects of this treatment include hair thinning, muscle cramps, weight loss, dry skin, and loss of taste. Learn more about targeted therapy.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED. 

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If a skin cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence). Certain parts of the body, such as the ears and lips, are more prone to develop recurrent skin cancers. In addition, people whose immune system is suppressed due to a medication or disease are also at higher risk for skin cancer recurrence.

When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer often experience emotions such as fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. You may use the menu to choose a different section to read in this guide.