Surgical excision is an operation to cut out the cancer along with surrounding healthy tissue to ensure the cancer is completely removed.
It may be carried out in combination with a skin graft, which involves removing a patch of healthy skin, usually from a part of the body where any scarring can't be seen, such as your neck, abdomen or upper thigh. It's then connected (grafted) to the affected area.
In most cases, surgery is enough to cure non-melanoma skin cancer.
Mohs micrographic surgery
Mohs micrographic surgery (MMS) is a specialist form of surgery used to treat non-melanoma skin cancers when:
- it's felt there's a high risk of the cancer spreading or returning
- the cancer is in an area where it would be important to remove as little skin as possible, such as the nose or close to the eyes
MMS involves surgical excision of the tumour and a small area of surrounding skin.
The edges are immediately checked under a microscope to make sure all the tumour has been completely removed.
If it has not, further surgery is carried out, usually on the same day. This minimises the removal of healthy tissue and reduces scarring while ensuring that the tumour has been completely removed.
Curettage and electrocautery
Curettage and electrocautery is a similar technique to surgical excision, but it's only suitable in cases where the cancer is quite small.
The surgeon will use a small spoon-shaped or circular blade to scrape off the cancer before burning (cauterising) the skin to remove any remaining cancer cells and seal the wound.
The procedure may need to be repeated 2 or 3 times to ensure the cancer is completely removed.
Cryotherapy uses cold treatment to destroy the cancer. It's sometimes used for non-melanoma skin cancers in their early stages.
Liquid nitrogen is used to freeze the cancer, and this causes the area to scab over.
After about a month, the scab containing the cancer will fall off your skin. Cryotherapy may leave a small white scar on your skin.
Anti-cancer creams are also used for certain types of non-melanoma skin cancers, but are only recommended when the tumour is contained within the top layer of the skin, such as early basal cell carcinoma and Bowen's disease.
There are 2 main types of anti-cancer cream:
- chemotherapy creams – these contain a medication called 5-fluorouracil
- immune stimulating creams – these contain a medication called imiquimod
For non-melanoma skin cancer, chemotherapy creams containing 5-fluorouracil are used.
The cream is applied to the affected area for a number of weeks.
As only the surface of the skin is affected, you will not experience the side effects associated with other forms of chemotherapy, such as vomiting or hair loss. However, your skin may feel sore for several weeks afterwards.
Imiquimod cream is used to treat basal cell carcinomas with a diameter of less than 2cm (0.8 inches). It's also used to treat actinic keratoses and Bowen's disease.
Imiquimod encourages your immune system to attack the cancer in the skin and is used over a number of weeks.
Common side effects of 5-fluorouracil cream and imiquimod include redness, flaking or peeling skin and itchiness. Less common and more serious side effects include blistering or skin ulceration.
Photodynamic therapy (PDT)
After the cream has been applied, a strong light source is shone on to the affected area of your skin, which kills the cancer.
PDT may cause a burning sensation and may leave scarring, although this is usually less than for surgery.
Radiotherapy is sometimes used to treat basal cell and squamous cell carcinomas if:
- surgery would be unsuitable
- the cancer covers a large area
- the area is difficult to operate on
Radiotherapy is sometimes used after surgical excision to try to prevent the cancer coming back. This is called adjuvant radiotherapy.
Electrochemotherapy is a possible treatment for non-melanoma skin cancer.
It may be considered if:
- surgery is not suitable or has not worked
- radiotherapy and chemotherapy have not worked
The procedure involves giving chemotherapy into the tumour or sometimes directly into a vein (intravenously). Short, powerful pulses of electricity are then directed to the tumour using electrodes.
The electrical pulses allow the medicine to enter the tumour cells more effectively and cause more damage to the tumour.
The procedure is usually carried out using general anaesthetic, where you're unconscious, but some people may be able to have local anaesthetic, where you're conscious but the area is numbed.
Depending on how many tumours need to be treated, the procedure can take up to an hour to complete.
The main side effect is pain where the electrode was used, which can last for a few days and may require painkillers.
It takes around 6 weeks for results to appear and the procedure usually needs to be repeated.
Your specialist can give you more detailed information about electrochemotherapy.
You can also read the 2013 National Institute for Health and Care Excellence (NICE) guidance about electrochemotherapy for metastases in the skin.