NON-MELANOMA SKIN CANCER

Non-melanoma skin cancer (NMSC) is a prevalent form of skin cancer that arises from the uncontrolled growth of abnormal cells in the skin’s outermost layer. While not as well-known as melanoma, NMSC accounts for a significant portion of all cancer diagnoses globally.

If you’ve recently received a diagnosis of nonmelanoma skin cancer, it’s important to recognize that catching it early significantly increases the chances of successful treatment. Fortunately, nonmelanoma skin cancer is often curable, particularly when detected and addressed promptly. You’ll find yourself presented with several treatment options tailored to the specific type of cancer you have.

However, it’s crucial to engage in a thorough discussion with your doctor regarding the advantages and drawbacks of each treatment option before making a decision. By weighing these factors carefully, you can make an informed choice about the most suitable course of action for your individual circumstances.

Causes

NMSC typically develops due to cumulative exposure to ultraviolet (UV) radiation from the sun or artificial sources like tanning beds. UV radiation damages the DNA of skin cells, leading to mutations that can trigger cancerous growth.

Prevalence

Non-melanoma skin cancer is one of the most common cancers worldwide, with its incidence steadily rising. It affects millions of people each year, particularly those with fair skin, light eyes, and a history of excessive sun exposure.

Symptoms

Signs of NMSC may include:

Persistent, non-healing sores or ulcers
Changes in the color, size, or texture of existing moles or skin lesions
Red, scaly patches that may bleed or crust
Raised, shiny bumps that may resemble pearls or warts

Risk Factors

Several factors increase the risk of developing NMSC, including:

Prolonged exposure to sunlight or UV radiation
History of sunburns or blistering sunburns
Fair skin, light hair, and light-colored eyes
Immunosuppression
Older age
Exposure to certain chemicals or radiation

Diagnosis

Diagnosing NMSC typically involves:

Visual inspection of the skin by a healthcare professional
Dermatoscopy, a non-invasive technique using a specialized magnifying device to examine skin lesions
Skin biopsy, where a sample of suspicious tissue is removed and examined under a microscope to confirm cancerous growth

Treatments for Non-melanoma skin cancer

Treatment options for NMSC vary depending on the cancer’s type, size, location, and the patient’s overall health. Common treatments include:

The localized treatments method

For precancerous lesions, small skin cancers, or those confined to the superficial layers of the skin, treatment can often be straightforward and minimally invasive. Several methods are available that avoid surgical procedures or placing undue stress on other parts of the body.

Gels and creams: Chemotherapy drugs are applied topically to target and eliminate cancer cells, while immune response drugs stimulate the body’s natural defenses to attack the affected area. Various topical formulations of these medications are available for application directly to the affected skin. Depending on the specific medication used, treatment duration may range from 2 days to 3 months, and side effects can range from mild to severe skin irritation.
Liquid nitrogen: This method involves the application of extremely cold liquid nitrogen to freeze and destroy the cancerous skin tumor. Multiple sessions may be required, but ultimately, it effectively kills the cancerous cells. Following treatment, the skin may blister and form a crust, but once it heals, a scar may remain as the only visible reminder.

Surgical options are commonly employed for basal cell and squamous cell skin cancers:

For basal cell and squamous cell skin cancers, which are the most prevalent forms of nonmelanoma skin cancer, surgery is often the preferred treatment approach. These surgical procedures are typically brief, lasting from a few minutes to an hour, and are usually performed under local anesthesia.

Excision: In this procedure, your doctor uses a surgical blade to remove the cancerous growth along with a margin of healthy skin. Although quick, this process may necessitate stitches and will result in a scar.
Electrodessication and Curettage (ED&C): This technique involves the use of a curette, a spoon-shaped instrument, to scrape away the cancerous cells. Following this, an electric needle is employed to destroy any remaining cancer cells in the surrounding skin. The process may be repeated multiple times during the appointment, and scarring is common.
Mohs surgery: Mohs micrographic surgery is particularly suited for skin cancers located in cosmetically sensitive areas such as the face. During this meticulous procedure, thin layers of skin are sequentially removed and examined under a microscope to detect cancer cells. The process may take several hours as it involves repeated removal and analysis of tissue layers until no cancer cells are detected. Mohs surgery offers high precision and minimizes the removal of healthy tissue, resulting in optimal cosmetic outcomes.

In cases where surgery is not suitable or desired, radiation therapy may be considered:

Radiation therapy can be an alternative option for those looking to avoid surgery or when the cancer is too large for surgical removal. This treatment utilizes high-energy rays or particles, such as X-rays, photons, electrons, or protons, to target and destroy cancer cells. It may be employed after surgery to eradicate any remaining cancer cells or as the primary treatment for individuals who are not suitable candidates for surgery due to age or underlying health conditions. In cases where surgical intervention may impact cosmetic appearance, such as tumors on the eyelids or tip of the nose, radiation therapy may be preferred to preserve aesthetics.

External radiation is commonly used to treat skin cancer, where focused beams are directed at the cancerous tumor to halt its growth or eradicate it entirely. To minimize side effects and target the tumor accurately, a type of radiation called electron beam radiation, which penetrates only superficially into the skin, may be employed. In some instances, internal radiation therapy involves placing radioactive materials directly into the affected area, particularly if the cancer has spread to other parts of the body, such as the lymph nodes.

Radiation therapy sessions are similar to receiving X-rays, generally painless and relatively quick, although multiple sessions may be necessary.

Side effects

Common side effects of radiation therapy include skin irritation, changes in skin color and texture, hair loss at the treatment site, and potential damage to nearby glands and teeth, particularly if the treatment area is in close proximity.

It’s worth noting that nonmelanoma skin cancers treated solely with radiation therapy are more prone to recurrence compared to those treated with surgery. Additionally, individuals with certain pre-existing health conditions, such as lupus or scleroderma, may experience worsening of their condition with radiation therapy. It’s essential to discuss the risks and benefits of radiation therapy with your doctor to determine the most suitable treatment approach for your specific situation.

Photodynamic therapy (PDT) can be an option for certain types of precancers or superficial skin cancers:

Photodynamic therapy (PDT), also known as phototherapy, is a treatment option for certain types of skin conditions, including actinic keratosis (a type of precancer), superficial basal cell carcinoma, and Bowen’s disease (squamous cell carcinoma in situ).

During PDT, your doctor applies a special light-sensitive drug, usually in the form of a cream, onto the affected skin area. After allowing time for the drug to be absorbed by the skin (typically 3-6 hours, sometimes longer), a specific type of light is used to activate the drug, triggering a reaction that destroys the cancerous cells. It’s important to note that PDT is suitable for cancers near the surface of the skin or covering a large area, as the light used in the therapy cannot penetrate deeply into the skin. Therefore, PDT is not appropriate for cancers that extend deep into the skin layers.

Comparatively, PDT is considered as effective as other treatments like surgery or radiation therapy, with the added benefits of minimal long-term side effects and no scarring. If you have any of the mentioned skin conditions, PDT may be a viable treatment option, but it’s essential to consult with your doctor to determine the most suitable approach for your specific situation.

Other treatment options may be recommended based on the specific type of skin cancer, its recurrence, and overall health.

Your doctor may explore various treatment options depending on the type of skin cancer, its recurrence risk, and your overall health. These options might include less common treatments, procedures not approved by the FDA, or participation in clinical trials. It’s crucial to have open discussions with your doctor about your specific goals and concerns to determine the most appropriate treatment plan.

Following completion of treatment and the healing of the affected area, protecting your skin becomes paramount. Many skin cancer treatments can increase skin sensitivity to sunlight. Therefore, it’s essential to adopt sun protection measures, such as wearing broad-spectrum sunscreen daily on all exposed skin and reapplying it every two hours when outdoors or near windows. Additionally, wearing hats, long sleeves, and seeking shade, particularly between 10 a.m. and 4 p.m., can help minimize sun exposure.

Given the increased risk of skin cancer recurrence after a previous diagnosis, regular skin checks and proactive preventive measures are essential. Your doctor may recommend frequent skin examinations, possibly biannually, to monitor for any signs of recurrence and to promptly address any concerns.

Home Care Tips

After NMSC treatment, it’s essential to:

Protect the skin from UV radiation by wearing sunscreen, protective clothing, and seeking shade
Perform regular skin self-exams to monitor for any changes or new lesions
Stay hydrated and maintain a healthy diet rich in antioxidants to support skin health

Prevention

Reducing the risk of NMSC involves:

Limiting exposure to UV radiation, especially during peak sunlight hours
Using broad-spectrum sunscreen with a high SPF regularly
Wearing protective clothing, including wide-brimmed hats and sunglasses
Avoiding indoor tanning beds and booths

When to See a Doctor

Consult a healthcare professional if you notice any suspicious changes in your skin, such as new growths, changes in existing moles, or persistent sores that do not heal.

Outlook/Prognosis:

The prognosis for NMSC is generally favorable, especially with early detection and treatment. However, it’s crucial to follow up with regular skin examinations to detect any recurrence or new lesions promptly.

Sources

American Academy of Dermatology Association. (n.d.). Skin cancer: Non-melanoma.
Cancer.Net. (2021, May). Non-melanoma skin cancer: Overview.
American Cancer Society.
UCLA Health
National Cancer Institute
Mayo Clinic
Canadian Cancer Society
Macmillan Cancer Support
Cancer Research UK
Cleveland Clinic
National Cancer Institute
Journal of Clinical and Aesthetic Dermatology: “Superficial Radiation Therapy for the Treatment of Nonmelanoma Skin Cancers.”