Treatment Options

Treatment Options for Non-Melanoma Skin Cancer (NMSC)

For NMSC there are a number of treatment options. The brief summaries below can be used as a basis for patient discussion. 

Metvix^®

Photodynamic Therapy (PDT) is a non-invasive topical treatment that destroys pre-cancerous and skin cancer lesions. Metvix^®-PDT has gained support from practitioners and patients alike for its efficacy, simplicity to perform, superior cosmetic outcomes, patient acceptability and side effects that are predictable and manageable.

Metvix^® has been registered for use in around 30 countries worldwide for treatment of  sBCC, nBCC, AK and BD.  Approved indications may vary from country to country.

How is Metvix^®-PDT Performed?

• Lesion preparation: The skin surface is roughened and scales are removed in order to maximise the penetration of the cream.
• After lesion preparation, Metvix^® cream, containing the photosensitising agent methyl aminolevulinate (MAL), is applied.
• The area is then covered with an occlusive dressing for a 3 hour period.
• The active ingredient MAL is preferentially absorbed by the tumour cells and porphyrin formation takes place which causes the tumour cells to be sensitive to light.
• This area is then exposed to a cold red light source (Aktilite^® lamp (by clicking on this link you will be leaving this site - Galderma is not responsible for the content)), which activates the Metvix^® cream. Oxygen radicals are formed.
• The activity of the  oxygen radicals leads to the destruction of the tumour cells.
• For treatment of AK, one session of Metvix^®-PDT should be conducted. Treatment can be repeated after 3 months if required. For BCC and BD two sessions should be performed with an interval of one week between them. Depending on lesion response and biopsy at 3 months, individual lesions can be re-treated.
• Studies researching patient satisfaction levels found that the majority of patients treated with Metvix^® preferred it to other forms of treatment they had experienced.
• Research has indicated that cosmetic outcomes were excellent after Metvix^® and often superior to other therapies.
• The latest 60 month clinical trial results have confirmed the long-term efficacy and reliability of Metvix^® treatment. It has recurrence rates within the range of the standard treatments cryotherapy and surgery.

Detailed summaries of the clinical data can be found by clicking on the About Metvix^®-PDT section.

For more information about the use of Metvix^®-PDT procedure please click here.

Cryotherapy

Cryotherapy has been in use since the 1960's and it uses extreme cold temperature by the direct application of a cryogenic agent such as liquid nitrogen or carbon dioxide 'snow' to destroy diseased tissue, skin tumours, pre-cancerous skin lesions, skin tags or nodules. It is widely used for treatment of AK.

How is Cryotherapy Performed?

• Liquid nitrogen is applied directly with a cotton swab or by spraying the externalised tissue.
• In situations when the tumour is internal, liquid nitrogen or argon gas is circulated through a cryoprobe which comes into contact with the tumour.
• The freezing of the tissue causes cell damage, lysis and death.

Surgical Options for NMSC Treatment

The following surgical treatments can be used to treat NMSCs or AK. Surgery is the accepted gold standard treatment for treating both BCC and SCC. Mohs' micrographic surgery achieves the highest cure rates among other forms of surgery with extremely low recurrence rates. Other surgical procedures such as excision, curettage and laser surgery have slightly higher recurrence rates but are also very effective. The major drawback is the risk of scarring.

How is Mohs' Micrographic Surgery Performed?

• The tumour is excised from the skin in thin layers.
• During surgery the thin sections are examined histologically for neoplastic cells.
• Layers are continually excised until no abnormal cells are observed.
• The area treated is sutured and allowed to heal.
• The wounds are then dressed with moist wound dressings to promote healing.

How is Simple Excision Surgery Performed?

• The tumour is excised conventionally, with a scalpel.
• The area from which the tumour is removed is sutured and allowed to heal.
• The wounds are then dressed with moist wound healing dressings to promote healing.

How is Shave Excision Surgery Performed?

• Using a small blade, the tumour is shaved off the surface.
• The wounds are then dressed with moist wound healing to promote healing.

How is Curettage and Electrodesiccation Performed?

• A curette (sharp spoon-shaped tool) is used to excise the tumour from the skin.
• A needle-shaped electrode applies a charge to the selected area.
• This controls bleeding and destroys cancer cells that may have remained around the edge of the tumour.

How is Laser Therapy Performed?

• This surgical method uses a laser beam of sufficient energy to destroy abnormal cells
• The laser is used to remove the surface of the lesion/ tumour and can be used in combination with other treatments.

Radiotherapy

Radiation therapy is more frequently used in patients over the age of 55 or in individuals who have had surgery and have a high chance of recurrence. Radiotherapy may be appropriate in cases where lesions are on the lip or the ear.

How is Radiotherapy Performed?

High energy X-rays are targeted at affected lesions by a computer. Several radiotherapy sessions are usually required over a few weeks to kill all the cancer cells.

Topical Therapies

There are a number of topical treatments that are available for use when treating NMSC, such as:

• 5-Fluorouracil.
• 3% Diclofenac gel.
• 5% Imiquimod cream.

How is 5-Fluorouracil Used?

• 5-Fluorouracil (5-FU) is a cream that is applied directly to the skin to treat small lesions (mainly AK and sBCC).
• 5-FU is a chemotherapeutic agent that prevents cell multiplication. 
• The cream is applied to the affected area twice daily after cleansing.
• The treatment lasts from two to eight weeks.
• Patients using 5-FU should stay out of the sun.

How is 3% Diclofenac Gel Used?

• This NSAID gel is used to treat AK lesions.
• It is applied to the affected area of the skin twice daily.
• Therapy lasts approximately 2-3 months.
• Patients using diclofenac gel should stay out of the sun.

How is 5% Imquimod Cream Used?

• This cream can be used for treating AK lesions and sBCC.
• Imiquimod inhibits the growth of tumour cells.
• It is applied to the affected area of the skin 5 times per week for 6 weeks for BCC and twice a week for 12 weeks for AK.
• During treatment the affected skin will appear different from normal skin.

Advantages and Disadvantages for Each Treatment

Below is a Table that lists the advantages and disadvantages of each treatment method discussed in this section.