Skin Cancer Treatments


Treating skin cancer can be approached in several different ways. Your oncologist will work with you to find the best combination given the stage and considering your overall health.

When it comes to nonmelanoma skin cancers, sometimes a biopsy is all it takes to remove it. If this is the case, no further treatment is needed. If you do need more treatment, your doctor will describe your options, which often include: 

  • Surgery
  • Topical Chemotherapy
  • Radiation Therapy
  • Photodynamic Therapy

For melanoma, one of these five treatments may be used:

The recommended treatments for both nonmelanoma skin cancers and melanoma might be used alone or in combination. 

Skin Cancer Surgery

Surgery is the primary treatment for melanoma, with possible follow up with other types of therapy. Nonmelanoma skin cancers are also often removed with surgery and may include other types of therapy depending on whether it was a basal cell or squamous cell skin cancer.

Surgery to treat skin cancer may be done in one of several ways. The method your oncologist recommends depends on the size and place of the growth and other factors.

Your oncologist can further describe these types of surgery:

  • Wide-local excision (WLE): This involves the removal of the tumor and some surrounding healthy skin and soft tissue, called a margin.  The size of the margin depends on the size of the growth. Some of the lymph nodes may also be removed. May also be referred to as excisional skin surgery.
  • Mohs surgery: Also called Mohs micrographic surgery, this involves cutting away thin layers of the growth and then immediately examining each layer under a microscope. The surgeon continues to shave away tissue until no cancer cells can be seen under the microscope. This procedure allows the surgeon to remove all the cancer and only a small bit of healthy tissue.
  • Curettage and Electrodesiccation: This is often used to remove small basal cell skin cancers. The doctor numbs the area to be treated. The cancer is removed with a sharp tool, called a curette, which is shaped like a spoon. An electric current is sent into the treated area to control bleeding and kill any cancer cells that may be left. Generally, curettage and electrodesiccation and curettage is a fast and simple procedure.
  • Skin grafts: Taking skin from another part of the body, such as the upper thigh, to replace the skin that is removed after skin cancer surgery. If you have a skin graft, you may have to take special care of the area until it heals.
  • Lymphadenectomy: A surgical procedure in which the lymph nodes are removed and a sample of tissue is checked under a microscope for signs of cancer. This may be used for treatment of melanoma.
  • Sentinel lymph node biopsy: The removal of the sentinel lymph node (the first lymph node the cancer is likely to spread to from the tumor) during surgery. The surgeon injects the area of the tumor with a dye and a radioactive tracer that flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. Used with melanoma treatment plans.


Chemotherapy is the use of drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. There are a few different ways chemotherapy can be used to treat skin cancer: 

  • Topical chemotherapy: Administering a drug directly on the skin. This is most often used when the skin cancer is too large for surgery, or, when the doctor keeps finding new cancers. Usually, the drug comes in a cream or lotion and is applied to the skin once or twice a day for several weeks. Some topical chemotherapy drugs include fluorouracil (5-FU) and imiquimod.
  • Systemic chemotherapy: Treatment with anticancer drugs that travel through the blood to cells all over the body. Drugs are often injected into a vein or muscle, but might also be administered orally. 
  • Regional chemotherapy: Chemotherapy that is delivered to a specific area of the body. Drugs are usually placed directly into the spinal fluid, an organ, or a body cavity such as the abdomen. This type of chemo can be helpful in treating melanoma patients.  

The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Even if all the melanoma is removed during surgery, there can be some left that can't be seen. In cases such as this, chemotherapy might be given after surgery to lower the risk that the cancer will come back. This is called adjuvant therapy.

Photodynamic Therapy

Photodynamic therapy (PDT) is a two-stage treatment that combines light energy with a chemical, called a photosensitizing agent, to kill cancer cells. Photodynamic therapy is used to treat cancer on or very near the surface of the skin. This is often done topically with a cream or with an injection.

The side effects of PDT are usually not serious. PDT may cause burning or stinging pain. It also may cause burns, swelling, or redness. It may scar healthy tissue near the growth. If you have PDT, you will need to avoid direct sunlight and bright indoor light for at least 6 weeks after your skin cancer treatment.

Radiation Therapy

Radiation therapy (also called radiotherapy) is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. 

Although not a common treatment for skin cancer, radiation therapy may be used for skin cancer in areas where surgery could be difficult or leave a bad scar. You may have this treatment if you have a growth on your eyelid, ear, or nose. It also may be used if the cancer comes back after surgery to remove it.

External beam radiation, which is radiation given from a machine outside the body, is the most common radiation therapy used to treat skin cancer. Delivering radiation in this way only affects cells in the treated area. This treatment regimen consists of a specific number of treatments given over a set period of time until the cancer is eliminated. 

At RCOG, we typically use intensity modulated radiation therapy (IMRT) — an advanced form of external beam radiation treatment. IMRT allows precise targeting of tumor cells with high-energy beams of radiation that can be adjusted to different levels of intensity. This helps the radiation oncologist deliver a higher dose to the targeted area while limiting damage to surrounding healthy tissue. 

Superficial radiotherapy (SRT) is a type of external radiotherapy. It treats cancer on or close to the skin surface. Superficial radiotherapy means that the radiation doesn't travel far into your body. SRT uses a precise dose of external radiation to destroy the cancer cells. The radiation only goes skin-deep, limiting risk to healthy internal tissues.

A less common type of radiation treatment for skin cancer is internal radiation therapy, more commonly called brachytherapy. This involves placing the radiation source very close to or inside of the skin cancer.

The side effects of radiation therapy could include rash, skin infection, itchy or inflamed skin, or a change in the color of the skin. However, your doctor can prescribe something to help provide relief. 


Immunotherapy is a type of biologic therapy that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer.

Interferon and interleukin-2 (IL-2) are types of biologic therapy used to treat melanoma. Interferon affects the division of cancer cells and can slow tumor growth. IL-2 boosts the growth and activity of many immune cells, especially lymphocytes (a type of white blood cell). Lymphocytes can attack and kill cancer cells.

Tumor necrosis factor (TNF) therapy is a type of biologic therapy used with other treatments for melanoma. TNF is a protein made by white blood cells in response to an antigen or infection. Tumor necrosis factor can be made in the laboratory and used as a treatment to kill cancer cells.

Targeted Therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. The following types of targeted therapy are being used in the treatment of melanoma:

  • Monoclonal antibody therapy: A cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Monoclonal antibodies may be used with chemotherapy as adjuvant therapy. Ipilimumab is a monoclonal antibody used to treat melanoma.
  • Signal transduction inhibitors: A substance that blocks signals that are passed from one molecule to another inside a cell. Blocking these signals may kill cancer cells. Vemurafenib is a signal transduction inhibitor used to treat advanced melanoma or tumors that cannot be removed by surgery.
  • Oncolytic virus therapy: A type of targeted therapy that is being studied in the treatment of melanoma. Oncolytic virus therapy uses a virus that infects and breaks down cancer cells but not normal cells. Radiation therapy or chemotherapy may be given after oncolytic virus therapy to kill more cancer cells.
  • Angiogenesis inhibitors: A type of targeted therapy that is being studied in the treatment of melanoma. Angiogenesis inhibitors block the growth of new blood vessels. In cancer treatment, they may be given to prevent the growth of new blood vessels that tumors need to grow.