Non-Surgical Treatment Options

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While surgical excision is the most common and effective way to remove non-melanoma skin cancers, alternative methods that target specific locations of concern also have a decent cure rate.

If skin cancer surgery is not feasible or if it is not your preferred treatment option, your doctor may recommend non-surgical treatment. Forms of in situ squamous cell carcinoma (SCC or intraepidermal carcinoma), superficial basal cell carcinoma (BCC) and pre-cancerous lesions (actinic keratoses), depending on the size, type and stage of cancer, can often be treated without surgery. Unfortunately, some types of skin cancer will always require surgical management - and close follow up is required if using a non-surgical method of treatment.

Non-surgical treatments are alternative methods to surgical excision to remove skin cancer cells.

In many cases, the result post-treatment has a good cosmetic appearance with non-surgical treatment, without the associated risks and down-time of traditional surgical methods.

Your doctor will complete an assessment of whether this type of skin cancer treatment is suitable for your individual situation and the skin cancer type. Risks, benefits and potential side effects and effectiveness of all treatments is always discussed in detail.

There are four main types of non-surgical treatment options for skin cancer as below.

  • To treat multiple solar keratoses, 5-fluorouracil cream is applied to the skin and then consumed by the sun damaged cells, causing them to die. Normal, healthy cells are preserved and healthy skin replaces the sun-damaged cells. Imiquimod creams activate the nearby immune system, causing an inflammatory reaction that clears abnormal cells in that area. 5-Fluorouracil can also be used to treat Bowen’s Disease (SCC in situ or intraepidermal carcinoma) in some low-risk areas in suitable patients. Imiquimod creams are also used to treat solar keratoses and some superficial basal cell carcinomas in low risk areas in suitable patients. If the skin cancer recurs, surgery is required.

  • As an alternative for the treatment of solar keratoses, intraepidermal carcinomas and some superficial basal cell carcinomas, photodynamic therapy involves application of a cream or liquid followed by activation by special LED lights on targeted areas of skin. Skin cancers treated with this technique usually require at least two treatments. If the skin cancer recurs, surgery is required. Please see the "PDT " page for further information. This treatment is not recommended for first line treatment of some keratinocyte cancers due to the risk of recurrence. If the skin cancer recurs, surgery is required.

  • Some superficial skin cancers (SCC in situ, superficial BCCs) can be treated with this method if they are low-risk. During this treatment, the doctor first injects local anaesthetic to numb the area. Then the skin cancer is then removed by scraping it with a long, thin instrument with a sharp looped edge on one end (called a curette). The area is then treated with an electrocautery device (diathermy) to destroy any remaining cancer cells and to prevent bleeding. This process is often repeated once or twice during the visit. A few days later, a crust or scab will form over the top of the wound. The scab then falls off after 1-4 weeks depending on the treated area. The treated area may look paler than the surrounding skin. If the skin cancer recurs, surgery is required.

  • Cryotherapy is a procedure that uses liquid nitrogen to remove actinic keratoses by freezing them off. The doctor will spray liquid nitrogen onto the skin lesion and a small area of surrounding skin - which will cause a stinging/burning sensation that can last up to a few minutes.

    The liquid nitrogen kills the abnormal skin cells through extreme cold and creates a small wound. The treated area will be red, and slightly sore afterwards. A blister often forms soon after. A few days after treatment, a crust or scab will form over the top of the wound. The scab will begin to resolve after 1-4 weeks post treatment, depending on the area treated.  Healthy skin cells will regenerate and grow under the scab, and a scar may develop. The scar often will look paler (hypopigmented) compared to the surrounding skin. In some cases, the procedure may need to be repeated for best results.

    Some superficial types of skin cancer (Bowen’s disease/IEC) and superficial BCCs can be treated with this method, however recurrence rates are high.