Types of treatment used

Types of treatment

More than nine out of ten people (90%) with basal cell and squamous cell carcinomas are completely cured. Surgery is an important treatment for many skin cancers. In many cases the only treatment needed is removal of the suspect lump. Radiotherapy may be used instead of surgery, or may be given after surgery if there is a risk that some cancer cells may still be present. Chemotherapy may occasionally be used.

Your doctor will plan your treatment by taking into consideration a number of factors including your age and general health, the type and size of the cancer, where it is on your body and what the cells actually look like under the microscope. The treatment you have will be tailored to your particular situation. Sometimes, people are asked to take part in a clinical trial of a new treatment.

A team of doctors will work together to decide on the best treatment for you. They will follow national cancer treatment guidelines. The team is known as a multidisciplinary team and will also include nurse specialists, psychologists and social workers.

Surgery for skin cancer can be done in a variety of ways. Small cancers can usually be removed under local anaesthetic. When larger tumours are removed, skin grafts are sometimes needed to replace the removed skin. A skin graft is a thin layer of healthy skin taken from another part of the body. This is done under general anaesthetic.

A very small number of patients with squamous cell skin cancers will have more major surgery to remove nearby lymph nodes. This is to see whether the cancer has spread into the lymph nodes.

Cryotherapy can be used to remove small skin cancers.

Radiotherapy can be a very effective alternative to surgery for basal and squamous cell carcinomas in areas of the face where surgery might cause scarring. It is also sometimes used for tumours that have grown into the deeper layers of the skin.

Chemotherapy is not often used to treat skin cancers. If it is used, it is usually as a cream that is applied directly to the cancer. More rarely, a course of chemotherapy is given by injection.

If you have any questions about your own treatment don’t be afraid to ask your doctor or nurse. It often helps to make a list of questions for your doctor. You may want to take a close friend or relative with you to appointments, who can remind you of questions you wanted to ask, and afterwards help you to remember what the doctor said.

More than 90% of patients with basal cell and squamous cell carcinoma are completely cured.

Giving your consent

Before you have any treatment your doctor will explain the aims of the treatment to you and you will usually be asked to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

• the type and extent of the treatment you are advised to have
• the advantages and disadvantages of the treatment
• any possible alternative treatments that may be available
• any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations.

Patients often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you, and the staff should be willing to make time for you to ask questions. You can always ask for more time to decide about the treatment, if you feel that you can’t make a decision when it is first explained to you.

You are also free to choose not to have the treatment, and the staff can explain what may happen if you do not have it. It is essential to tell a doctor, or the nurse in charge, immediately so that he or she can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.

The benefits and disadvantages of treatment

Many people are frightened at the idea of having cancer treatments, particularly because of the side effects that can occur. Some people ask what would happen if they did not have any treatment.

Treatment can be given for different reasons and the potential benefits will vary depending upon the individual situation. Treatment can cure most people with basal cell or squamous cell skin cancer, and although the treatment can cause side effects such as scarring in the affected area, this is often minimal or easy to disguise.

If treatment is not given the cancer will continue to grow. The growth is very slow, but over years the cancer may spread into deeper tissues of the skin and may need more extensive surgery or other treatment, which may cause more scarring. It is important to discuss treatments in detail with your doctors, especially if you are given a choice of treatments.