Skin Cancer Treatment: What Patients Need to Know
Receiving a skin cancer diagnosis requires prompt assessment and clear information about the type and extent of the disease. Treatment options vary considerably according to the diagnosis, stage, site of the cancer and a person’s general health.
A dermatologist, surgeon, oncologist or multidisciplinary skin cancer team can explain the recommended treatment plan. Common approaches include surgical removal, radiotherapy, topical or local treatments for selected cancers, immunotherapy and targeted medicines.
Basal cell carcinoma and squamous cell carcinoma are usually managed differently from melanoma, which may require more extensive staging and, in some cases, additional treatment after surgery.
Second opinions can be helpful, particularly for complex, high-risk or advanced diagnoses. Patients should discuss the potential benefits, risks, alternatives and follow-up requirements of each option with their clinical team.
Early diagnosis and appropriate treatment are associated with better outcomes for many forms of skin cancer. Attending follow-up appointments and reporting new or changing skin lesions remain important after treatment.
The Main Types of Skin Cancer and Why They Matter
The main types of skin cancer have different patterns of growth and different treatment approaches.
Basal cell carcinoma is the most common type. It usually grows slowly and only rarely spreads to other parts of the body, although it can cause significant local damage if untreated.
Squamous cell carcinoma can grow more quickly and has a greater potential to spread than basal cell carcinoma, particularly when it has high-risk features such as greater depth, recurrence, location, or immune suppression.
Melanoma is less common than basal or squamous cell carcinoma, but it is more likely to spread. Outcomes are generally better when melanoma is diagnosed before it has spread. Survival statistics vary by country, stage, subtype, and the treatments available, so they should be discussed with the treating team.
Once the diagnosis and extent of disease are clear, treatment can be tailored to the individual. Dr James Wilson is a London-based clinical oncologist who provides assessment and personalised treatment planning for non-melanoma skin cancers, including cases where radiotherapy or targeted treatments may be considered. Patients who would like to understand the available treatment approaches can find further information about Dr James Wilson’s skin cancer services on his website: https://drjameswilson.co.uk/conditions/skin-cancer/
The specific diagnosis is central to treatment planning. Pathology results, tumour features and staging information help clinicians choose the most appropriate course of action.
How Do Doctors Diagnose Skin Cancer?
Diagnosis usually begins with a clinical skin examination. Clinicians may use a dermatoscope to examine suspicious lesions more closely. The ABCDE guide can help identify concerning moles, but it does not diagnose skin cancer and does not identify every melanoma.
If a lesion is suspicious, a biopsy or complete removal may be needed. The tissue is examined in a laboratory to confirm whether cancer is present and to identify its type.
For melanoma and selected higher-risk skin cancers, further tests may be required to determine whether cancer has spread. These can include sentinel lymph node biopsy and imaging such as ultrasound, CT, MRI or PET scans, depending on the circumstances. Not everyone needs these tests.
After treatment, follow-up appointments are used to assess healing, monitor for recurrence and identify new skin cancers.
What Do the Stages of Skin Cancer Mean for Treatment?
Staging describes the size, depth and spread of a cancer, but staging systems differ between skin cancer types. Stage 0 to Stage 4 is commonly used for melanoma and some squamous cell carcinomas. Basal cell carcinoma is not usually described using the same staging system.
Early-stage cancers are often treated with local methods, most commonly surgery. For melanoma, treatment may include wider excision around the original site, and some people may be offered sentinel lymph node biopsy for staging.
More advanced disease may require a combination of surgery, radiotherapy and systemic treatment. Immunotherapy and targeted therapy are particularly important options for some high-risk or advanced melanomas. The stage is important, but it is not the only factor guiding treatment.
How to Choose the Right Skin Cancer Specialist
The right specialist depends on the diagnosis and complexity of the cancer. A dermatologist may diagnose and treat many skin cancers, while dermatological surgeons, plastic surgeons, surgical oncologists, medical oncologists, and radiation oncologists may be involved in more complex cases.
For melanoma, high-risk squamous cell carcinoma or advanced disease, care is often planned by a multidisciplinary team. Patients can ask who will be involved in their care, what experience the team has with their diagnosis and how treatment recommendations are made.
Clear communication matters. A patient should understand the diagnosis, the purpose of each proposed treatment, possible side effects, and the planned follow-up schedule.
Why Surgery Is the Most Common Skin Cancer Treatment
Surgery is a key treatment for many skin cancers because it can remove the tumour and provide tissue for laboratory examination. The appropriate procedure depends on the cancer type, size, depth, location and risk features.
For basal cell carcinoma and squamous cell carcinoma, options may include standard excision, curettage and cautery, cryotherapy, topical treatments, photodynamic therapy or Mohs surgery in selected cases. Not every treatment is suitable for every cancer.
Mohs surgery removes thin layers of tissue one at a time, examining each layer under a microscope during the procedure. It can be especially useful for certain cancers that are recurrent, have unclear borders, occur in high-risk areas, or require maximum preservation of healthy tissue, such as on the face, ears, hands, or genital area.
Surgery for melanoma usually involves wide local excision. The amount of surrounding tissue removed depends on the thickness and other pathological features of the melanoma.
Radiation, Immunotherapy, and Other Non-Surgical Options
Non-surgical treatment may be used when surgery is unsuitable, as an additional treatment, or when cancer has spread. The choice depends on the diagnosis, stage and individual circumstances.
Radiotherapy uses high-energy radiation to damage cancer cells. It may be used for selected basal cell or squamous cell carcinomas, after surgery for some high-risk cancers, or to control symptoms from advanced disease.
Immunotherapy helps the immune system recognise and attack cancer cells. It is most commonly used for high-risk or advanced melanoma, and may also be used for selected advanced squamous cell carcinomas, Merkel cell carcinomas and other rare skin cancers.
Radiation Therapy Explained
Radiotherapy may be considered if surgery would be difficult, if a cancer cannot be fully removed or when there is a significant risk of recurrence. It can also be used to control cancer or relieve symptoms in advanced cases.
Possible side effects depend on the part of the body being treated and the dose of radiation. They can include skin redness, soreness, fatigue and longer-term changes to the treated skin. The radiotherapy team can explain the likely benefits and risks for each person.
Immunotherapy Benefits Explored
Immunotherapy includes checkpoint inhibitors such as pembrolizumab and nivolumab. These medicines can produce durable responses for some people with advanced melanoma and selected other skin cancers, but not everyone responds.
Immunotherapy can also cause immune-related side effects. These may affect the skin, bowel, lungs, liver, thyroid, joints or other organs. Symptoms should be reported promptly to the oncology team, as early treatment of side effects is important.
Immunotherapy is not automatically less severe than chemotherapy. Its side effects are different, and some can be serious. The potential benefits and risks need individual discussion.
Photodynamic Therapy Overview
Photodynamic therapy, or PDT, uses a light-sensitive medicine followed by a specific light source to destroy abnormal cells. It may be used for actinic keratoses, Bowen’s disease and some superficial basal cell carcinomas.
PDT is not suitable for invasive melanoma or most invasive squamous cell carcinomas. The treated area may be painful, red and sensitive to light for a period after treatment.
Other local treatments, including creams such as imiquimod or 5-fluorouracil, may be appropriate for selected superficial conditions. A clinician should confirm whether these are suitable for a particular diagnosis.
What to Expect During Skin Cancer Recovery
Recovery depends on the treatment received, the area treated and the size of the wound or treatment field. After surgery, soreness, swelling, bruising and a scar are common. The clinical team will provide wound-care instructions and advise when to seek help.
Contact the treating team if there is increasing pain, spreading redness, warmth, swelling, discharge, fever, wound separation or unexpected bleeding. These may indicate infection or another complication.
After systemic treatment, follow-up may include blood tests, scans and appointments to monitor treatment response and side effects.
Managing Post-Treatment Side Effects
Side effects vary by treatment. Surgery can lead to pain, swelling, bleeding, infection and scarring. Radiotherapy may cause redness, irritation and fatigue. Immunotherapy and targeted medicines can cause a wide range of effects, some requiring urgent assessment.
Patients should follow their care team’s aftercare instructions and report symptoms rather than trying to manage significant side effects alone. Psychological support, counselling and peer-support services can also be useful after a cancer diagnosis or treatment.
Follow-Up Care Importance
Follow-up schedules are personalised. They vary according to the type and stage of cancer, treatment received, personal risk factors and local clinical guidance. They may be more frequent in the first years after treatment, but there is no single schedule that is right for everyone.
Appointments can include examination of the treated area, a whole-body skin check, discussion of symptoms and review of sun-protection measures. Patients should also report new or changing lesions between appointments.
Signs Your Skin Cancer May Have Come Back
A treated skin cancer can recur, and people may also develop a new skin cancer elsewhere. Possible signs include a new or changing lesion, a sore that does not heal, a growth or thickening at or near the treatment site, persistent bleeding or crusting, and a changing mole.
Itching, tenderness or pain can occur for many reasons and do not by themselves prove recurrence. However, these symptoms should be assessed if they occur with a visible skin change or persist at a previously treated site.
Regular follow-up and self-awareness can help identify changes early. Any concerning change should be assessed by a healthcare professional.
How to Lower Your Risk of Future Skin Cancer
No method can completely prevent skin cancer, but reducing ultraviolet exposure can lower risk. Seek shade when the sun is strong, wear protective clothing and a wide-brimmed hat, and use sunglasses that provide UV protection.
Use broad-spectrum sunscreen with an SPF of at least 30 on exposed skin. Apply it generously and reapply at least every two hours, as well as after swimming, sweating or towelling. Sunscreen should be used alongside shade and clothing, not as a reason to stay in strong sunlight for longer.
Avoid tanning beds. Check the skin regularly for new, changing or persistent lesions, and attend the follow-up appointments recommended by the clinical team.
Conclusion
Skin cancer treatment depends on the diagnosis, tumour features, location, stage and the patient’s overall health. Surgery is the main treatment for many skin cancers, while radiotherapy, topical or local therapies, immunotherapy and targeted treatments may be appropriate in specific situations.
Understanding the diagnosis and discussing all appropriate options with an experienced clinical team can support informed treatment decisions. Follow-up care, sensible sun protection and prompt assessment of new or changing lesions are important parts of long-term skin health.
