The Different Types of Chemotherapy for Skin Cancer

A bag of chemotherapy drugs.
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If you have been diagnosed with skin cancer, your doctor will discuss the treatment options that he or she believes will provide the best outcome. Although exceedingly rare, one treatment option that may be presented is chemotherapy. Chemotherapy is the use of certain anti-cancer drugs to destroy cancer cells. Chemotherapy drugs work by slowing or stopping the growth of cancer cells, which divide more rapidly than normal cells, by disrupting the way the cancer cells work.

When used to treat skin cancer, chemotherapy has two distinct and very different methods of delivery. Chemotherapy may be used:

  • As a topical medication to treat early stage basal cell carcinomas or precancerous skin growths, such as actinic keratosis or Bowen disease
  • As a systemic medication to treat skin cancer that has spread to other parts of the body

Uses of Chemotherapy in the Treatment of Skin Cancer

Chemotherapy can be used in a variety of ways to treat skin cancer. How it is used will depend upon how advanced your cancer is and whether it has spread to other parts of the body. Chemotherapy can be used to treat skin cancer:

  • As a primary form of treatment, using the topical medication 5-fluorouracil (5-FU)
  • As a way to shrink a cancerous tumor
  • To destroy any remaining cancer cells after a tumor has been surgically removed
  • To alleviate symptoms of advanced cancer (palliative treatment)

Treatment With Chemotherapy

Treatment with chemotherapy varies based upon the way in which the drug is delivered, either topically through the skin or systemically through the vein or orally.

Chemotherapy Cream

The chemotherapy drug 5-fluorouracil is available as a cream with many different formulations, which is applied topically on and around the site of the skin cancer or pre-cancerous lesion. With topical chemotherapy, the drug works locally where it is applied, with very little of the drug being absorbed into the body. This prevents many of the side effects associated with systemic chemotherapy.

If your doctor prescribes 5-FU, you will be given specific instructions on how and when to apply the cream. In most cases, you will be instructed to apply the cream once or twice a day over the entire affected area for one to several weeks.

During treatment, your skin may become red, inflamed, and sore. Some patients may experience even more severe effects, with blister formation and pain at the application site. Some people experience a greater degree of inflammation than others. A week or two into treatment, you may notice the formation of a crust or a scab. As the tumor disintegrates and your skin exfoliates, the crust will fall off and the lesion will no longer be visible. In the following weeks, your skin will complete its healing process and new skin will regrow in the treatment area. 

Systemic Chemotherapy

Chemotherapy may be delivered into a vein or taken orally to treat skin cancer that has spread to other parts of the body. While this happens exceedingly rarely with skin cancer, this is an important option for patients with advanced disease. The treatment may be performed to slow the growth of cancer or to relieve symptoms caused by cancer. This therapy is most often used to treat metastatic squamous cell carcinoma or melanoma. The treatment may involve one drug or a combination of drugs.

Types of Skin Cancer Treated

Topical chemotherapy is typically used to treat superficial, non-invasive basal cell carcinoma and precancerous lesions, such as Bowen’s disease and actinic keratosis. Intravenous or oral chemotherapy may be used to treat any type of skin cancer that has spread to other parts of the body but is most commonly used to treat squamous cell carcinoma and melanoma.

Risks and Benefits

Topical chemotherapy is able to treat basal cell carcinomas and other precancerous lesions less scarring than surgical procedures, which makes it a desirable treatment. Topical chemotherapy, however, is not as effective as other methods, such as surgical removal or Mohs micrographic surgery, and there is a higher chance that cancer may come back. Topical chemotherapy is also associated with other side effects such as pain and soreness at the treatment site, sensitivity to sunlight during and after treatment, and an unsightly wound during treatment. Intravenous and oral chemotherapy are associated with a wide range of side effects, which will vary based upon the specific drug or drugs being used and the patient’s unique response to the treatment.

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