How Do You Treat Skin Cancer on the Nose?

The nose is a relatively common spot for skin cancer to develop. Skin cancer often starts on the face because it's usually the body part that's exposed to the sun.

The two most common types of skin cancer that develop on the nose are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). While both should be addressed right away, BCC is usually slow-growing and SCC grows more quickly.

Basal cell carcinoma is the most common type of skin cancer, with about 80% of cases occurring on the face and 25% to 30% on the nose. 

The third type of skin cancer, melanoma, is rare and much more serious. It almost always requires excisional surgery to remove it. Fortunately, most forms of skin cancer are very treatable, especially when caught early. Treatment may include surgery, radiation, topical treatments, and more. 

Types of Skin Cancer 

The first step in treating skin cancer on the nose is determining what type it is and how far it has spread. Skin cancer is usually diagnosed through a skin biopsy. Your dermatologist will remove a tissue sample after numbing the area and send it to the lab. There, a pathologist will examine the cells under a microscope and determine if cancer is present. The types of skin cancer that can appear on the nose are basal cell carcinoma, squamous cell carcinoma, and melanoma. 

Basal Cell Carcinoma

Basal cell carcinoma is the most common form of skin cancer. It is slow-growing and rarely metastasizes to other areas of the body. However, the longer it grows, the more harm it can do.

Basal cell carcinoma tends to spread through the skin and outwards. This means that a small lesion on the nose could be hiding a larger problem beneath the surface. When the cancer cells spread on the nose and face, they are more difficult to treat and cause more serious cosmetic concerns as well. People with fair skin and those with a history of frequent sun or tanning bed exposure are more at risk. 

Squamous Cell Carcinoma

Squamous cell carcinoma is the second most common form of skin cancer, and frequently presents on the face. Like basal cell carcinoma, it is curable when caught early. Squamous cell carcinoma lesions tend to look a little different on everyone, but usually appear as scaly red patches, open sores that don’t heal, rough, thickened skin, or wart-like growths. 

Melanoma

Melanoma is considered the most dangerous type of skin cancer because of its ability to spread to other parts of the body. Melanoma lesions are caused by mutations in melanocytes, skin cells responsible for producing melanin or pigment. These growths are usually black or brown in color and have irregular borders. Like the other types of skin cancer, melanoma, though aggressive, is curable when caught early, and the five-year survival rate is 99% when diagnosed and treated in the earliest stage. 

Surgical Treatment

The options for treating skin cancer on the nose depend on the type of cancer and how advanced it is, as well as other factors like age and general health. Because skin cancer rarely spreads beyond its original site, surgery is a common treatment.  

Before going ahead with surgical treatment, be sure to find the right doctor and obtain a second opinion. Search for a dermatologist who has extensive experience in treating skin cancer on the face. Ask your dermatologist if they have completed a dermatology surgery fellowship, which would give them the most expertise for your type of cancer. Doctors who have received this specialized training will be the most skilled in removing cancer while sparing as much skin and tissue on and around the nose as possible. A plastic surgeon may also be needed depending on the size of your tumor. 

Curettage and Electrodesiccation

This common type of skin cancer surgery involves scraping or burning off the skin growth. It is used for skin cancer lesions, as well as benign growths. First, the physician injects a numbing medication in and around the lesion, and then it is scraped off. Cauterization is used to stop bleeding. This procedure sometimes needs to be repeated depending on the size of the lesion. Research has shown that there is no significant difference in cure rates between skin cancers treated with curettage and electrodesiccation and those treated with excisional surgery.

Mohs Surgery

Mohs surgery is the careful practice of removing thin layers of cancer cells. This approach helps to save the surrounding tissue, and can take several hours to complete. Mohs surgery is more likely to be used when cancer is found in the skin folds around the nose. The rate of recurrence after Mohs surgery is less than 5%, the lowest of all treatment options. 

Excisional Surgery

When performing excisional surgery, your physician will remove the skin cancer growth along with some of the healthy tissue around it. The area is first numbed with a local anesthetic, and stitches are usually required. If the growth is large, a skin graft may be needed. There is a risk of scarring with excisional surgery; this can often be corrected with reconstructive surgery. The cure rates for excisional surgery in early skin cancer are 95% for basal cell carcinoma and 92% for squamous cell carcinoma. 

Laser Surgery

Laser surgery involves shining a laser beam directly at the skin to vaporize cancer cells. It is most commonly used in precancerous growths like actinic keratosis or as a secondary treatment for skin cancer. 

Cryosurgery

Cryosurgery, also known as cryotherapy, is often used to treat very small cancer growths or precancerous lesions. In this technique, your physician applies liquid nitrogen to the skin cancer growth to freeze it off. This kills the cancer cells and causes the skin to blister and then crust over. It may need to be repeated a few times at the same office visit. This process usually leaves a scar, and the blister should heal within one to two months.

Radiation Therapy

When a skin cancer tumor is very large or cannot be removed with surgery, radiation therapy may be considered. During therapy, high-energy rays or particles are used to kill cancer cells. Radiation has been proven effective at curing early-stage basal cell carcinoma and squamous cell carcinoma. It can also help to shrink advanced tumors and treat metastases. Radiation therapy is often used with other treatments. For example, your physician may recommend radiation after surgery to ensure that all of the cancer cells are destroyed. This could reduce the risk of recurrence. 

Photodynamic Therapy

Photodynamic therapy has been proven effective at treating precancerous lesions, but is not yet an approved treatment for skin cancer. It involves applying a gel over the lesion, which is then absorbed into the skin. This drug causes the cancer cells to become very sensitive to light. A special light is then shown directly onto the lesion, destroying the cancerous cells. Photodynamic therapy can make the skin extremely sensitive to sunlight. Talk with your dermatologist about how to stay safe in the sun after treatment. 

Topical Medications

It is possible to treat both basal cell carcinoma and squamous cell carcinoma with topical chemotherapy.

These medications usually come in the form of a cream or ointment that can be applied directly to the cancerous growth:

• 5-FU (5-fluorouracil) can be used to destroy cancer cells near the skin’s surface, but cannot be absorbed deep into the skin. It is meant to treat both precancerous lesions and early-stage skin cancer.
• Solaraze (diclofenac) is a nonsteroidal anti-inflammatory medication. It can be used to treat precancerous lesions and is applied twice daily for two to three months.
  
• Zyclara (imiquimod) is an immune response moderator cream that works to boost the immune system’s response to skin cancer. It can be used for precancerous lesions or very early-stage basal cell carcinoma.
• Interferon can be injected directly into the cancerous skin growth to increase the immune system’s response. It is usually considered when surgery is not an option.

Picato (ingenol mebutate) is another topical chemotherapy agent. It can be used to treat precancerous lesions, but is not approved to treat squamous or basal cell carcinomas.

Oral Medications for Advanced BCC

It is rare for skin cancer to reach advanced stages, but when it does, oral medications may help. In addition to chemotherapy, targeted drugs may be used to treat advanced skin cancer. Targeted therapy means that the medication is able to directly target the cancer cells without destroying healthy cells. This can help to reduce side effects from treatment. 

Vismodegib (Erivedge) and sonidegib (Odomzo) are hedgehog pathway inhibitors that work to prevent cancer cells from growing and spreading. The capsules are taken once per day and may be considered after surgery and other treatments. These medications come with several possible side effects and should never be taken during pregnancy since they can affect fetal growth.

Cetuximab (Erbitux) is an EGFR inhibitor that can help to stop the spread of cancerous squamous cells. Its possible side effects include skin infections, diarrhea, mouth sores, and loss of appetite. 

Intravenous (IV) Immunotherapy

Keytruda (pembrolizumab) is approved for the treatment of locally advanced cutaneous squamous cell carcinoma (cSCC), head and neck squamous cell cancer (HNSCC), Merkel cell carcinoma (MCC), and melanoma that is not curable by surgery or radiation.

This treatment is not chemotherapy or radiation therapy. It is a drug therapy that works with your immune system to help fight certain cancers.

Side effects associated with Keytruda can sometimes become severe or life-threatening and can lead to death.

Opdualag (nivolumab and relatlimab) is approved for the treatment of metastatic melanoma or melanoma that cannot be removed by surgery. The most common side effects include muscle and bone pain, diarrhea, fatigue, and skin rash.

Coping

While most skin cancer treatments are very effective, they can come with side effects. The most common risks of treating skin cancer on your nose are scarring and possible disfigurement. Even if you become cancer-free, these effects can be very bothersome. Talk with your oncologist or dermatologist about working with a plastic surgeon if needed. Any surgery will cause scarring, but a plastic surgeon can help to reduce it while focusing on not changing your appearance as much as possible. 

The best way to reduce scarring and to avoid disfigurement is by catching skin cancer early. Set up annual appointments with your dermatologist and perform skin self-checks every month to look for new or changing skin growths. 

A Word From Verywell

Being diagnosed with skin cancer on your nose is an incredibly stressful experience. It’s helpful to remember that most cases of skin cancer are highly curable, especially when caught in the early stages. Talk with your physician about the best treatment options for you and your individual cancer. The earlier you begin treatment, the more successful it will be and the lower the risk of scarring and disfigurement.