Non-Melanoma Skin Cancer (NMSC)
Read more clinical background about NMSC treatment, including treatment type, treatment description, advantages, and risks.
Curative treatment of NMSC is broadly divided into surgical excision (which accounts for most cases), radiation therapy, and other treatments.
Choice of treatment depends on:
- Tumor factors – histological diagnosis, stage, location of lesion, and number of lesions
- Patient factors – comorbidities, previous treatments, condition of surrounding skin, and patient choice
- Treatment factors – cure rate, side effects, cosmetic, and functional effects
- Availability of treatment modalities
X-ray therapy is also used for the treatment of pre-cancerous lesions (e.g., carcinoma in situ, actinic keratosis, and lentigo maligna), where radiation therapy is deemed to provide more favorable treatment outcome than other treatment options.
The patient population tends to be mainly adults. The major risk factor for NMSC (and pre-cancerous lesions) is chronic ultraviolet sun exposure, and lesions are most commonly found on sun-exposed areas such as the head and neck.
Basal Cell Carcinoma (BCC)
BCC’s can grow and cause significant local damage but do not tend to metastasize to other areas and do not tend to cause mortality.
Squamous Cell Carcinoma (SCC)
SCCs grow and cause local damage but can also spread (metastasize) to regional lymph nodes and to distant sites, and therefore they can ultimately be fatal.
All Treatment options (including X-ray therapy) for BCC and SCC are detailed and compared in the following table, with advantages and disadvantages.
Pre-Invasive NMSC lesions
Pre-invasive NMSC lesions include actinic keratosis and Bowen’s disease (squamous cell carcinoma in situ). They can progress to invasive cancers and cause morbidity due to their appearance and associated symptoms, such as itching. They can present as single lesions, but more often present as wide areas of field change. Therapies can be directed towards individual lesions or towards wide fields of cancerization. All treatment options for pre-invasive NMSC lesions are listed below with detailed descriptions provided in the previous table.
- Surgical excision and curettage – These are effective ways of removing or destroying single lesions but may not be possible or desirable due to comorbidities (including anticoagulation). Risks include infection, bleeding, wound rupture, and poor cosmetic outcome.
- Topical creams including Effudix and Imiquimod – these can be effective in some patients, but do not clear all lesions, need to be repeated, and have inflammatory side-effects.
- Photodynamic therapy – This can be effective in the treatment of single lesions, but its utility for wider fields is limited by pain.
- Radiation therapy is effective at clearing single lesions and areas of field change, including pre-cancerous change and admixed invasive NMSC. Advantages, disadvantages, and side effects are detailed above.
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