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 pre-cancerous 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 in 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
the cancer or to relieve symptoms caused by the 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.
What types of skin cancer does chemotherapy treat?
Topical
chemotherapy is typically used to treat superficial, non-invasive basal
cell carcinoma and pre-cancerous 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
pre-cancerous 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 the 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.
