Non-Melanoma Skin Cancer Treatment Planning
Following a diagnosis of non-melanoma, we work carefully to determine the best treatment options for you and to prepare a treatment plan personalized for your needs.
Your treatment depends primarily on the type of skin cancer, where on the body it is located, and whether it has been previously treated.
WHAT TO KNOW ABOUT NON-MELANOMA TREATMENT PLANNING
1Getting Started In Your Care
2Getting Your Diagnosis
3Planning Your Treatment
Considering Your Options
4Undergoing Treatment & Follow-Up
Select your type of treatment below.
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Assessment
Evaluating Options
Choosing Treatment
The team evaluates different options for your treatment plan, based on the details of your diagnosis, including:
- Type of non-melanoma skin cancer
- Location of the lesion
- Depth of the lesion
About non-melanoma
- Your age and overall health
- Whether you have had cancer before
There are a number of other consideration which may impact your treatment plan.
We discuss different types of treatment and how to combine them in a sequence that will best treat the cancer.
a. Your doctors may prescribe a treatment plan that combines one or more of types of treatment. These include surgery (the main type of therapy for non-melanoma), non-surgical procedures, and drug therapy. This may include topical medications or medications that travel through the bloodstream to attack cancer anywhere in the body. Radiation therapy is sometimes used in the setting of more advanced non-melanoma to enhance local control of the tumor. The combination of treatment types may need to take place in a specific order to best treat your specific condition.
Learn about treatments for non-melanoma
b. Your treatment options will also be determined by the stage of your cancer. We can treat all the stages of non-melanoma, from the least to the most severe.
Your care team will explain the options and the possible treatment sequence. Your doctors will help you make an informed decision about which options may be right for you.
The best treatment for one person might not be the best treatment for another. There are three topics to consider when discussing with your doctor what works best for you.
Medical goals
Your care team will recommend treatment options based on your specific diagnosis. Different types of treatment for non-melanoma have different goals, such as:
- Destroying or surgically removing cancer cells in the skin to increase the chance of cure
- Destroying or surgically removing any cancer cells that may have spread to other parts of the body
- Slowing or stopping the growth of cancer
- Delaying or preventing cancer from coming back (recurrence)
- Managing symptoms of incurable cancer or those related to treatment of advanced disease
Personal treatment goals
As you and your care team discuss and make decisions about your treatment plan, it helps to think about your goals for treatment. These goals are different for each person, but health and quality of life are likely at the top of your list. Within those two priorities, there are several questions to consider:
- What’s important to me?
- What do I value?
- What do I need from my relationships?
- What do I want from the treatment experience?
It’s important for your loved ones to understand your treatment goals and wishes, so talk to them. You can ask family and friends for emotional support and help with a variety of issues during your care journey.
The effect of treatment on everyday life
Your care team can help you understand how various treatments can help you achieve your goals. Discuss what you want to be able to do, both during treatment and after it is complete. Issues specific to your health include:
- Treatment: How cancer and treatments will affect you and your ability to continue your everyday activities at work and home
- Side effects and symptoms: How to manage and cope with disease symptoms and treatment side effects
- Balance: Ways to balance aggressive treatment that prolongs survival with side effect management that maintains a good quality of life
Other important issues to consider include:
- Communication: Ways to talk to your family, friends, and others (such as co-workers) about your diagnosis, and how to ask for help
- Emotional well-being: How to manage your own emotions and the emotional impact of your diagnosis on your family and friends
- Relationships: How to maintain relationships with your partner, family, and friends, including intimacy, everyday activities, and responsibilities
- Appearance and body image: Ways to cope with changes that may result from treatment and the cancer itself
- Daily activities: How to take care of yourself, look after your family, and balance work responsibilities while undergoing non-melanoma treatment
- Travel and distance: How to manage family and work responsibilities if you are coming to Stanford from outside the Bay Area
The team evaluates different options for your treatment plan, based on the details of your diagnosis, including:
- Type of non-melanoma skin cancer
- Location of the lesion
- Depth of the lesion
About non-melanoma
- Your age and overall health
- Whether you have had cancer before
There are a number of other consideration which may impact your treatment plan.
close Assessment
We discuss different types of treatment and how to combine them in a sequence that will best treat the cancer.
a. Your doctors may prescribe a treatment plan that combines one or more of types of treatment. These include surgery (the main type of therapy for non-melanoma), non-surgical procedures, and drug therapy. This may include topical medications or medications that travel through the bloodstream to attack cancer anywhere in the body. Radiation therapy is sometimes used in the setting of more advanced non-melanoma to enhance local control of the tumor. The combination of treatment types may need to take place in a specific order to best treat your specific condition.
Learn about treatments for non-melanoma
b. Your treatment options will also be determined by the stage of your cancer. We can treat all the stages of non-melanoma, from the least to the most severe.
close Evaluating Options
Your care team will explain the options and the possible treatment sequence. Your doctors will help you make an informed decision about which options may be right for you.
The best treatment for one person might not be the best treatment for another. There are three topics to consider when discussing with your doctor what works best for you.
Medical goals
Your care team will recommend treatment options based on your specific diagnosis. Different types of treatment for non-melanoma have different goals, such as:
- Destroying or surgically removing cancer cells in the skin to increase the chance of cure
- Destroying or surgically removing any cancer cells that may have spread to other parts of the body
- Slowing or stopping the growth of cancer
- Delaying or preventing cancer from coming back (recurrence)
- Managing symptoms of incurable cancer or those related to treatment of advanced disease
Personal treatment goals
As you and your care team discuss and make decisions about your treatment plan, it helps to think about your goals for treatment. These goals are different for each person, but health and quality of life are likely at the top of your list. Within those two priorities, there are several questions to consider:
- What’s important to me?
- What do I value?
- What do I need from my relationships?
- What do I want from the treatment experience?
It’s important for your loved ones to understand your treatment goals and wishes, so talk to them. You can ask family and friends for emotional support and help with a variety of issues during your care journey.
The effect of treatment on everyday life
Your care team can help you understand how various treatments can help you achieve your goals. Discuss what you want to be able to do, both during treatment and after it is complete. Issues specific to your health include:
- Treatment: How cancer and treatments will affect you and your ability to continue your everyday activities at work and home
- Side effects and symptoms: How to manage and cope with disease symptoms and treatment side effects
- Balance: Ways to balance aggressive treatment that prolongs survival with side effect management that maintains a good quality of life
Other important issues to consider include:
- Communication: Ways to talk to your family, friends, and others (such as co-workers) about your diagnosis, and how to ask for help
- Emotional well-being: How to manage your own emotions and the emotional impact of your diagnosis on your family and friends
- Relationships: How to maintain relationships with your partner, family, and friends, including intimacy, everyday activities, and responsibilities
- Appearance and body image: Ways to cope with changes that may result from treatment and the cancer itself
- Daily activities: How to take care of yourself, look after your family, and balance work responsibilities while undergoing non-melanoma treatment
- Travel and distance: How to manage family and work responsibilities if you are coming to Stanford from outside the Bay Area
close Choosing Treatment
Every cancer is different, even in the early stages. The best treatment for one person might not be the best treatment for another. Your doctor will help you make an informed decision about which options may be right for you. Your treatment plan may consist of one or any combination of the following:
- Regular monitoring by your care team
- Surgery
- Nonsurgical Procedures
- Drug Therapy
- Radiation Oncology
Surgery
Your care team may recommend surgery to diagnose, stage, or treat cancer:
- Diagnosis: Your doctor may recommend that you have a biopsy, to obtain tissue samples and determine a more precise diagnosis. Most patients with non-melanoma have already had a diagnostic skin biopsy, but additional biopsies may be recommended if there are other skin lesions of concern, or if any enlarged lymph nodes are present.
- Staging: Surgery and sentinel lymph node biopsy can help determine the stage of non-melanoma, by showing the thickness of the skin tumor and other details, as well as whether nearby (regional) lymph nodes are involved at the outset.
- Treatment: Surgically removing the tumor from the skin provides the best chance for cure in most cases of non-melanoma.
Surgery Resources
Should surgery be part of your care plan, we are here to help guide you through the process.
If surgery provides a good treatment option, you will meet with a dermatologic surgeon or surgical oncologist to develop a plan. Surgery for non-melanoma is different for every patient, and depends on the stage of your non-melanoma. Your surgeon will work with you to determine the least invasive and most effective surgery for the type of non-melanoma you have.
Combining surgery with other treatments
To achieve the best possible outcome, your care team may recommend combining surgery with other treatments such as drug therapy.
Nonsurgical Procedure
Nonsurgical Treatments for Non-Melanoma
Some nonsurgical treatments are options for precancerous conditions. They work faster than topical skin creams, but may take several treatments to achieve complete results.
Nonsurgical treatment Resources
Photodynamic light therapy offers a precise way to treat some skin cancers and precancerous growths caused by sun damage.
What to expect during treatment with photodynamic light therapy and how to prepare
Drug Therapy (Medical Oncology)
Drug therapy may consist of a topical skin cream administered by a dermatologist. For more aggressive or advanced cancers, you may be referred to a medical oncologist for medications that travel throughout the body to address cancer wherever it may be found.
The recommended treatment depends on the subtype of non-melanoma seen in the biopsy and other factors.
Types of Drug Therapy for Non-Melanoma
At Stanford, our medical oncologists use several types of drug therapy, including:
Topical medications: A few topical creams can be used to treat the very superficial types of non-melanoma. Various topical medications may also be used to treat skin infections or rashes that can occur during treatment for your non-melanoma. Our Supportive Dermato-Oncology team can help to address any uncomfortable skin side effects you are having related to your cancer therapy.
Topical Medication Resources
Topical medications treat superficial non-melanomas at the tumor site. We are here to help you prepare and guide you through the process.
Chemotherapy: This group of medications stops the growth of rapidly dividing cells in the body, both cancerous and noncancerous. While powerful, chemotherapy can cause more side effects than other medication types, because it cannot distinguish between cancerous and healthy cells. Chemotherapy is a treatment option for almost anyone with cancer.
Chemotherapy Resources
Chemotherapy is a treatment option for some progressed non-melanomas. We are here to help you prepare and guide you through the process.
Targeted therapy: Medications that target certain features (including gene mutations) on cancer cells to block their growth, without harming nearby tissues.
For treatment to work, the cancer must have the specific markers a particular medication was designed to target. Some non-melanoma cells have certain proteins on the cells that promote growth. These proteins cause cancer to grow quickly and spread. Our pathologists look for the presence of these proteins by examining samples of tissue taken during a biopsy.
Targeted Therapy Resources
Should targeted therapy be part of your care plan, we are here to help you prepare and guide you through the process.
Drug therapy scheduling
If your treatment plan involves drug therapy, you will have routine visits to have lab work done, see your doctor, and receive medication. You may need to come in once or twice per week. If you need an infusion, you will visit one of Stanford’s infusion treatment centers, where a nurse specializing in non-melanoma care will provide your treatment.
Drug therapy side effects
Side effects from drug therapies vary depending on the type of medication you receive. For example, immunotherapy can cause itchy skin rashes or autoimmune-like symptoms, because it stimulates your immune system to attack the cancer; targeted therapy has different side effects in the body, and chemotherapy (though less commonly used for non-melanoma these days) may affect your hair and nails, because it slows their growth as it slows the growth of cancer cells. Fatigue is also possible. Ask your care team – we can help you manage or prevent many symptoms and side effects that can affect your everyday life.
Radiation Oncology
Radiation therapy is painless treatment that uses high-energy X-rays or other types of radiation to destroy cancer cells. Our radiation oncologists have years of experience safely and effectively treating non-melanoma with radiation, athough this treatment is used less these days due to better systemic (drug) therapies. Using the latest technology, we can precisely target tumors and minimize damage to nearby healthy tissue.
Radiation Therapy Resources
Should radiation therapy be part of your care plan, we are here to help you prepare and guide you through the process.
What to expect during external radiation therapy and how to prepare
Radiation therapy may provide effective local control depending on the type of non-melanoma you have. Radiation therapy has also been used successfully with immunotherapy in the setting of advanced disease to promote the chance for cure. If your are a candidate for radiation therapy, your doctor will speak with you about the best options. The types of radiation therapy we use for non-melanoma treatment at Stanford include:
External radiation uses a machine called a linear accelerator (LINAC) to deliver radiation to the area where the cancer cells are found. Some of the types of external radiation we use include:
- 3D (3-dimensional) conformal radiation therapy (3D-CRT)
With this method, 3D images help the doctor better target the tumor. The images are created using a special machine — a computed tomography (CT) or magnetic resonance imaging (MRI) machine. The radiation beams can be aimed from many different angles to match the exact shape of the cancer. - Intensity-modulated radiation therapy (IMRT)
This method is similar to the first method, but the doctor can adjust how much radiation you get from each beam. In certain situations, this enables the doctor to avoid nearby normal cells to reduce the risk for side effects. - Stereotactic body radiation therapy (SBRT) or stereotactic ablative radiation therapy (SABR)
This method works like the first two methods, and the total amount of radiation you get is similar. But with SBRT, the radiation is given in fewer but stronger doses. This is often used for non-melanoma or other cancers.
Receiving radiation treatments
Radiation therapy does not cause pain, so you won’t feel anything during your treatments. Radiation does not make you radioactive, and you can safely be around other people, including children.
The exact number and timing of your radiation treatments depends on the type of non-melanoma you have and the type of radiation therapy you need:
- Typically, you will be treated once a day, Monday through Friday, over a few weeks.
- Most treatment sessions take 15 to 30 minutes, but some may take up to 1 hour.
- We offer treatment sessions between 8 a.m. and 5 p.m. at our Cancer Centers in Palo Alto, Pleasanton, South Bay, and Turlock.
Radiation therapy side effects
Everyone has a different response to radiation therapy. It may cause short-term side effects during treatment or long-term side effects after treatment ends.
The side effects of treatment depend on the type of radiation you receive, the dose, and your overall health. Common side effects that you may experience after radiation treatment include:
- Fatigue
- Skin color changes, like a tan or sunburn
- Skin irritation
- Skin side effects from radiation therapy are often managed in the Supportive Dermato-Oncology Clinic, in conjunction with Stanford Radiation Oncology.
No matter what you experience, your care team can help ease the side effects of treatment. At least once a week, your radiation oncology team will meet with you to discuss your progress and any side effects that you may have.
Clinical Trials
At Stanford, our doctors are always working to improve care for people with melanoma. As an academic medical center, we conduct clinical trials to evaluate new medical techniques, devices, medications, and other treatments for safety and effectiveness.
For melanoma, we study new approaches to preventing, screening, detecting, diagnosing, and treating melanomama. Some clinical trials look at new methods, while others evaluate new combinations of approved, existing approaches.
Depending on your individual circumstances, a clinical trial may provide a treatment option for you. Like any treatment, clinical trials have possible risks and benefits, including:
Possible benefits of joining a clinical trial:
- Access to a new treatment that isn’t widely available
- Expert care from our world-renowned cancer specialists and their teams
- Low- or no-cost treatment
- Participation in research that can save lives in the future
Possible risks of a clinical trial:
- Treatment that may not work for you
- Side effects that may be unexpected or worse than current standard-of-care treatments
- Additional doctor visits, meaning more time and travel
- Additional tests, which may be uncomfortable or time consuming
- Extra expenses if your health insurance does not cover all patient costs for a trial
Early Stage
Beyond Early Stage
In this stage, skin cancer is confined to the top layer of skin and is quite treatable. Non-melanoma skin cancers are prone to come back, so careful, regular monitoring by your dermatologist or dermato-oncologist is important.
Non-melanoma skin cancers do not commonly spread to other parts of the body. If pathology results and clinical exam leave your care team is concerned about a chance your skin cancer has spread, they may recommend imaging such as a CT scan, a PET-CT scan, or an MR, and perhaps a lymph node biopsy.
In this stage, skin cancer is confined to the top layer of skin and is quite treatable. Non-melanoma skin cancers are prone to come back, so careful, regular monitoring by your dermatologist or dermato-oncologist is important.
close Early Stage
Non-melanoma skin cancers do not commonly spread to other parts of the body. If pathology results and clinical exam leave your care team is concerned about a chance your skin cancer has spread, they may recommend imaging such as a CT scan, a PET-CT scan, or an MR, and perhaps a lymph node biopsy.
close Beyond Early Stage
Your melanoma care team includes doctors who specialize in diagnosing melanoma, removing in with surgery, or treating it with drugs chosen to be most effective.
- Dermatologists/Cutaneous oncologists: doctors who specialize in the diagnosis and treatment of skin cancers; Supportive Dermato-oncologists specialize in treating skin side effects from advanced cancer treatment and work to make patients more comfortable so that they can continue their cancer therapy
- Surgical oncologists: Cancer surgeons who remove thicker melanoma, perform lymph node biopsies and surgery for more advanced melanoma
- Medical oncologists: Cancer doctors who treat advanced melanoma with drugs
- Pathologists/dermatopathologists: doctors who specialize in evaluating skin tissue to diagnose melanoma
- Genetic counselor/skin cancer genetic specialists: Health care professional trained in cancer genetics and testing
Your treatment plan will address the following:
- Location, size, and stage of the cancer
- Treatment goals
- Treatment options, their possible side effects, and ways to minimize or relieve side effects
- Expected length of treatment
- Follow-up care after treatment
What is nonmelanoma skin cancer?
Nonmelanoma skin cancers comprise most skin cancer cases. When caught early, they are usually curable. The most common types of nonmelanoma skin cancer are basal cell carcinoma and squamous cell carcinoma.
Skin cancer tumors form in the skin, the body’s largest organ. The skin contains three layers:
- Epidermis: The outermost layer contains squamous cells, basal cells, and melanocytes.
- Dermis: The middle layer contains numerous structures, such as blood vessels, nerves, hair follicles, and sweat glands.
- Subcutaneous (fat): This is the deepest layer of skin.
How does nonmelanoma skin cancer develop?
Cancer starts when cells become abnormal (mutate) and grow out of control. Nonmelanoma skin cancer forms in the basal or squamous cells of the skin’s outer layer.
Nonmelanoma skin cancer typically appears as unusual spots or sores on areas of the skin exposed to the sun. However, nonmelanoma can also develop in unexposed areas, including the palms of the hands, soles of the feet, fingernails, or toenails.
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Other than an unusual-looking spot on your skin, you may or may not experience symptoms with nonmelanoma skin cancer. Symptoms may include:
- Bleeding at the spot or sore
- A scab or crust that doesn’t heal after bleeding
- A mole that is growing faster than others
Some skin cancers grow faster than others and may spread into nearby tissues or other parts of the body (metastasize). It’s important to see a doctor if you see any unusual spot on your skin, even if you have no other symptoms.
Risk factors increase your chance of developing skin cancer and other conditions. Having one or more risk factors does not mean you will develop cancer, and some people with no risk factors develop the disease.
Nonmelanoma skin cancer risk factors include:
- Excessive exposure to the sun, including a history of sunburns and living in a sunny climate
- Fair skin and light-colored eyes and hair
- Family history of skin cancer
- Personal history of skin cancer or precancerous lesions (areas of abnormal cells)
- Radiation exposure
- Weakened immune system
The most common forms of nonmelanoma skin cancer are:
- Basal cell carcinoma: This type comprises the majority of skin cancer cases. It starts in the top layer of skin (basal cell layer), grows very slowly, and rarely spreads.
- Squamous cell carcinoma: This is the second most common type of skin cancer. It occurs most often in fair-skinned and elderly people.
Melanoma is a different type of skin cancer. It starts in the melanocytes, the cells that give skin its color. Melanoma is much less common than basal cell and squamous cell carcinomas.
Your doctor will examine you and review your test results to determine if you have early-stage cancer or if your cancer is considered advanced.
The best way to prevent skin cancer is to limit your exposure to the sun, specifically:
- Use sunscreen. Make sure to follow instructions about how much to apply and how often to re-apply it.
- Wear a hat.
- Wear clothes that cover your skin, including your arms and legs. Light-colored clothes can keep you cooler.
- Wear sunglasses to protect your eyes.
If you have had skin cancer, you have a greater chance of getting it again. Therefore, it’s important to reduce your sun exposure and see your dermatologist annually for a skin exam.
We begin your care by establishing or confirming your diagnosis. Your doctor reviews your prior health records and completes a physical exam, including a thorough examination of your skin. Your doctor may recommend specific tests, including:
During this procedure, your doctor (usually a dermatologist) removes a tissue sample from your skin for evaluation.
We perform imaging tests of your skin if your doctor suspects your cancer has spread. A radiologist interprets the images to identify cancer cells.
Also called blood tests or draws, we remove a small blood sample to analyze. We conduct blood tests only if your doctor thinks your cancer has spread.
