Lasers. Laser surgery may be useful for certain basal cells and for keratoses that appear on the lips, although it is not clear whether lasers offer any advantages over other surgical treatments. Lasers do not appear to be very effective for thick or tough squamous cell carcinomas.
Cryosurgery
Cryosurgery removes skin cancer cells or actinic keratoses by freezing the affected tissue with liquid nitrogen (a technique known as cryosurgery). Studies report the following:
- It can remove even wide areas of actinic keratoses and may be more effective over the long term than treatment with 5-fluorouracil, the standard drug. Cryosurgery also appears to reduce the risk for squamous cell carcinoma in these patients.
- A head-to-head comparison or a freezing technique with Mohs micrographic surgery in patients with basal cell carcinomas (BCCs) reported similar recurrence rates with each approach. Over 85% of the patients with the freezing technique were satisfied with the appearance of the area afterwards. Five-year recurrence rates were only 2.1%. (Mohs surgery is still the treatment of choice for high-risk BCCs.)
Cryotherapy achieves good cosmetic results for many patients. However, it may cause blistering and ulceration, leading to pain and infection, as well as harmless, but undesirable, skin-color changes.
Radiation
In unusual cases where the carcinoma may be in an inoperable position (such as the eyelid or the tip of the nose) or if cancer has recurred multiple times, radiation therapy may be indicated. Radiation is directed at the tumor. It may take one to four weeks with treatments performed several times a week. One technique being investigated for basal and squamous cell carcinoma uses radiation implants (brachytherapy) and custom-made molds to specifically target the radiation. Studies suggest that this treatment is very effective with few complications.
Topical Phototherapy and Aminolevulinic Acid (ALA)
Topical phototherapy with aminolevulinic acid (ALA) is a nonsurgical method that is proving to be a good choice for treating actinic keratoses and some nonmelanoma skin cancers (Bowen's disease and basal cell carcinoma). It employs blue light administered after that patient has taken aminolevulinic acid (Levulan, Karastik). ALA accumulates in the skin cells and when exposed to intense light, the chemical causes these cells to die. This approach allows precise targeting of one or more lesions, leaving healthy skin unaffected.
It does not penetrate deeper than the epidermis (the top layer of the skin), so it does not produce scarring or changes in skin color, as cryotherapy or other more invasive treatments do.
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