Chemotherapy

Chemotherapy involves using drugs to kill cancer cells. The chemotherapy used to treat nonmelanoma skin cancer may be either topical (applied directly to the skin) or systemic (injected or taken orally).

Topical Chemotherapy
With topical chemotherapy, the drugs used to kill the cancer cells are placed directly onto the skin (rather than being given orally or by injection).

The topical medications currently available in Canada include 5-fluorouracil (5-FU) and imiquimod. These creams are more commonly used to treat pre-cancerous (not yet cancer) skin lesions such as actinic keratosis. These rough, red, scaly spots, which may itch or sting, indicate excess exposure to sun over many years. This condition increases a person's risk of developing skin cancer.

Actinic keratoses

5-FU is applied directly onto the skin in the form of a cream. This treatment only reaches cancer cells near the skin's surface. It cannot reach cancer cells that have gone deeper into the skin or spread to other organs.

Side effects from 5-FU treatment are common. The cream may make your skin red and sensitive for a few weeks. It can cause burning, oozing, pain, itchiness and skin colour changes. 5-FU also increases the skin's sensitivity to sunlight. Sunlight on the treated area can cause intense pain and burning, so treated areas must be protected from the sun for a few weeks afterwards.

The second drug, imiquimod, belongs to a new group of medications called immune response modifiers. These stimulate a person’s immune system to produce substances which interfere with the growth of cancer cells. Imiquimod has been approved by Health Canada to treat actinic keratoses and basal cell carcinomas. This treatment is recommended only for low-risk, superficial basal cell carcinomas.

Systemic Chemotherapy
Systemic chemotherapy involves taking chemotherapy drugs in the form of a pill or by injection. These drugs travel through the bloodstream and attack cancer cells that have spread beyond the skin to the lymph nodes or other organs.

One or more drugs may be used to treat squamous cell carcinoma that has spread to other organs. Some chemotherapy drugs, such as cisplatin, doxorubicin, 5-FU or mitomycin, can temporarily delay the spread of these cancers and relieve some symptoms. However, systemic chemotherapy (taken alone or together with radiation therapy) is usually not able to cure nonmelanoma skin cancer after it has spread.

Chemotherapy drugs damage not only cancer cells but also some normal cells, which, in turn, can cause side effects. Side effects from chemotherapy will depend on the type of drugs you are taking, your dosage and the length of time you are on the medication. Side effects may include:

• nausea and vomiting (You will be given anti-nausea drugs that may help.)
• loss of appetite
• temporary loss of hair
• mouth or vaginal sores
• increased chance of infection
• fatigue
• bleeding and bruising after minor cuts and injuries
• hearing loss

Most of the side effects, with the possible exception of hearing loss, will go away when the treatment is over.

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