Nonmelanoma Skin Cancer: Chemotherapy

Being diagnosed with skin cancer can be scary. The good news is that effective treatment choices are available, including chemotherapy. Chemotherapy (chemo) uses strong medicines to kill fast-growing cancer cells by keeping them from dividing to make more cells and growing larger.

Topical chemo. Chemo for nonmelanoma skin cancer is most often a cream or ointment you put right on the skin. You will only have chemo this way when the cancer is just in the top layers of the skin. This topical medicine doesn't reach the deeper layers of skin or any other parts of your body. Usually, you apply the medicine several times a week for a few weeks. You'll be taught how to do this and can do it at home.

Systemic chemo. With this method, chemo medicine is put directly into your blood through an I.V. (intravenous) tube. The I.V. is a small, soft tube that's placed in a vein in your hand or arm. Systemic chemo might be used to treat squamous cell skin cancer that has spread to lymph nodes and other organs. It may be done as an outpatient visit to a hospital. This means you can go home the same day. You may also have systemic chemo at your doctor's office or a chemo infusion clinic.

The medicines used for your treatment will depend on the type of nonmelanoma skin cancer you have. The three most common types of these cancers are:

Squamous cell skin cancer. Treatment for this type of cancer may be topical chemo or systemic chemo.

The most common medicines used for topical chemo is 5-fluorouracil (5-FU).

Some of the medicines most often used for systemic chemo are:

• Cisplatin
• 5-fluorouracil (5-FU)
• Carboplatin
• Capecitabine
• Docetaxel
• Paclitaxel

Basal cell skin cancer. Topical chemo with fluorouracil, calcipotriene/fluorouracil, and imiquimod may be used. I.V. chemo is rarely used to treat basal cell carcinoma. But in advanced cases, other medicines you take by mouth might be a choice. These medicines are called targeted therapies. You can take them at home like other oral medicines.

Cutaneous (skin) lymphoma. Many different medicines and combinations of medicines are used to treat lymphoma of the skin. The choice depends on the exact kind of lymphoma you have.

The most common medicines used for topical chemo are:

• Mechlorethamine
• Carmustine

Some of the medicines most often used for systemic chemo are:

• Methotrexate
• Cyclophosphamide
• Liposomal doxorubicin
• Pralatrexate
• Gemcitabine
• Etoposide
• Vincristine

Chemo affects and kills cancer cells, which divide and grow quickly. It also affects some kinds of normal cells, which can cause side effects.

Topical chemo

Side effects for topical chemo can include:

• Red, itchy, and painful skin where the cream or ointment is being used. This goes away over time after treatment ends.
• Infection, which can be treated with topical antibiotic cream
• Increased sensitivity to sunlight. This lasts for a few weeks after treatment. Be sure to protect your skin from sunburns.

If your skin becomes red, hot, swollen, or hurts during treatment, see your doctor.

Systemic chemo

Systemic or I.V. chemo can affect cells in many parts of the body. The side effects depend on the medicines you're given and the dose. Some common side effects include:

• Feeling weak and tired
• Nausea or vomiting
• Loss of appetite
• Mouth sores
• Diarrhea or constipation
• Hair loss
• Rashes
• Peripheral neuropathy. This is nerve damage that can cause numbness or tingling (a "pins and needles" feeling) in your fingers or toes.
• Increased risk of infection from low white blood cell counts
• Easy bruising or bleeding from low blood platelet counts
• Fatigue from low red blood cell counts

You can receive treatment for many chemo side effects to keep them from getting worse. You may also be able to take steps to help prevent some of them. Most side effects go away over time after treatment ends. But some may remain long term. If you have side effects, talk with your doctor about how to manage them.

It's important to know which medicines you're taking. It's a good idea to write down their names. Be sure to ask your health care team how they work, what side effects they might cause, and how to manage them.

Talk with your doctors about what symptoms to watch for and when to call them. For instance, chemo can make you more likely to get infections. You may be told to check your temperature and stay away from people who are sick. You may need to call if you have a fever or chills. Make sure you know what number to call with questions. Find out if there is a different number to call during evenings. weekends, and holidays.

It may be helpful to keep a diary of your side effects. Write down physical, mental, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your health care team to make a plan to manage your side effects.