Skin Cancer Treatment Glossary

Our glossary gives you detailed information on the treatments physicians currently use for skin cancers and precancers. These include basal cell carcinomas, squamous cell carcinomas and melanomas, as well as precancerous actinic keratoses and atypical moles. We’ve divided the glossary into two sections:

• Medications: topical therapies and drugs that are injected or taken orally.
• Procedures: surgeries, laser and light-based treatments and radiation therapy.

MEDICATIONS (click medication to expand)

  • 5-fluorouracil (Carac®, Efudex®, Fluoroplex®)

    5-fluorouracil (5-FU) cream or solution, a topical chemotherapy, is one of the most commonly used medications for actinic keratoses, the most common skin precancers. It is especially effective for “field therapy,” treating areas of skin with multiple lesions. Efudex® cream is also FDA-approved to treat superficial basal cell carcinoma, with cure rates between 80 and 90 percent, and is sometimes used off-label (without FDA approval) for superficial squamous cell carcinoma.

    You rub this medicine gently onto and around the lesion once or twice daily for two to four weeks. Side effects include redness, swelling and crusting, but for many the therapeutic benefits outweigh any temporary discomfort. There is minimal risk of scarring. 5-FU is available in concentrations ranging from 0.5 to 5.0 percent.

  • Cobimetinib-Vemurafenib, Combination

    This combination of two drugs taken by mouth, cobimetinib (Cotellic®) and vemurafenib (Zelboraf®), is part of a new class of treatments known as targeted therapies, which along with new immunotherapies have been making giant strides in the treatment of advanced melanoma. In patients with stage IV melanoma, these targeted therapies are designed exclusively for those who have a defective, cancer-producing version of a gene called BRAF. About half of all melanoma patients have this defective gene. Normally, BRAF controls skin cell growth, but the defective version essentially becomes stuck in the “on” position, leading to out-of-control growth of cancer cells.

    The FDA approved this combination therapy in 2015 for patients with stage IV inoperable or metastatic melanoma, pairing the BRAF blocker vemurafenib with the new drug cobimetinib that blocks another protein called MEK. As with patients on another targeted combination therapy, dabrafenib-trametinib, those on this combination therapy have slower disease progression and live longer on average than those on vemurafenib or dabrafenib alone. Cobimetinib is used only in combination with vemurafenib, not as an individual therapy. In general, the combined targeted therapies are having such success that the single-therapy targeted regimens are being eliminated.

  • Dabrafenib (Tafinlar®)

    Taken by mouth, this drug is one of a new class of treatments known as targeted therapies, which along with new immunotherapies have been making giant strides in the treatment of advanced melanoma. In patients with stage IV melanoma, these targeted therapies are designed exclusively for those who have a defective, cancer-producing version of a gene called BRAF. About half of all melanoma patients have this defective gene. Normally, BRAF controls skin cell growth, but the defective version essentially becomes stuck in the “on” position, leading to out-of-control growth of cancer cells.

    The FDA approved this oral BRAF inhibitor for advanced melanoma patients in 2013. Like its predecessor, vemurafenib, dabrafenib blocks the BRAF protein, turning off cancerous growth in many patients for months or even years. While it increases the length of time before patients’ disease starts to advance again, as well as length of survival, in most patients the melanoma eventually develops resistance to the drug, and the disease begins to advance again. Drugs that block an enzyme called MEK (see trametinib and cobimetinib) further delay progression of the disease, and drugs combining them with dabrafenib and vemurafenib are improving outcomes. The most serious side effect of both vemurafenib and dabrafenib is the formation of nonmelanoma skin cancers, especially squamous cell carcinomas, most of which are small or superficial and can be treated effectively.

  • Dabrafenib-Trametinib, Combination

    This combination of two drugs taken by mouth, dabrafenib (Tafinlar®) and trametinib (Mekinist®), is part of a new class of treatments known as targeted therapies, which along with new immunotherapies have been making giant strides in the treatment of advanced melanoma. In patients with stage IV melanoma, these targeted therapies are designed exclusively for those who have a defective, cancer-producing version of a gene called BRAF. About half of all melanoma patients have this defective gene. Normally, BRAF controls skin cell growth, but the defective version essentially becomes stuck in the “on” position, leading to out-of-control growth of cancer cells.

    The FDA approved this combination therapy in 2014 for patients with stage IV inoperable or metastatic melanoma, pairing the BRAF blocker dabrafenib with the drug trametinib, which blocks another protein called MEK. This combination therapy has produced some of the best results ever achieved for stage IV melanoma. As with patients on another targeted combination therapy, cobimetinib-vemurafenib, those on this combination therapy have slower disease progression and live longer on average than those on vemurafenib or dabrafenib alone, while also producing less serious side effects. In general, trametinib has been used only in combination with vemurafenib, not as an individual therapy. In fact, the excellent results achieved with the combination targeted therapies is essentially eliminating the use of the single-drug targeted therapies.

  • Diclofenac and hyaluronic acid (Solaraze®)

    This topical gel combining hyaluronic acid, a chemical found naturally in the body, with the nonsteroidal anti-inflammatory drug diclofenac can be effective against precancerous lesions called actinic keratoses (AKs) for people whose skin is sensitive to 5-fluorouracil. Recent research found that a formula of 3 percent diclofenac twice a day successfully eliminated AKs in organ transplant patients, who are highly susceptible to AKs and skin cancers. It also effectively prevented invasive squamous cell skin carcinoma. Treatment typically continues for two to three months. The most common side effects include mild to moderately severe skin reactions, such as dermatitis, rash, itching, dry skin, scaling or other skin irritations, and sometimes nausea and stomach irritations. There is minimal risk of scarring.

  • Imiquimod (Aldara®, Zyclara®)

    This topical cream stimulates the immune system to produce interferon, a chemical that attacks cancerous and precancerous cells. It is available in different strengths, usually applied two or three times a week for several weeks or months to treat people with multiple precancerous lesions called actinic keratoses. This immunotherapy is also FDA-approved to treat superficial basal cell carcinoma, rubbed gently into the tumor five times a week for six weeks or longer, with cure rates between 80 and 90 percent. It is used off-label (without FDA approval) for the treatment of some superficial squamous cell carcinomas. The most common side effects are flaking, itching, swelling, redness and other skin irritations, sometimes accompanied by diarrhea, sinus infections and headaches. There is minimal risk of scarring.

  • Ingenol mebutate (Picato®)

    This gel, approved by the FDA in 2012, is the first topical therapy to treat precancerous lesions called actinic keratoses effectively with just two or three days of application time. It is available in one strength for the face and scalp and another for the rest of the body. Skin redness, flaking, scaling, crusting and swelling are the most common side effects. Ingenol mebutate can cause painful reactions in the first days of treatment, but these usually begin to improve within a week. There is minimal risk of scarring.

  • Interferon alfa-2b (Intron® A)

    Using synthetic versions of natural immune system chemicals, or by inhibiting proteins that block immune functions, immunotherapies boost the immune system’s ability to fight disease. This older form of immunotherapy, injected intravenously for high-risk stage II and stage III melanoma patients, helps to keep melanomas from recurring and advancing. Synthetically derived from natural immune system interferons, it has been found to give patients a longer period before recurrence, but has not been proven to extend lives, and it is used less today because of the success of newer immunotherapies and targeted therapies.

  • Interleukin-2 (Proleukin®/aldesleukin)

    Using synthetic versions of natural immune system chemicals, or by inhibiting proteins that block immune functions, immunotherapies boost the immune system’s ability to fight disease. This older form of immunotherapy, injected intravenously and subcutaneously, was the first immunotherapy approved by the FDA to treat stage IV metastatic melanoma. It has been found to delay recurrence and increase survival in some patients, with about 6 percent of patients achieving complete remission. The technique is used less today because of the success of newer immunotherapies and targeted therapies.

  • Ipilimumab (Yervoy®)

    Using synthetic versions of natural immune system chemicals, or by inhibiting proteins that block immune functions, immunotherapies boost the immune system’s ability to fight disease. This intravenously injected drug, FDA-approved in 2011, was the first medication approved for stage IV melanoma patients in a new class of immunotherapies called checkpoint blockade therapy. By blocking a protein receptor called CTLA-4 that normally keeps the immune system in check, ipilimumab releases waves of helpful T cells to fight melanoma. Ipilimumab has substantially increased the life span of many patients, some of whom are considered cured. However, the drug can produce serious side effects, requiring some patients to stop the therapy.

    In 2015, the FDA approved use of ipilimumab for stage III melanoma patients as well. The hope is that it will provide even greater benefits for these patients whose disease is less advanced, preventing or delaying recurrence and progression of the disease, and therefore saving more lives.

  • Ipilimumab-Nivolumab, Combination

    Using synthetic versions of natural immune system chemicals, or by inhibiting proteins that block immune functions, immunotherapies boost the immune system’s ability to fight disease. In late 2015, the FDA approved this immunotherapy, combining the drugs ipilimumab (Yervoy®) and nivolumab (Opdivo®) for patients with metastatic or inoperable melanoma. Both ipilimumab and nivolumab belong to a new class of immunotherapies called checkpoint blockade therapies that have made headline news with their success in treating advanced melanomas. Ipilimumab blocks a protein receptor called CTLA-4 and nivolumab blocks a similar receptor called PD-1, both of which normally keep the immune system in check. By blocking these receptors, the combination therapy releases waves of helpful T cells to fight melanoma.

    This regimen was approved based on research demonstrating a major reduction in disease progression with the combination therapy compared with ipilimumab alone. About 50 percent of patients have responded to the combination therapy, many going into complete remission. The combination treatment is also slightly more effective than nivolumab alone, though with a higher risk of dangerous side effects than nivolumab alone. Patients have to decide with their doctors whether nivolumab, ipilimumab or the combination therapy is preferable for them.

    Previously, this combination therapy could be used only after ipilimumab alone or another type of treatment called targeted therapy had been tried unsuccessfully. But in 2016, the FDA approved combination ipilimumab-nivolumab as a front-line therapy for stage IV patients, meaning it can now be used for advanced melanoma before any other treatments are tried.

  • Nivolumab (Opdivo®)

    Using synthetic versions of natural immune system chemicals, or by inhibiting proteins that block immune functions, immunotherapies boost the immune system’s ability to fight disease. In 2014, the FDA approved two intravenously injected therapies, nivolumab (Opdivo®) and pembrolizumab (Keytruda®), which belong to a new class of immunotherapies called checkpoint blockade therapies that have made headline news with their success in treating advanced melanomas. By blocking a protein receptor called PD-1, which normally helps keep the immune system in check, both these drugs release massive amounts of T cells to fight the melanoma.

    Previously, these therapies could be used only after an earlier checkpoint blockade therapy, ipilimumab, or another type of treatment called targeted therapy had been tried unsuccessfully. But the FDA recently approved both nivolumab and pembrolizumab as front-line therapies, meaning they can now be used before any other treatments are tried for advanced melanoma patients. Studies have shown that both nivolumab and pembrolizumab are safer than ipilimumab, with fewer serious side effects, and are significantly more effective in fighting off melanoma and lengthening lives.

  • Pembrolizumab (Keytruda®)

    Using synthetic versions of natural immune system chemicals, or by inhibiting proteins that block immune functions, immunotherapies boost the immune system’s ability to fight disease. In 2014, the FDA approved two intravenously injected therapies, nivolumab (Opdivo®) and pembrolizumab (Keytruda®), which belong to a new class of immunotherapies called checkpoint blockade therapies that have made headline news with their success in treating advanced melanomas. By blocking a protein receptor called PD-1, which normally helps keep the immune system in check, both these drugs release massive amounts of T cells to fight the melanoma.

    Previously, these therapies could be used only after an earlier checkpoint blockade therapy, ipilimumab, or another type of treatment called targeted therapy had been tried unsuccessfully. But the FDA recently approved both nivolumab and pembrolizumab as front-line therapies, meaning they can now be used before any other treatments are tried for advanced melanoma patients. Studies have shown that both pembrolizumab and nivolumab are safer than ipilimumab, with fewer serious side effects, and are significantly more effective in fighting off melanoma and lengthening lives.

  • Sonidegib (Odomzo®)

    In 2015 the FDA approved this medicine, taken by mouth, for patients with locally advanced basal cell carcinomas whose tumors have recurred following surgery or radiation therapy, or who are not candidates for surgery or radiation therapy. The second of two medications approved in the past few years for rare, advanced forms of basal cell carcinoma (the first was vismodegib), it works by blocking abnormal signals that promote cancerous growth.

    Like vismodegib, sonidegib can cause severe birth defects, so both male and female patients should use effective contraception. Other potential side effects include serious musculoskeletal problems and muscle pain and spasms.

  • Talimogene Laherparepvec (Imlygic®)

    Using synthetic versions of natural immune system chemicals, or by inhibiting proteins that block immune functions, immunotherapies boost the immune system’s ability to fight disease. In late 2015, the FDA approved this new type of immunotherapy for stage III and IV melanoma patients who have recurring skin or lymph node lesions that cannot be completely removed by surgery. The drug is the first oncolytic virus therapy approved for melanoma. An oncolytic virus is one that specifically targets, infects and kills cancer cells. T-VEC, injected directly into tumors, is a version of the herpes simplex virus that has been genetically modified to infect cancer cells but not healthy cells. It also secretes an immune-boosting protein that can strengthen the body’s immune response against melanoma. In clinical trials, T-VEC modestly delayed disease progression for patients with advanced disease. While benefits to date are limited, the excitement is that oncolytic virus therapy has opened up a promising new avenue for treatment.

  • Vemurafenib (Zelboraf®)

    Taken by mouth, this drug is one of a new class of treatments known as targeted therapies, which along with new immunotherapies have been making giant strides in the treatment of advanced melanoma. In patients with stage IV melanoma, these targeted therapies are designed exclusively for those who have a defective, cancer-producing version of a gene called BRAF. About half of all melanoma patients have this defective gene. Normally, BRAF controls skin cell growth, but the defective version essentially becomes stuck in the “on” position, leading to out-of-control growth of cancer cells.

    In 2011, vemurafenib (Zelboraf®) became the first targeted therapy approved to inhibit the defective BRAF gene in advanced melanoma patients, stopping the cancerous growth without harming normal cells. Vemurafenib often rapidly eliminates tumors and has been found to slow down disease progression and increase life span in many patients for months or even years, but in most patients the melanoma eventually develops resistance to the drug, and the disease begins to advance again.

    Drugs that block an enzyme called MEK (see trametinib and cobimetinib) further delay progression of the disease, and drugs combining MEK blockers with vemurafenib or another BRAF blocker called dabrafenib are improving outcomes. (See Cobimetinib-Vemurafenib, Combination and Dabrafenib-Trametinib, Combination.) The most serious side effect of both vemurafenib and dabrafenib is the formation of nonmelanoma skin cancers, especially squamous cell carcinomas, most of which are small or superficial and can be treated effectively.

  • Vismodegib (Erivedge®)

    Vismodegib (Erivedge®) was the first of two medications (the second was sonidegib) approved in the past few years for rare, advanced forms of basal cell carcinoma (BCC). Taken by mouth like sonidegib, vismodegib was approved in 2011 for very rare cases of metastatic or locally advanced BCCs for which other treatment options, such as surgery or radiation, are not options. Both vismodebib and sonidegib work by blocking abnormal signals that promote cancerous growth. Due to a risk of birth defects, women who are pregnant or may become pregnant should not use vismodegib. Other side effects include hair loss, loss of the sense of taste, and muscle spasms.


PROCEDURES (click procedure to expand)

  • Chemical Peel

    To repair superficial skin damage, the physician applies trichloroacetic acid and/or similar chemicals to the face, causing the top skin layers to slough off. New skin generally regrows within a few weeks. This method may require local anesthesia. It can cause temporary irritation and discoloration.

    Chemical peel can be used to remove superficial facial actinic keratoses (precancerous skin lesions), especially when previous treatments have not succeeded. It is also used as a rejuvenation technique.

  • Cryosurgery

    In cryosurgery (“cryo” means cold), most commonly used to treat actinic keratoses (precancerous skin lesions), the doctor applies liquid nitrogen to the growth with a spray device or cotton-tipped applicator. This freezes the tissue without requiring any cutting. It may cause a mild stinging sensation, but usually local anesthesia isn’t needed. Later, the lesion and surrounding frozen skin may blister or become crusted and fall off. Temporary redness and swelling can occur. Cryosurgery may cause a loss of pigment in the area treated.

    Cryosurgery is especially useful when a limited number of precancers are present. It is also used for superficial basal cell carcinomas and, more rarely, for superficial squamous cell carcinomas.

  • Curettage and Electrodesiccation

    This technique can be used for both actinic keratoses (skin precancers) and certain skin cancers. Using local anesthesia, the physician scrapes off part or all of the lesion with a curette, an instrument with a sharp ring-shaped tip. Then the doctor uses electrodesiccation, which cauterizes the area with heat and destroys any residual abnormal cells that the curette did not remove. When treating a skin cancer, the doctor may repeat the entire procedure twice at the same session.

    While curettage and electrodesiccation can be used to remove small basal cell carcinomas (BCCs) and small squamous cell carcinomas (SCCs) as well as actinic keratoses, it is usually not recommended for larger, aggressive or invasive BCCs or SCCs or for lesions on the face. The treated area may not regain its pigment.

  • Excisional Surgery

    Using a scalpel, the physician removes, or excises, the entire cancerous tumor along with a surrounding border of presumably normal skin as a safety margin. The physician closes the skin around the surgical site with stitches and sends the tissue specimen to a lab to verify that all cancerous cells have been removed. If the lab finds evidence of skin cancer beyond the safety margin, the patient may need to return for another surgery.

    Excisional surgery can be used for basal cell carcinomas and squamous cell carcinomas as well as melanomas. For tumors discovered at an early stage that have not spread beyond the tumor margin, excisional surgery is frequently the only treatment required.

  • Laser Surgery

    Used for skin precancers as well as superficial skin cancers, ablative lasers (such as CO2 lasers) give the physician good control over the depth of tissue removed, without causing bleeding. The physician may remove the skin’s outer layer and/or variable amounts of deeper skin, so local anesthesia may be needed. The risks of scarring and pigment loss are slightly greater than with other techniques.

    Laser surgery is effective for removing precancerous skin lesions called actinic keratoses from the face and scalp, and precancerous lesions called actinic cheilitis from the lips. It can also be used to treat superficial basal cell carcinomas and, in rarer instances, superficial squamous cell carcinomas. In addition, it can serve as a secondary therapy when topical medications or other techniques are unsuccessful.

  • Mohs Micrographic Surgery

    Mohs surgery is the gold standard for treating many basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), including those in cosmetically important areas, those that have recurred, are poorly demarcated (have indistinct margins) or are in critical areas around the eyes, nose, lips and ears. The procedure is done in stages, with each removed layer of tissue examined under a microscope in an on-site lab at the time of surgery.

    A surgeon specially trained in the Mohs technique injects a local anesthetic. Using a scalpel, the doctor removes the thinnest possible layer of visible cancerous tissue. After the wound is bandaged, the patient waits while the surgeon color-codes the excised tissue with ink to map its surgical location. Next, a technician processes the tissue in an on-site laboratory by freezing the tissue, slicing it horizontally and placing the slices on slides. The Mohs surgeon examines these slides under a microscope. If the doctor finds any remaining cancer cells, the areas are pinpointed on the map, and the patient is called back into the operating room. The doctor then removes another layer of tissue exactly in the locations where cancer cells remain.

    The team repeats this whole process until the margins are clear and the tissue is cancer-free. If more than one or two rounds are needed, the entire process can take up to several hours. Depending on its size and location, the wound may be left open to heal or may be closed with stitches. In some cases, a wound may need reconstruction using neighboring tissue or a skin graft. In some cases, a plastic surgeon may perform the reconstruction.

    This precise technique has a cure rate of 99 percent for BCCs and SCCs. It has the highest cure rate of any treatment method and can save the greatest amount of healthy tissue, leaving the smallest scar possible.

    Long considered the single most effective technique for removing BCCs and SCCs, Mohs surgery to treat thin melanomas is relatively new and not yet widely used. For many years, physicians believed that atypical melanocytes (the pigment cells that give rise to atypical moles and melanomas) were difficult to assess using Mohs surgery. More recently, however, special stains called immunostains allow the Mohs surgeon to see individual melanoma cells that may not be clearly visible with routine staining. The use of Mohs surgery and tumor mapping for thin melanomas requires special training, experience and skills.

  • Photodynamic Therapy

    To eliminate skin precancers or cancers, the physician applies a light-sensitizing agent to the lesions and the areas surrounding them. The patient waits for an hour or more to let this absorb into the skin. The doctor then uses a strong blue or red light or laser to activate these medicated areas. This selectively destroys lesions while causing minimal damage to surrounding healthy tissue. Some redness, pain, peeling, flaking and swelling can result. After the procedure, patients must strictly avoid sunlight for at least 48 hours, as UV exposure will increase activation of the medication and may cause severe sunburns.

    Photodynamic therapy (PDT) is FDA-approved for the treatment of precancerous lesions called actinic keratoses (AKs) and superficial basal cell carcinomas (BCCs), with cure rates ranging between 70 and 90 percent for BCC. It can also be used for certain nodular BCCs and superficial forms of squamous cell carcinoma. PDT is especially useful for widespread AKs on the face and scalp.

  • Radiation Therapy

    Radiation, directing X-ray beams at the tumor, is sometimes used to treat basal or squamous cell carcinoma tumors that are hard to manage surgically and for elderly patients or others in poor health. It may require several treatments over a few weeks or daily treatment for a month. Cure rates are around 90 percent. Although radiation limits damage to adjacent tissue, it can involve long-term cosmetic problems and radiation risks.

    Radiation is also often combined with other treatments for advanced squamous cell carcinoma, and is being tested in combination with certain treatments for advanced melanoma.