Skin cancer is the most commonly diagnosed cancer in America with more than 1 million people affected annually by non-melanoma skin cancer.

There are two types of skin cancer: basal cell carcinoma, the most common and squamous cell, which is less common but more likely to be fatal, according to information from the American Cancer Society.

Further, although these cancers are highly treatable and not usually fatal, people who develop them once are more likely to get them again.

As skin cancer rates in America continue to escalate, the push to develop effective treatments with fewer side effects increases.

While surgical treatments remain the most widely applied therapies utilized in the treatment of precancerous skin or skin cancer, these procedures have the inherent drawbacks of pain, permanent scarring and possible surgical complications such as bleeding and infection.

Several novel approaches to treat skin precancers as well as the most common varieties of skin cancer have recently gained interest, outcome data and FDA approval, in some instances. The FDA, or Food and Drug Administration, is the federal agency tasked with approving drugs and medicines after certain trial requirements have been met.

The two categories of nonsurgical treatment options for these common malignancies are topical medications (applied to the outside of the skin) and photodynamic, or light, therapy.

Topical Medications
There are three types of topical medications available in the United States for the treatment of skin cancer.

Flurorouracil
The oldest and most widely accepted of these medications is Fluorouracil (FU). Available in different concentrations, FU is an actual chemotherapy drug which is also used to treat internal cancer. When applied to the skin, the medication exploits the properties of abnormally dividing skin cells to gain access into these cells and destroy them. Topical brands include Efudex® and Carac™.

The treatment course requires nightly application for two to six weeks and may result in mild to severe irritation with redness, flaking and crusting. The treated skin heals, with normal skin cells covering the treated areas.

FU is FDA-approved for and is reliably effective to treat actinic keratosis (AK’s, or precancerous change) as well as early superficial basal cell carcinoma (BCC), one of the most common types of skin cancer.

Imiquimod
The newest topical agent gaining popularity for skin cancer treatment is Imiquimod, found in Aldara™.

Unlike Fluorouracil, Imiquimod activates the body’s immune system to identify and destroy the abnormal cells composing a precancer or skin cancer. Although the treatment course with Aldara™ is a bit longer, from six to 12 weeks, some patients tolerate it better.

One patient, Benjamin Bailey of West Melbourne, said “The treatment was easy and allowed me to avoid surgery.”

Aldara™ is currently FDA-approved for treating precancerous change and superficial basal cell carcinoma. Additionally, investigational trials for its use in a variety of other cancers are ongoing.

Diclofenac Sodium
One final topical alternative to mention is Diclofenac Sodium, found in Solaraze#153;. This is a non-steroidal topical medication which is also used to eliminate precancerous change of the skin.

The mechanism of destruction of abnormal cells is not yet fully understood with this application and the treatment is considerably longer at 60 to 90 days, with some effects considered to be suppressive more than curative by some dermatologists. Multiple courses are often required, but the treatment tends to be tolerated well.

Photodynamic – or Light – Therapy
Photodynamic Therapy (PDT) utilizes light therapy to destroy abnormally-dividing cells.

The process requires that a photosensitizing agent be painted onto the skin. This agent is concentrated on the abnormal area and is later activated with a light source. With this application of light, toxic compounds are created and cell death results.

Since the treatment process targets only the abnormal cells (precancerous or skin cancer cells), the treatment can be administered with little effect on the surrounding normal skin. In the United States, the most commonly used PDT combination is aminolevulinic acid HCl (Levulan®) with blue light activation.

On rare occasions, there is pain associated with the treatment, which lasts anywhere from 20 to 45 minutes. Redness, swelling and irritation of the treated area is expected with a time frame of one to two weeks to resolve. Most commonly, a single treatment is required, although multiple treatments can be prescribed for larger, thicker, or more aggressive lesions.

PDT is widely available in Europe with a variety of different photosensitizers and light sources which may provide better results. The FDA has approved Levulan® combination PDT for the treatment of actinic keratosis, a precancerous bump or scaly patch that forms on the surface of the skin and sometimes are referred to as sun spots.

The acceptance and availability of PDT in the United States has been slow, but progress is gradually being made and the use of the technology is being expanded and tested to include early skin cancers. Work also is being completed to optimize the photosensitizing agent and determine the best light source to affect cell death.

Only trained medical personnel can appropriately diagnose and discuss treatment options for any skin precancer or skin cancer. Multiple factors and the risks and benefits of both surgical and non-surgical options must be carefully considered on an individual basis.

In many cases in the past, promising innovative treatments have failed to live up to expectations with durable long term results, so alternative therapies should be considered with this in mind. And, of course, preventing the necessity for any skin cancer treatment through safe sun practices may be the best option of all.

Jeannine Stein, MD, is a Board Certified Otolaryngologist and fellowship-trained Dermatologic Surgeon for Florida Dermatology Associates. She specializes in treating a wide range of skin cancers. To reach her, email steingina@yahoo.com or call (321) 799-2840.