There are some new and exciting treatments for skin cancer that do not involve surgical excision. But all of them have limitations. We know they only work on certain specific skin cancers and only in certain locations. Some of these treatments are as follows:
Imquimod cream (Aldara ®)
Imiquimod modifies the immune system in the skin tricking the body into trying to destroy the skin cancer. It has been shown to be effective for superficial BCCs, with 80% responding to this treatment. 10% of these tumours treated with Imiquimod will still recur within two years. Imiquimod does not work or is not approved for any other type of skin cancer. Further, it is never to be used in difficult areas of the body such as on or anywhere near the eyes, nose, lips and ears. As such, it is only used for selected tumours in selected locations.
Photodynamic therapy
This treatment also requires light therapy focused on the skin surface after the ointment is applied. Again the treatment has limitations. It can be used on selected tumours beyond the scope of imiquimod. It is also approved for tumours on the difficult body locations under certain circumstances. But there is a substantial failure rate with many tumours either not responding or recurring after treatment. The recurrence problem is greater than that demonstrated thus far with imiquimod. Find out more about photodynamic therapy. Only approved photodynamic therapy should ever be offered to patients. The only approved product in Australia is Metvix(c).
5 Fluorouracil topical (Efudix ®)
The only cancer this cream is approved for is Bowen's Disease (squamous cell carcinoma in situ). Again, some cases of Bowens Disease will not respond and others recur following treatment. Surgery is then required.
Diclofenac (Solaraze ®)
Diclofenac gel is not approved for treating skin cancers. It is a treatment for sun spots (solar keratoses). These are areas of sun damaged skin that have not yet progressed to the point of cancer. Diclofenac is not as strong as any of the above treatments. This cuts both ways. It kills fewer sun spots but has fewer side effects than any of the above approaches.
Surgery after creams
A common theme to the above treatments is that all of them have failure rates. Many patients end up having surgery because their skin cancer has not responded or has recurred. It is not true to say that cream therapies will "save you from the knife". They may do so for certain tumours in certain circumstances and only if your tumour responds and does not recur. If you have had a cream treatment for a skin cancer and it appears to be persisting or re-growing, it is important you return to your doctor.
Sun damage
All of the above treatments are also effective at treating sun damage such as solar keratoses. All are used for these benign lesions under their own regulated circumstances.
Dr. Anthony Dixon