What is chemotherapy?

Being diagnosed with skin cancer can be scary. However, effective treatment options are available for non-melanoma types of skin cancer, including chemotherapy. Chemotherapy, or chemo, uses strong medicines to kill cancer cells.

How does chemotherapy for non-melanoma skin cancer work?

Chemo for non-melanoma skin cancer is most often a cream or ointment you put right on the skin. This is called topical chemotherapy. You will only get chemotherapy this way when the cancer is just in the top layers of the skin. The 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.

When the medicine is put directly into your blood through an IV (intravenous catheter), it is called systemic chemotherapy. The IV is a small, soft tube that's placed in a vein in your 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, meaning you can go home the same day. You may also have systemic chemo at your healthcare provider’s office or a chemo clinic.

What chemo medicines are used to treat non-melanoma skin cancer?

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

• Squamous cell skin cancer

• Basal cell skin cancer

• Cutaneous (skin) lymphoma

Squamous cell skin cancer

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

The most common medicine 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

• Paclitaxel

Basal cell skin cancer

Chemo is seldom used to treat basal cell carcinoma. For low-risk basal cell skin cancer, topical chemo may be used with topical imiquimod and 5-fluorouracil (5-FU) as possible options. But in advanced cases, other medicines you take by mouth might be an option. 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 (nitrogen mustard)

• Carmustine

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

• Methotrexate

• Cyclophosphamide

• Doxorubicin

What are the common side effects of chemotherapy?

Chemo affects and kills cancer cells, which divide and grow quickly. It also affects some kinds of normal cells, which can cause side effects. Side effects depend on the chemotherapy used.

Topical chemo

Side effects for topical chemotherapy 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 healthcare provider.

Systemic chemo

Systemic or IV chemo can affect cells in many parts of the body. The side effects depend on the medicines used and the dose. Some common side effects include:

• Weakness

• 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 for 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 get 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 last longer or be permanent. If you have side effects, talk with your healthcare provider about how to manage them.

Working with your healthcare providers

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 healthcare team how they work, what side effects they might cause, and how long the side effects may last.

Talk with your healthcare providers about what symptoms to watch for and when to report 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 and if there is a different number to call during evenings and on 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 healthcare team to make a plan to manage your side effects.