Taking a pain-free approach to non-melanoma skin cancer treatment

Prof Dr med. Julia Tietze

Clinic and Polyclinic for Dermatology and Venerology, University Medical Centre, Rostock

Patients with invasive non-melanoma skin cancers have often had to endure painful surgery which can leave scars. However, a non-invasive, pain-free option is now available.

Non-melanoma skin cancers (NMSCs) — which include basal cell carcinomas and squamous cell carcinomas — are worryingly common. Between 2007–2017, incidences increased by 33%, reaching 7.7 million cases worldwide. One in five people over 70 have been diagnosed with at least one NMSC.

Treating non-melanoma skin cancers

If found early enough, these types of skin cancers are very treatable. “In the main, NMSCs are not life-threatening as they only metastasise in rare cases — unlike melanomas, which can be highly virulent,” explains Prof Dr med. Julia Tietze, from the Clinic and Polyclinic for Dermatology and Venerology at University Medical Centre, Rostock, Germany. “Nevertheless, invasive non-melanoma skin cancers are locally destructive and should be removed.”

It may be possible to treat a superficial NMSC with a topical cream, but, usually, surgery is recommended for invasive tumours. Unfortunately, these cancers are often found in conspicuous locations such as the head and neck, making this intervention problematic.

Removing non-melanoma skin cancers without surgery

“The downside with surgery is that it can result in scarring or, in some cases, disfigurement,” says Prof Dr Tietze. “Plus, there is the pain of local anaesthesia injections. If further NMSCs are diagnosed, patients may be increasingly hesitant to take the surgical route.” Alternative treatment options are needed, particularly for tumours located on sensitive areas such as the nose, ears or lips.

However, a non-surgical, non-invasive epidermal radiotherapy is now available for NMSC patients. Unlike surgery, the treatment is quick and easy: the lesion is identified and covered with a clear plastic film; a radioactive Rhenium-188 paste is applied, which begins to target and kill cancer cells. After some time — usually between 45 minutes and 180 minutes — the film and paste are removed, and the patient is free to go home.

Non-surgical treatment efficacy and availability

Treatment can be completed in one session. It’s highly effective, with complete tumour regression reported in 98.5% of lesions treated. Currently, it’s only available privately in the UK, although NICE (National Institute for Health and Care Excellence) has recently produced positive guidance on the therapy. Hopefully, it could be available on the NHS in the long term. “Many of my patients procrastinate about surgery because of the pain,” says Prof Dr Tietze. “However, this treatment is pain-free, effective and leaves no scarring — it’s a very good option for them.”