Non-Melanoma Skin Cancer
Skin cancer is the most common cancer in Australia and New Zealand and at least 2 in 3 Australians will get skin cancer.
Skin cancer occurs when skin cells change into abnormal cells and grow at an uncontrolled rate.
There are 2 main types: melanoma and non-melanoma skin cancer.
The 2 most common types of non-melanoma skin cancer are squamous cell carcinoma and basal cell carcinoma.
Merkel cell carcinoma is a rare skin cancer that can be treated with radiation therapy.
Non-melanoma skin cancer can occur anywhere on the skin. However, it is often found in areas of long-term sun exposure such as the head, face, neck, arms, legs and back of the hands.
Radiation Therapy and Non-Melanoma Skin Cancer
The best person to talk to about radiation therapy for skin cancer is a radiation oncologist. A radiation oncologist is a specialist doctor who is part of the team that takes care of people having radiation therapy.
You can ask your doctor for a referral to a radiation oncologist to learn if radiation therapy is an option for you.
The Treatment Team
Doctors make a treatment plan for each person based on the:
- type of skin cancer
- where the cancer is
- what other treatments have been tried
- the person’s health.
The type of treatment a person gets is worked out by a team of doctors and health professionals often called a Multidisciplinary Team.
A highly trained radiation oncology team takes care of people having radiation therapy. This includes radiation oncologists, radiation therapists, medical physicists and radiation oncology nurses.
Treatment for Non-Melanoma Skin Cancer
Treatment can include:
- surgery
- topical treatments applied to the skin cancer
- radiation therapy
- medicine such as immunotherapy or chemotherapy.
Role of Radiation Therapy for Non-Melanoma Skin Cancer
Radiation therapy can be used as the main treatment, without surgery, or it can be used after surgery to lower the chances of the cancer coming back.
It can also be used to ease symptoms for patients with advanced cancer, including ones that have spread. This is called palliative radiation therapy.
For small and low-risk skin cancers, radiation therapy can work as well as surgery. This can be good for areas like the face, where surgery might not be ideal, or for people who can’t have surgery.
For larger or more advanced skin cancers, especially those near the lymph nodes, surgery is usually the first choice. The treating team may offer radiation therapy after surgery to get rid of any last cancer cells and improve the chances of a cure.
Merkel cell carcinomas respond well to radiation therapy and can be cured without surgery. People with this cancer should see a radiation oncologist quickly because early treatment is important. Immunotherapy is also used for this cancer.
Types of Radiation Therapy Used for Non-Melanoma Skin Cancer
External Beam Radiation Therapy (EBRT)
This is the most common type of radiation therapy used for non-melanoma skin cancer.
Radiation oncologists often use Volumetric Arc Therapy (VMAT) or stereotactic radiotherapy, which are advanced types of External Beam Radiation Therapy (EBRT) to carefully deliver radiation to the areas that need to be treated.
These advanced techniques allow the treating team to target the radiation on the cancer while limiting radiation to healthy parts of the body.
Superficial radiation therapy (SXRT) is another way to treat skin cancer. It allows the radiation oncologist to target the cancer while sparing the healthy areas.
In Australia, a topical radiation therapy called Rhenium is also available for some small, thin skin cancers. More research is needed to confirm its effectiveness and safety.
During radiation therapy, people lie on a treatment couch while the machine moves around them. People sometimes wear a mask for treatments on the head, neck, or scalp.
People get radiation therapy once a day, 5 days a week from Monday to Friday. The length of treatment varies according to the cancer type and stage. Your radiation oncologist will help decide this.
General Information About Side Effects of Radiation Therapy
Radiation therapy is more effective with fewer side effects than ever before.
Recent advances mean radiation oncologists can effectively treat the cancer while getting less radiation on healthy body parts. This means much fewer side effects.
Side effects from radiation therapy vary between people, even for those having the same treatment.
While some people feel no side effects, some feel mild side effects, such as tiredness or skin redness during and/or just after treatment. These usually get better within a few weeks.
The treatment team will offer advice and medicine to help with side effects.
Serious side effects that start later (months to years after the radiation therapy) are rare.
Before starting treatment, your radiation oncologist will talk to you about side effects and answer your questions.
The side effects of radiation treatment can be split into 2 groups:
- Early side effects which occur during and shortly after radiation treatment.
- Late side effects which can occur months to years after radiation treatment.
For more information, go to the Potential Side Effects page.
Early Side Effects of Radiation Therapy for Non-Melanoma Skin Cancer
Early side effects of radiation therapy may include:
Fatigue: This is very common in the second half of treatment and varies between people. Fatigue may continue for several weeks after treatment.
Other side effects of radiation treatment may come from body parts close to where the radiation is targeted.
Skin reddening and irritation: The skin may become red and itchy during treatment. Blisters and peeling can also occur. This usually peaks 7-14 days after treatment ends.
Hair loss: Hair in the treatment area may fall out during or after radiation therapy. This can be temporary or permanent.
What can help early side effects?
Resting as needed helps with fatigue. During treatment your radiation oncology team will provide advice on creams and dressings to help your skin.
It helps to keep the area treated out of the sun and wind. For sun protection during and right after treatment don’t use sunscreen on the skin receiving radiation. Instead wear a wide brimmed hat and loose protective clothes.
Late Side Effects of Radiation Therapy for Non-Melanoma Skin Cancer
Late side effects vary between people and can happen a few months to a few years after treatment.
These side effects may never occur, occur once, continue over time, or come and go.
Skin and underneath soft tissue changes: Lasting skin changes are usually cosmetic and can be managed. Sometimes, the treated skin looks slightly lighter or darker. Small blood vessels under the skin might be more visible and the skin can become thinner and more prone to injury. Underneath the skin may feel firmer and tighter.
Skin ulceration or ulcer: This is a very rare side effect of radiation treatment to the skin.
Swelling of an arm, leg or around the face: This is called lymphoedema. The risk of lymphoedema varies and is higher after radiation therapy on an area where the lymph nodes were removed. Lymphoedema is usually mild to moderate but can sometimes be severe.
Second cancer: Cancers caused by radiation therapy are a very rare side effect.
What can help late side effects: Late side effects depend on the body part being treated. Your radiation oncologist will explain the ones that could affect you.
To prevent skin issues after radiation therapy, it’s important to follow the advice of your treating team. They’ll provide tips on creams and dressings as well as general skin care. If a skin ulcer doesn’t heal after radiation, surgery can help.
Skin treated with radiation stays very sensitive to sunlight and may take longer to heal. It’s important to use an SPF 50 sunscreen, protective clothing and a hat. Makeup can hide any lasting skin changes.
Massage and physiotherapy can help with ongoing skin firmness. In the case of lymphoedema, it’s helpful to get advice from a specialist. Treatment may include exercises, compression wear and massage.
Other Useful Resources for Non-Melanoma Skin Cancer
Find additional information about cancer types, research groups, and support groups.
Radiation Oncologist
The best person to talk to is a radiation oncologist. You can ask your doctor for a referral to find out if radiation treatment is right for you.
GPs and Health Professionals
Information for any health professional involved in a patient's cancer care with a particular focus on primary care providers.
Talking to Your Doctor
Your GP or other doctors in the cancer team can organise a referral to a radiation oncologist.
Treatment Centres
Search and find your closest Radiation Oncology Treatment Centre.
