How Do You Treat Skin Cancer on the Nose?

The nose is a relatively common site for skin cancer because it is frequently exposed to the sun and prone to sunburns. The treatment can vary by the type of cancer you have and may include surgery, radiation, topical chemotherapy, cryosurgery, or immunotherapy.

The two most common types of skin cancer on the nose are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). While both need to be addressed right away, BCC is usually slow-growing while SCC grows more quickly. The third type of skin cancer, called melanoma, is far more serious and almost invariably requires surgery to remove it.

This article describes each type of skin cancer of the nose and how it is treated.

Types of Skin Cancer 

The first step in treating skin cancer on the nose is determining what type it is and how far it has spread.

Skin cancer is usually diagnosed through a skin biopsy. Your dermatologist will remove a tissue sample after numbing the area and send it to the lab. Then, a pathologist will examine the cells under a microscope and determine if cancer is present, most typically:

• Basal cell carcinoma: This is the most common type of skin cancer, with about 80% of cases occurring on the face and 25% to 30% occurring on the nose. BCC lesions can differ in appearance and may appear as a shiny bump, a patch of scaly skin, or a waxy scar. 
• Squamous cell carcinoma: The second most common type of skin cancer can appear as scaly red patches, open sores that don’t heal, or wart-like growths. SCC can also sometimes develop on the inside of the nose.
• Melanoma: This is the most dangerous skin cancer that can readily metastasize (spread to other parts of the body). It can develop on normal skin as an irregular, fast-growing patch or be recognized by sudden changes in the size, shape, or color of a mole.

The course of treatment varies by not only the type of cancer you have but also by the stage of cancer. The staging describes how advanced a cancer is based on the tumor size and whether it has spread to nearby lymph nodes or distant organs.

Skin Cancer Surgery

The options for treating skin cancer on the nose depend on the type of cancer and how advanced it is. Because skin cancer rarely spreads beyond its original site, surgery is a common treatment.

Many skin cancers can be removed by a dermatologist who has completed a dermatology surgery fellowship. More advanced lesions may be better treated by a surgical oncologist who specializes in cancer surgery. A plastic surgeon may be needed if the surgery causes scarring or disfigurement.

Here are some of the most common types of surgery used:

Excisional Surgery

Excisional surgery is the removal of skin cancer with a scalpel. A border (margin) of normal skin will also be removed just to be safe. Excisional surgery requires the numbing of the skin with a local anesthetic. Stitches are usually needed.

There is a risk of scarring with excisional surgery, which can be corrected with reconstructive surgery. If the growth is large, a skin graft may be needed.

The cure rates for excisional surgery in early skin cancer are 95% for BCC and 92% for SCC.  

Curettage and Electrodesiccation

This type of surgery involves scraping or burning off the skin growth. It can be used for skin cancer lesions, as well as benign (non-cancerous) skin growths.

For this procedure, the healthcare provider will inject a numbing medication in and around the lesion and use a specialized tool with a sharp scooped edge to scrape it off. An electrical probe is then inserted into the skin to kill any remaining cancer cells.

This procedure sometimes needs to be repeated depending on the size of the lesion. Research has shown that there is no difference in cure rates between skin cancers treated with curettage and electrodesiccation and those treated with excisional surgery.

Mohs Surgery

Mohs surgery is a procedure in which layers of cancer cells are gradually removed in order to preserve normal tissues. During this procedure, the surgeon removes layers of skin one at a time and examines each layer under a microscope to see if any cancer cells. This process continues until only cancer-free tissue is left.

Mohs surgery is more likely to be used when cancer is found in the skin folds around the nose. The rate of recurrence after Mohs surgery is less than 5%, the lowest of all treatment options. 

Laser Surgery

Laser surgery involves directing a laser beam at a skin lesion to vaporize cancer cells. It is most commonly used for precancerous growths like actinic keratosis or as a secondary treatment for skin cancer.

Laser surgery is not currently used as a standard treatment for BCC or SCC. It can, however, be an effective secondary treatment after Mohs surgery. On its own, laser surgery cannot confidently remove enough cancer cells to be effective.  

Cryosurgery

Cryosurgery, also known as cryotherapy, is often used to treat very small cancer growths or precancerous lesions.

In this technique, your healthcare provider will numb the skin with a local anesthetic and then apply a swab of liquid nitrogen to freeze the lesion off. This causes the skin to blister and crust over. The procedure may need to be repeated several times during the same visit.

While the tissues should heal fully within one to two months, the procedure can leave a scar.

Radiation Therapy

When a skin tumor is very large or cannot be removed with surgery, radiation therapy may be used to manage rather than cure the cancer. However, if the tumor is small and surgery cannot be used for whatever reason, radiation may be enough to cure the malignancy.

During this procedure, a narrow beam of high-energy radiation is targeted at cancer cells. Radiation has been proven effective at curing early-stage BCC and SCC. It can also treat metastatic tumors or shrink advanced tumors to avoid disease progress.

Radiation therapy can also be useful after surgery to ensure that all cancer cells are destroyed. This can help reduce the risk of recurrence. 

Photodynamic Therapy

Photodynamic therapy has proven effective at treating precancerous lesions but is not yet an approved treatment for skin cancer itself.

Photodynamic therapy involves applying a photosensitizing gel over the lesion that causes cells to become extremely sensitive to light. A special light is then directed at the lesion, which damages the structure of the precancerous cells, effectively killing them.

Topical Therapies

It is possible to treat both early-stage BCC and SCC with topical chemotherapy. These medications usually come in a cream or ointment form that can be applied directly to the skin.

Among the approved options:

• Efudex (5-fluorouracil) can destroy cancer cells near the skin’s surface but is not well absorbed in the skin. It is meant to treat both precancerous lesions and early-stage skin cancer.
• Solaraze (diclofenac) is a nonsteroidal anti-inflammatory drug applied twice daily for two to three months to treat precancerous lesions.
  
• Zyclara (imiquimod) is an immune response moderator that boosts the immune system’s response to skin cancer. It can be used for precancerous lesions or very early-stage BCC.
• Picato (ingenol mebutate) is another topical chemotherapy agent used to treat precancerous lesions. It is not approved to treat either BCC or SCC.
  

Oral Medications for Advanced Skin Cancer

It is rare for BCC and SCC to reach advanced stages, but when they do, oral medications may help. In addition to chemotherapy, targeted drugs may be recommended to treat advanced skin cancer. Targeted drugs are those that damage cancer cells without destroying healthy cells.

Erivedge (vismodegib) and Odomzo (sonidegib) are two targeted drugs that prevent cancer cells from growing and spreading. The capsules are taken once daily and are generally used when BCC returns after surgery or radiation or cannot be treated with surgery or radiation. The drugs cannot cure BCC, but they can help sustain disease-free remission.

Erbitux (cetuximab) is another class of drug that can help to stop the spread of SCC. It is given intravenously (into a vein) every two weeks by a healthcare provider for a maximum of six treatments. Each infusion takes about two hours to complete. 

Immunotherapy

Keytruda (pembrolizumab) is approved for the treatment of locally advanced SCC that is not curable by surgery or radiation. It is a type of immunotherapy that helps your immune system better fight certain cancers. It is delivered by intravenous (IV) injection every three or six weeks.

Opdualag (nivolumab + relatlimab) is another IV immunotherapy approved for the treatment of metastatic melanoma or melanoma that cannot be removed by surgery. It is given every four weeks.

Coping

While most skin cancer treatments are very effective, they can come with side effects. The most common risks of treating skin cancer on your nose are scarring and possible disfigurement. Even if you become cancer-free, these effects can be very bothersome.

Talk with your oncologist or dermatologist about working with a plastic surgeon if needed. Any surgery will cause scarring, but a plastic surgeon can help to reduce it while focusing on maintaining your appearance as much as possible. 

The best way to reduce scarring and avoid disfigurement is by catching skin cancer early. Set up annual appointments with your dermatologist and perform skin self-checks every month to look for new or changing skin growths. 

Summary

Skin cancers like basal cell carcinoma, squamous cell carcinoma, and melanoma can be treated with surgery, radiation, targeted therapies, topical chemotherapy, or immunotherapy. Other treatments can be used to treat early-stage skin cancers or precancers, including cryosurgery and photodynamic therapy.

The choice of treatment depends on the type and stage of skin cancer you have.