SYSTEMIC TREATMENTS
Systemic Treatments for Skin Cancer
Medicines that treat cancer throughout the body
Many skin cancers can be treated with surgery or radiation. Sometimes, medicines are also needed to treat the cancer or reduce the chance of it coming back.
These medicines are called systemic treatments. They travel through the bloodstream and work throughout the body. Treatment may be given as tablets, injections or an intravenous (IV) infusion. Chemotherapy is one option, but today’s treatments also include immunotherapy and targeted medicines.
When might systemic treatment help?
Your cancer care team may recommend systemic treatment when:
- Surgery or radiation alone cannot safely treat the cancer.
- The cancer has spread or returned.
- Treatment before surgery could help in a selected situation.
- Treatment after surgery could reduce the risk of the cancer coming back.
Not every skin cancer needs systemic treatment. Most early basal cell carcinomas and skin squamous cell carcinomas are treated locally. The right approach depends on the cancer type, its stage and your health.
The three main types of treatment
Immunotherapy
Immunotherapy helps your immune system recognize and attack cancer cells. It is an important treatment for some skin cancers. It can also cause inflammation in healthy parts of the body, so careful monitoring is needed.
Targeted therapy
Targeted medicines block signals that help certain cancers grow. Tests on your tumour may help your oncology team decide whether a targeted medicine could work for you.
Chemotherapy
Chemotherapy damages rapidly dividing cells. It still has a role in treating some skin cancers, although immunotherapy or targeted treatment may be more suitable in others.
Treatment options by skin cancer type
These are examples of treatments that may be discussed—not a recommendation for your individual care. Your oncology team will confirm which options are appropriate and available to you.
Melanoma
Immunotherapy is commonly used for advanced melanoma. Examples include pembrolizumab and nivolumab, sometimes combined with another immunotherapy medicine.
If tumour testing finds a gene change called BRAF, targeted tablets may be an option. Examples include dabrafenib with trametinib, or encorafenib with binimetinib. Your team will explain whether immunotherapy or targeted treatment is the better starting point for you.
Some higher-risk melanomas may also be treated before surgery or after surgery to reduce the risk of recurrence. Chemotherapy is used less often, usually when other treatments are unsuitable or have not worked.
Basal cell carcinoma (BCC)
Most BCCs do not need systemic treatment. Medicines may be considered when the cancer has grown extensively into nearby tissues, cannot be treated safely with surgery or radiation, or has spread.
Targeted tablets such as vismodegib block a growth signal involved in many BCCs. Sonidegib is another medicine used for locally advanced BCC, but access and funding must be checked with your oncology team.
Cemiplimab, an immunotherapy, may be considered for certain advanced BCCs after targeted treatment has stopped working or cannot be tolerated. The BC Cancer pathway has specific eligibility and access requirements.
Cutaneous squamous cell carcinoma (skin SCC)
Most skin SCCs are treated with surgery or radiation. When these treatments cannot control advanced cancer, immunotherapy may be recommended. Cemiplimab is one example.
Selected patients may be offered a targeted medicine such as cetuximab or chemotherapy. These are not usual treatments for a small, readily treatable skin SCC.
For some patients at very high risk of recurrence, immunotherapy after surgery and radiation may also be discussed. Research supports this approach in selected cases, but your team must confirm current BC eligibility and funding.
Merkel cell carcinoma
Merkel cell carcinoma is uncommon and can grow quickly. Prompt specialist assessment is important. Surgery and radiation are often used when the cancer is confined to the skin or nearby lymph nodes.
For advanced disease, immunotherapy may be considered. Avelumab is one example used under specific BC Cancer criteria. Chemotherapy may also be an option when immunotherapy is unsuitable, has stopped working or rapid cancer control is needed. Your team will explain the treatment choices and access requirements.
Cutaneous angiosarcoma
Angiosarcoma needs assessment by a specialist cancer team. Surgery, sometimes with radiation, may be used when the tumour can be removed.
If it cannot be removed or has spread, chemotherapy may be considered. Paclitaxel is one option covered by a published BC Cancer treatment pathway; other chemotherapy approaches may be discussed. Your team will confirm the most suitable plan and where treatment can be given.
Dermatofibrosarcoma protuberans (DFSP)
Surgery is the main treatment for most localized DFSPs. If the tumour cannot be removed, has returned or has spread, a specialist may consider imatinib, a targeted medicine.
Tumour testing helps determine whether this medicine is appropriate. It is not needed for every DFSP, and access and funding are assessed individually.
Adnexal carcinomas
These uncommon cancers start in skin structures such as sweat glands or hair follicles. The exact diagnosis matters, because the different types can behave differently.
Surgery is often the main treatment, sometimes with radiation. For advanced disease, an oncology team may discuss chemotherapy, treatment matched to a tumour test result or a clinical trial. There is no single standard systemic treatment for every adnexal carcinoma.
How is treatment chosen?
Your oncology team will consider your biopsy results, scans, previous treatments and overall health. Tumour testing may help identify suitable medicines.
They will also discuss what treatment is intended to achieve, its possible side effects and how it may affect your daily life. Tell your team if you have an autoimmune condition, have had an organ transplant, or take medicines or supplements—these can affect treatment decisions.
Your goals and preferences are part of the plan. You can ask why a treatment is recommended, what the alternatives are and what to expect.
Side effects: what to know
Side effects depend on the medicine and vary from person to person.
Immunotherapy can cause inflammation in the skin, bowel, lungs, hormone glands or other organs. Effects can appear during treatment or months later, and some can be long-lasting.
Targeted medicines may cause rash, diarrhea, fatigue, fever or other medicine-specific effects. BCC tablets may cause muscle cramps, taste changes and hair loss.
Chemotherapy may cause nausea, mouth sores, fatigue, hair loss and low blood counts, which can increase infection or bleeding risk.
Your team will explain which symptoms to watch for and how to get help during and outside office hours.
Get help promptly: Follow your oncology team’s urgent-contact instructions for fever or chills, severe diarrhea or vomiting, new breathing problems, confusion, unusual bleeding or other concerning symptoms. Do not wait until your next appointment. If you cannot reach your team and symptoms are urgent, seek emergency care. Call 911 for severe breathing difficulty, severe chest pain or another life-threatening emergency.
Your care in Kelowna
At Kelowna Private Skin Cancer Clinic, we can discuss your biopsy results and help arrange an appropriate specialist referral when needed.
BC Cancer–Kelowna (Sindi Ahluwalia Hawkins Centre) is a separate regional cancer centre that provides systemic cancer treatment. Its oncology team recommends and oversees specialist drug treatment. They will confirm whether your treatment can be given in Kelowna and explain current eligibility and funding. Some specialized care or clinical trials may require another centre.
Common questions
Do I need a referral?
Yes. Your treating physician or other appropriate clinician arranges the referral to BC Cancer. You do not need to choose a medicine before being referred.
Will treatment be covered?
Coverage depends on the medicine, the reason it is being used and current BC Cancer criteria. Your oncology team will confirm what applies to your situation.
Could I join a clinical trial?
Possibly. Ask your oncology team whether a suitable trial is available. Eligibility and location vary, and not every patient will qualify.
Let’s discuss the next step
If your skin cancer may need specialist treatment, we can help you understand your biopsy result and arrange an appropriate referral.
Contact Kelowna Private Skin Cancer Clinic to discuss your diagnosis and next steps.
This page provides general information, not personal medical advice or a treatment recommendation. Treatment options and funding can change. Your treating clinician and oncology team should guide your individual care.