What is chemotherapy?

Chemotherapy (chemo) uses strong medicines to kill cancer cells. The medicines attack and kill cancer cells, which grow quickly. Some normal cells also grow quickly. Because of this, chemo can harm those cells. This can cause side effects.

How is chemotherapy given for nonmelanoma skin cancer?

Chemo for nonmelanoma skin cancer is most often used as a cream or ointment that's put right on the skin. This is called topical chemotherapy. Chemotherapy is only used this way when the cancer is just in the top layers of the skin. It doesn't reach the deeper layers of skin or any other parts of the body. The medicine is often applied several times a week for a few weeks. You'll be taught how to do this and can do it at home.

Systemic chemotherapy is put right into your blood through an IV (intravenous catheter). The IV is a small soft tube that's put 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. This means you go home the same day. Or it may be at your doctor’s office or a chemo clinic.

What chemo medicines are used to treat nonmelanoma skin cancer?

The medicines used depend on the type of nonmelanoma skin cancer you have. The 3 most common types of these cancers are:

• Squamous cell skin cancer

• Basal cell skin cancer

• Cutaneous (skin) lymphoma

Chemo for squamous cell skin cancer

The most common medicines used for topical chemo are:

• 5-fluorouracil (5-FU)

• Imiquimod. This medicine works with your immune system to treat early basal cell cancer.

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

• Cisplatin

• 5-fluorouracil (5-FU)

• Carboplatin

• Capecitabine

• Docetaxel

• Paclitaxel

Chemo for basal cell skin cancer

Chemo is seldom used to treat basal cell carcinoma. But in advanced cases, other medicines you take by mouth might be an option. These medicines are called targeted therapies. They can be taken at home like other oral medicines.

Chemo for cutaneous or 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. Some of the most common medicines include:

• Methotrexate

• Cyclophosphamide

• Doxorubicin

• Gemcitabine

• Etoposide

What are common side effects of chemotherapy?

Because chemo affects cells that divide quickly, it affects some kinds of normal cells as well as cancer cells.

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, which lasts for a few weeks after treatment. 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:

• Feeling weak and severely tired (fatigue)

• Nausea or vomiting

• Loss of appetite

• Mouth sores

• Diarrhea or constipation

• Hair loss

• Rashes

• Nerve damage called peripheral neuropathy. This can cause numbness or tingling ("pins-and-needles") in your fingers or toes.

• Increased risk of infection from low white blood cell counts

• Easy bruising or bleeding from low blood platelet counts

Many chemo side effects can be treated to keep them from getting worse. There may even be things you can do to help prevent some of them. Most side effects go away over time after treatment ends. Talk with your healthcare provider about the side effects you experience and how to manage them.

Working with your healthcare provider

It's important to know which medicines you're taking. Write down the names of your medicines. Ask your healthcare team how they work and what side effects they might cause.

Talk with your healthcare providers about what symptoms to watch for and when to call 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 weekends.

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.