Purpose of This PDQ Summary

This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of skin cancer. This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board.

Information about the following is included in this summary:

• Clinical features.
• Cellular classification.
• Staging.
• Treatment options for different types of tumors.

This summary is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.

Some of the reference citations in the summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations. Based on the strength of the available evidence, treatment options are described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for reimbursement determinations.

This summary is available in a patient version, written in less technical language, and in Spanish.

General Information

Note: Separate PDQ summaries on Screening for Skin Cancer and Prevention of Skin Cancer are also available.

Basal cell carcinoma is the most common form of skin cancer, and squamous cell carcinoma is the second most common type of skin malignancy. Although the two types of skin cancer are the most common of all malignancies, they account for less than 0.1% of patient deaths caused by cancer. Both of these types of skin cancer are more likely to occur in individuals of light complexion who have had significant exposure to sunlight, and both types of skin cancer are more common in the southern latitudes of the Northern hemisphere. [1]

The overall cure rate for basal cell carcinoma and squamous cell carcinoma is directly related to the stage of the disease and the type of treatment used. [2] Since neither basal cell carcinoma nor squamous cell carcinoma are reportable diseases, precise 5-year cure rates are not known.

Although basal cell carcinoma and squamous cell carcinoma are by far the most frequent types of skin tumors, the skin can also be the site of a large variety of malignant neoplasms. Other types of malignant disease include malignant melanoma, cutaneous T-cell lymphomas (e.g., mycosis fungoides), Kaposi sarcoma, extramammary Paget disease, apocrine carcinoma of the skin, and metastatic malignancies from various primary sites. (Refer to the PDQ summaries on Melanoma Treatment; Mycosis Fungoides and the Sézary Syndrome Treatment; and Kaposi Sarcoma Treatment for more information.) Guidelines for the care of cutaneous squamous cell carcinoma have been published. [3]

References:

1. Wagner RF, Casciato DA: Skin cancers. In: Casciato DA, Lowitz BB, eds.: Manual of Clinical Oncology. 4th ed. Philadelphia, Pa: Lippincott, Williams, and Wilkins, 2000, pp 336-373.
2. Rowe DE, Carroll RJ, Day CL Jr: Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up. J Dermatol Surg Oncol 15 (3): 315-28, 1989.
3. Guidelines of care for cutaneous squamous cell carcinoma. Committee on Guidelines of Care. Task Force on Cutaneous Squamous Cell Carcinoma. J Am Acad Dermatol 28 (4): 628-31, 1993.

Cellular Classification

Basal cell carcinoma and squamous cell carcinoma are both of epithelial origin. They are usually diagnosed on the basis of routine histopathology. [1] Squamous cell carcinoma is graded 1 to 4 based on the proportion of differentiating cells present, the degree of atypicality of tumor cells, and the depth of tumor penetration. [2] Apocrine carcinomas, which are rare, are associated with an indolent course and usually arise in the axilla. [3]

References:

1. Lever WF, Schaumburg-Lever G: Histopathology of the Skin. New York: JB Lippincott, 6th ed., 1983.
2. Immerman SC, Scanlon EF, Christ M, et al.: Recurrent squamous cell carcinoma of the skin. Cancer 51 (8): 1537-40, 1983.
3. Paties C, Taccagni GL, Papotti M, et al.: Apocrine carcinoma of the skin. A clinicopathologic, immunocytochemical, and ultrastructural study. Cancer 71 (2): 375-81, 1993.

Stage Information

Basal cell carcinoma rarely metastasizes, and thus a metastatic work-up is usually not necessary. [1] Regional lymph nodes should be routinely examined in all cases of squamous cell carcinoma, especially for high-risk tumors appearing on the lips, ears, perianal and perigenital regions, or high-risk areas of the hand. [2] In addition, regional lymph nodes should be examined in cases of squamous cell carcinoma arising in sites of chronic ulceration or inflammation, burn scars, or sites of previous radiation therapy treatment.

The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification. [3] The TNM classification is used to stage both basal cell carcinoma and squamous cell carcinoma.

TNM Definitions

Primary tumor (T)
• TX: Primary tumor cannot be assessed
• T0: No evidence of primary tumor
• Tis: Carcinoma in situ
• T1: Tumor not larger than 2 cm in greatest dimension
• T2: Tumor larger than 2 cm but not larger than 5 cm in greatest dimension
• T3: Tumor larger than 5 cm in greatest dimension
• T4: Tumor invades deep extradermal structures (e.g., cartilage, skeletal muscle, or bone)

  In the case of multiple simultaneous tumors, the tumor with the highest T category will be classified, and the number of separate tumors will be indicated in parentheses, e.g., T2 (5).

Regional lymph nodes (N)
• NX: Regional lymph nodes cannot be assessed
• N0: No regional lymph node metastasis
• N1: Regional lymph node metastasis

Distant metastasis (M)
• MX: Distant metastasis cannot be assessed
• M0: No distant metastasis
• M1: Distant metastasis

AJCC Stage Groupings

Stage 0
• Tis, N0, M0

Stage I
• T1, N0, M0

Stage II
• T2, N0, M0
• T3, N0, M0

Stage III
• T4, N0, M0
• Any T, N1, M0

Stage IV
• Any T, any N, M1

Basal cell carcinoma

Basal cell carcinoma is at least three times more common than squamous cell carcinoma in nonimmunocompromised patients. It usually occurs on sun-exposed areas of skin, and the nose is the most frequent site. Although there are many different clinical presentations for basal cell carcinoma, the most characteristic type is the asymptomatic nodular or nodular ulcerative lesion that is elevated from the surrounding skin and has a pearly quality and contains telangiectatic vessels. Basal cell carcinoma has a tendency to be locally destructive. High-risk areas for tumor recurrence include the central face (e.g., periorbital region, eyelids, nasolabial fold, or nose-cheek angle), postauricular region, pinna, ear canal, forehead, and scalp. [4] A specific subtype of basal cell carcinoma is the morpheaform type. This subtype typically appears as a scar-like, firm plaque. Because of indistinct clinical tumor margins, the morpheaform type is difficult to treat adequately with traditional treatments. [1]

Squamous cell carcinoma

Squamous cell tumors also tend to occur on sun-exposed portions of the skin such as the ears, lower lip, and dorsa of the hand. However, squamous cell carcinomas that arise in areas of non–sun-exposed skin or that originate de novo on areas of sun-exposed skin are prognostically worse since they have a greater tendency to metastasize. Chronic sun damage, sites of prior burns, arsenic exposure, chronic cutaneous inflammation as seen in long standing skin ulcers, and sites of previous x-ray therapy are predisposed to the development of squamous cell carcinoma. [1]

Actinic keratosis

Actinic keratoses are potential precursors of squamous cell carcinoma. These typical red scaly patches usually arise on areas of chronically sun-exposed skin, and are likely to be found on the face and dorsal aspects of the hand. Although the vast majority of actinic keratoses do not become squamous cell carcinomas, as many as 5% of actinic keratoses will evolve into this locally invasive carcinoma. Due to this premalignant potential, the destruction of actinic keratoses is advocated. [1]

References:

1. Wagner RF, Casciato DA: Skin cancers. In: Casciato DA, Lowitz BB, eds.: Manual of Clinical Oncology. 4th ed. Philadelphia, Pa: Lippincott, Williams, and Wilkins, 2000, pp 336-373.
2. Rayner CR: The results of treatment of two hundred and seventy-three carcinomas of the hand. Hand 13 (2): 183-6, 1981.
3. Carcinoma of the skin (excluding eyelid, vulva, and penis). In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 203-208.
4. Dubin N, Kopf AW: Multivariate risk score for recurrence of cutaneous basal cell carcinomas. Arch Dermatol 119 (5): 373-7, 1983.

Basal Cell Carcinoma of the Skin

The traditional methods of treatment involve the use of cryosurgery, radiation therapy, electrodesiccation and curettage, and simple excision. Each of these methods is useful in specific clinical situations. [1] Depending on case selection, these methods have cure rates ranging from 85% to 95%.

Mohs micrographic surgery has the highest 5-year cure rates for surgical treatment of both primary (96%) and recurrent (90%) tumors. This method uses microscopic control to evaluate the extent of tumor invasion.

Treatment options:

1. Mohs micrographic surgery. [2] [3] Although this method is complicated and requires special training, it has the highest cure rate of all surgical treatments because the tumor is microscopically delineated until it is completely removed. While other treatment methods for recurrent basal cell carcinoma have failure rates of about 50%, cure rates have been reported at 96% when treated by Mohs micrographic surgery. In addition, its use is indicated for the treatment of primary basal cell carcinomas when they occur at sites known to have a high initial-treatment failure rate with traditional methods (e.g., periorbital area, nasolabial fold, nose-cheek angle, posterior cheek sulcus, pinna, ear canal, forehead, scalp, or tumors arising in a scar). Mohs micrographic surgery is also indicated for:
   • Tumors with poorly defined clinical borders.
   • Tumors with diameters more than 2 cm.
   • Tumors with histopathologic features showing morpheaform or sclerotic patterns.
   • Tumors arising in regions where maximum preservation of uninvolved tissue is desirable such as the eyelid, nose, finger, and genitalia.


2. Simple excision with frozen or permanent sectioning for margin evaluation. This traditional surgical treatment usually relies on surgical margins ranging from 3 mm to 10 mm, depending on the diameter of the tumor. [4]

   Tumor recurrence is not uncommon because only a small fraction of the total tumor margin is examined pathologically. Recurrence rate for primary tumors more than 1.5 cm in diameter is at least 12% within 5 years; if the primary tumor measures more than 3 cm, the 5-year recurrence rate is 23.1%. Primary tumors of the ears, eyes, scalp, and nose have recurrence rates ranging from 12.9% to 25%.



3. Electrodesiccation and curettage. This method is the most widely employed method for removing primary basal cell carcinomas. Although it is a quick method for destroying the tumor, adequacy of treatment cannot be assessed immediately since the surgeon cannot visually detect the depth of microscopic tumor invasion.

   Tumors with diameters ranging from 2 mm to 5 mm have a 15% recurrence rate after treatment with electrodesiccation and curettage. When tumors more than 3 cm are treated with electrodesiccation and curettage, a 50% recurrence rate should be expected within 5 years.



4. Cryosurgery. Cryosurgery may be considered for patients with small, clinically well-defined primary tumors. It is especially useful for debilitated patients with medical conditions that preclude other types of surgery.

   Absolute contraindications for cryosurgery include abnormal cold tolerance, cryoglobulinemia, cryofibrinogenemia, Raynaud disease (only for treatment of lesions on hands and feet), and platelet deficiency disorders. Morphea or sclerosing basal cell carcinoma should not be treated by cryosurgery. Relative contraindications to cryosurgery include tumors of the scalp, ala nasi, nasolabial fold, tragus, postauricular sulcus, free eyelid margin, upper lip vermillion border, and lower legs. Caution should also be used before treating nodular ulcerative neoplasia more than 3 cm, carcinomas fixed to the underlying bone or cartilage, tumors situated on the lateral margins of the fingers and at the ulnar fossa of the elbow, or recurrent carcinomas following surgical excision. Significant morbidity is associated with the use of cryosurgery.

   Edema is common following treatment, especially around the periorbital region, temple, and forehead. Treated tumors usually exude necrotic material after which an eschar forms and persists for about 4 weeks. Permanent pigment loss at the treatment site is unavoidable. Atrophy and hypertrophic scarring have been reported as well as instances of motor and sensory neuropathy.



5. Radiation therapy. Radiation therapy is a logical treatment choice, particularly for patients with primary lesions requiring difficult or extensive surgery (e.g., eyelids, nose, or ears). [5] Radiation therapy eliminates the need for skin grafting when surgery would result in an extensive defect. Cosmetic results are generally good to excellent with a small amount of hypopigmentation or telangiectasia in the treatment port. Radiation therapy can also be used for lesions that recur after a primary surgical approach. [6]

   Radiation therapy is contraindicated for patients with xeroderma pigmentosum, epidermodysplasia verruciformis, or the basal cell nevus syndrome because it may induce more tumors in the treatment area.



6. Carbon dioxide laser. This method is most frequently applied to the superficial type of basal cell carcinoma. It may be considered when a bleeding diathesis is present, since bleeding is unusual when this laser is used.


7. Topical fluorouracil (5-FU). This method may be helpful in the management of selected patients with superficial basal cell carcinomas. Careful and prolonged follow-up is required, since deep follicular portions of the tumor may escape treatment and result in future tumor recurrence. [7]


8. Interferon alpha. Several early studies have shown variable responses of basal cell carcinoma to intralesional interferon alpha. [8] [9] Further reports are awaited until this treatment may be recommended for routine clinical practice.


9. Photodynamic therapy. [10] Photodynamic therapy with photosensitizers may be effective treatment for patients with superficial epithelial skin tumors. [11]

Follow-up:

• Following treatment for basal cell carcinoma, patients should be clinically examined every 6 months for 5 years. [12] Thereafter, patients should be examined for recurrent tumors or new primary tumors at yearly intervals. Of the patients who develop a basal cell carcinoma, 36% will develop a second primary basal cell carcinoma within the next 5 years. Early diagnosis and treatment of recurrent basal cell carcinomas or another primary basal cell carcinoma is desirable since the treatment of the disease in its earliest stages results in less patient morbidity.

Current Clinical Trials

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with basal cell carcinoma of the skin. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References:

1. Preston DS, Stern RS: Nonmelanoma cancers of the skin. N Engl J Med 327 (23): 1649-62, 1992.
2. Malhotra R, Huilgol SC, Huynh NT, et al.: The Australian Mohs database, part II: periocular basal cell carcinoma outcome at 5-year follow-up. Ophthalmology 111 (4): 631-6, 2004.
3. Thomas RM, Amonette RA: Mohs micrographic surgery. Am Fam Physician 37 (3): 135-42, 1988.
4. Abide JM, Nahai F, Bennett RG: The meaning of surgical margins. Plast Reconstr Surg 73 (3): 492-7, 1984.
5. Caccialanza M, Piccinno R, Moretti D, et al.: Radiotherapy of carcinomas of the skin overlying the cartilage of the nose: results in 405 lesions. Eur J Dermatol 13 (5): 462-5, 2003 Sep-Oct.
6. Lovett RD, Perez CA, Shapiro SJ, et al.: External irradiation of epithelial skin cancer. Int J Radiat Oncol Biol Phys 19 (2): 235-42, 1990.
7. Dabski K, Helm F: Topical chemotherapy. In: Schwartz RA: Skin Cancer: Recognition and Management. New York, NY: Springer-Verlag, 1988, pp 378-389.
8. Greenway HT, Cornell RC, Tanner DJ, et al.: Treatment of basal cell carcinoma with intralesional interferon. J Am Acad Dermatol 15 (3): 437-43, 1986.
9. Padovan I, Brodarec I, Ikić D, et al.: Effect of interferon in therapy of skin and head and neck tumors. J Cancer Res Clin Oncol 100 (3): 295-310, 1981.
10. Wilson BD, Mang TS, Stoll H, et al.: Photodynamic therapy for the treatment of basal cell carcinoma. Arch Dermatol 128 (12): 1597-601, 1992.
11. Wolf P, Rieger E, Kerl H: Topical photodynamic therapy with endogenous porphyrins after application of 5-aminolevulinic acid. An alternative treatment modality for solar keratoses, superficial squamous cell carcinomas, and basal cell carcinomas? J Am Acad Dermatol 28 (1): 17-21, 1993.
12. Rowe DE, Carroll RJ, Day CL Jr: Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up. J Dermatol Surg Oncol 15 (3): 315-28, 1989.

Squamous Cell Carcinoma of the Skin

Localized squamous cell carcinoma of the skin is a highly curable disease. [1] The traditional methods of treatment involve the use of cryosurgery, radiation therapy, electrodesiccation and curettage, and simple excision. Each of these methods may be useful in specific clinical situations.

Of all treatment methods available, Mohs micrographic surgery has the highest 5-year cure rate for both primary and recurrent tumors. This method uses microscopic control to evaluate the extent of tumor invasion. Lymphadenectomy is indicated when regional lymph nodes are involved.

Treatment options:

1. Mohs micrographic surgery. [2] Although this method is complicated and requires special training, it has the highest cure rate of all surgical treatments because the tumor is microscopically delineated until it is completely removed. It is indicated for the treatment of:
   • primary squamous cell carcinomas when they occur at sites known to have a high initial treatment failure rate following traditional methods;
   • primary tumors with poorly defined clinical borders, primary tumors with diameters more than 2 cm; or
   • primary tumors arising in regions where the maximum preservation of uninvolved tissue is desirable such as the face, head, and genitalia.

   Mohs micrographic surgery should be used for squamous cell carcinomas that show perineural invasion since tumor transit along nerves may extend many centimeters away from the primary or recurrent tumor site. [3] Recurrent squamous cell carcinomas can also be treated with this technique.



2. Simple excision with frozen or permanent sectioning for margin evaluation. This traditional surgical treatment usually relies on surgical margins ranging from 3 mm to 10 mm, depending on the diameter of the original tumor. [4] Tumor recurrence is not uncommon because only a small fraction of the total tumor margin is examined pathologically.


3. Electrodesiccation and curettage. This is a quick method for destroying the tumor, but the adequacy of treatment cannot be assessed immediately since the surgeon cannot visually detect the depth of microscopic tumor invasion. It should be reserved for very small primary tumors since this disease has metastatic potential.


4. Cryosurgery. Cryosurgery is used for patients with clinically well-defined in situ tumors. It is especially useful for debilitated patients with medical conditions that preclude other types of surgery.

   Absolute contraindications for cryosurgery include abnormal cold tolerance, cryoglobulinemia, cryofibrinogenemia, Raynaud disease, and platelet deficiency disorders. Relative contraindications to cryosurgery include tumors of the scalp, ala nasi, nasolabial fold, tragus, postauricular sulcus, free eyelid margin, upper lip vermillion border, and lower legs. Caution should also be used before treating nodular ulcerative neoplasia more than 3 cm, carcinomas fixed to the underlying bone or cartilage, tumors situated on the lateral margins of the fingers and at the ulnar fossa of the elbow, or recurrent carcinomas following surgical excision. Significant morbidity is associated with the use of cryosurgery.

   Edema is common following treatment, especially around the periorbital region, temple, and forehead. Treated tumors usually exude necrotic material after which an eschar forms and persists for about 4 weeks. Permanent pigment loss at the treatment site is unavoidable. Atrophy and hypertrophic scarring have been reported as well as instances of motor and sensory neuropathy.



5. Radiation therapy. Radiation therapy is a logical treatment choice, particularly for patients with primary lesions requiring difficult or extensive surgery (e.g., eyelids, nose, or ears). [5] Radiaiton therapy eliminates the need for skin grafting when surgery would result in an extensive defect. Cosmetic results are generally good to excellent with a small amount of hypopigmentation or telangiectasia in the treatment port. Radiation therapy can also be utilized for lesions that recur after a primary surgical approach. [6]

   Radiation therapy is contraindicated for patients with xeroderma pigmentosum, epidermodysplasia verruciformis, or the basal cell nevus syndrome because it may induce more tumors in the treatment area.



6. Topical fluorouracil (5-FU). This method may be helpful in the management of selected in situ squamous cell carcinomas (Bowen disease). Careful and prolonged follow-up is required since deep follicular portions of the tumor may escape treatment and result in future tumor recurrence. [7]


7. Carbon dioxide laser. This method may be helpful in the management of selected squamous cell carcinoma in situ. It may be considered when a bleeding diathesis is present, since bleeding is unusual when this laser is used.


8. Interferon alpha. Clinical trials are ongoing to treat squamous cell carcinoma with intralesional interferon alpha. [8] The results should be available in several years. One report shows the combination of interferon alpha and retinoids is effective treatment for squamous cell carcinoma. [9]

Follow-up:

• Since squamous cell carcinomas have definite metastatic potential, patients should be re-examined every 3 months for the first several years and then followed indefinitely at 6-month intervals.

Current Clinical Trials

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with squamous cell carcinoma of the skin. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References:

1. Preston DS, Stern RS: Nonmelanoma cancers of the skin. N Engl J Med 327 (23): 1649-62, 1992.
2. Thomas RM, Amonette RA: Mohs micrographic surgery. Am Fam Physician 37 (3): 135-42, 1988.
3. Cottel WI: Perineural invasion by squamous-cell carcinoma. J Dermatol Surg Oncol 8 (7): 589-600, 1982.
4. Abide JM, Nahai F, Bennett RG: The meaning of surgical margins. Plast Reconstr Surg 73 (3): 492-7, 1984.
5. Caccialanza M, Piccinno R, Moretti D, et al.: Radiotherapy of carcinomas of the skin overlying the cartilage of the nose: results in 405 lesions. Eur J Dermatol 13 (5): 462-5, 2003 Sep-Oct.
6. Lovett RD, Perez CA, Shapiro SJ, et al.: External irradiation of epithelial skin cancer. Int J Radiat Oncol Biol Phys 19 (2): 235-42, 1990.
7. Dabski K, Helm F: Topical chemotherapy. In: Schwartz RA: Skin Cancer: Recognition and Management. New York, NY: Springer-Verlag, 1988, pp 378-389.
8. Padovan I, Brodarec I, Ikić D, et al.: Effect of interferon in therapy of skin and head and neck tumors. J Cancer Res Clin Oncol 100 (3): 295-310, 1981.
9. Lippman SM, Parkinson DR, Itri LM, et al.: 13-cis-retinoic acid and interferon alpha-2a: effective combination therapy for advanced squamous cell carcinoma of the skin. J Natl Cancer Inst 84 (4): 235-41, 1992.

Actinic Keratosis

Actinic keratosis commonly appears in regions of chronic sun exposure such as the face and dorsa of the hands. Actinic cheilitis is a related condition that usually appears on the lower lips. [1] These conditions represent early epithelial transformation that may eventually evolve into invasive squamous cell carcinoma. Actinic keratosis is a premalignant condition that should be treated with one of the methods available. [2]

Treatment options:

1. Topical agents:
   • Fluorouracil (5-FU): Treats the clinically obvious disease as well as regions of subclinical involvement.
   • Imiquimod 5% cream. [3] [4] [5]
   • Diclofenac sodium 3% gel.
   • Trichloroacetic acid.
   • Phenol.
2. Cryosurgery.
3. Electrodesiccation and curettage.
4. Dermabrasion.
5. Shave excision.
6. Carbon dioxide laser.
7. Photodynamic therapy.

Current Clinical Trials

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with actinic keratosis. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

General information about clinical trials is also available from the NCI Web site.

References:

1. Picascia DD, Robinson JK: Actinic cheilitis: a review of the etiology, differential diagnosis, and treatment. J Am Acad Dermatol 17 (2 Pt 1): 255-64, 1987.
2. Preston DS, Stern RS: Nonmelanoma cancers of the skin. N Engl J Med 327 (23): 1649-62, 1992.
3. Lebwohl M, Dinehart S, Whiting D, et al.: Imiquimod 5% cream for the treatment of actinic keratosis: results from two phase III, randomized, double-blind, parallel group, vehicle-controlled trials. J Am Acad Dermatol 50 (5): 714-21, 2004.
4. Tran H, Chen K, Shumack S: Summary of actinic keratosis studies with imiquimod 5% cream. Br J Dermatol 149 (Suppl 66): 37-9, 2003.
5. Lee PK, Harwell WB, Loven KH, et al.: Long-term clinical outcomes following treatment of actinic keratosis with imiquimod 5% cream. Dermatol Surg 31 (6): 659-64, 2005.

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The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

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