Non-surgical treatments for skin cancers

Many early skin cancers are superficial or in situ

Superficial basal cell carcinoma (sBCC) and Bowen’s disease (squamous cell carcinoma in situ) may suit non-surgical treatment such as cryotherapy, prescription creams or photodynamic therapy (PDT). Surgery is included below as a comparator.

The most appropriate treatment depends on:

• the type of skin cancer, its size and location
• the likelihood of complete clearance
• side effects, including discomfort and scarring
• cost and convenience.

Treatment is chosen after clinical assessment, and usually after a biopsy confirms the diagnosis. For all management approaches, including surgery, see our skin cancer treatments page.

How well does each treatment work?

The results below come from published clinical trials. They are grouped by diagnosis because the evidence differs between sBCC and Bowen’s disease. The follow-up period is shown for each figure, because clearance rates fall as follow-up gets longer.

Reading the tables: a “clearance” figure is the percentage of treated patients or lesions that were free of skin cancer at that time point. Figures from different trials used different methods and should not be compared directly.

Superficial basal cell carcinoma

*Includes nodular BCC at low-risk sites.

In the largest head-to-head trial (601 patients), imiquimod had the highest long-term clearance of the three non-surgical treatments (3–5). In a separate trial, cryotherapy and PDT had similar five-year recurrence rates (20% and 22%) (6).

Bowen’s disease (squamous cell carcinoma in situ)

The largest trial directly comparing surgery with non-surgical treatment (250 patients) reported these results (10, 11):

Almost all treatment failures appeared within the first year. After that, recurrence was rare (11).

Earlier, smaller trials also included cryotherapy (7, 8):

Lesions that partly responded were retreated in these trials.

Cosmetic outcome

Across these trials, PDT generally left the best appearance. In one sBCC trial, 94% of lesions treated with PDT had a good or excellent cosmetic result at 12 months, compared with 60% after excision (1). In another, 60% of PDT patients had an excellent result, compared with 16% after cryotherapy (6).

In Bowen’s disease, good or excellent cosmetic results were more common after fluorouracil or PDT than after excision (10). In an earlier trial, good or excellent results were reported in 94% after PDT, 76% after fluorouracil and 66% after cryotherapy (8).

Evidence context

Trial results reflect selected patients treated under study conditions. Outcomes in practice vary with tumour type, size, site and individual factors. Your doctor will discuss which options suit your circumstances.

Photodynamic therapy may also be used in selected cases of nodular BCC.

Combination topical treatment

A short course of combination topical field treatment (calcipotriol with fluorouracil) is used for solar keratoses. In one trial, people who received it for solar keratoses developed fewer squamous cell carcinomas on the treated face and scalp over the following 3 years (12). At Spot Check, the combination may also be used for selected Bowen’s disease (SCC in situ), supported by a 2026 international expert panel (13). Controlled-trial success rates for this use are not yet available. It is not a treatment for invasive SCC; suitability requires clinical assessment.

What is involved?

Cream treatment courses shown are those used in the trials above (3, 10). The trials cited above used PDT sessions about one week apart. Your doctor will confirm the schedule that suits you.

Preparing for treatment

For all treatments: tell your doctor about any medicines, including blood thinners, any allergies and whether you are pregnant or breastfeeding. Plan around the expected healing time, especially for visible sites such as the face.

Surgical excision: eat normally beforehand. Avoid heavy exercise and swimming until your doctor advises. See excision aftercare.

Cryotherapy: no special preparation is needed. Wear clothing that gives easy access to the treatment area.

Prescription creams: apply as directed to the marked area only, and wash your hands afterwards. Avoid starting treatment just before a major event, because the treated area becomes red and crusted for several weeks. Pregnancy should be avoided during and after fluorouracil treatment.

Photodynamic therapy: allow about 3–4 hours for each visit, and bring something to read. The area is gently prepared and the cream is left under a dressing for around 3 hours before light treatment. Plan to avoid direct sunlight on the treated area for about a week after each session. Bring a hat or clothing to cover the area. If you get cold sores, tell your doctor before treatment, because preventive medication may be recommended.

What does it feel like?

• Excision: the local anaesthetic injection stings briefly. Mild aching for a few days is common.
• Cryotherapy: stinging or burning during freezing, which may last several hours afterwards.
• Creams: tenderness, itch and burning build up over the treatment weeks and settle after the course ends.
• PDT: burning or stinging mainly during the light treatment. It usually settles within hours.

PDT tends to cause more intense pain than creams, but for a much shorter time (9). Pain relief options are discussed before treatment.

What are the side effects?

Surgical excision

• Short term: bleeding, bruising, swelling, infection.
• Long term: a scar in almost all cases, and occasionally wound breakdown or nerve damage.

Cryotherapy

• Short term: blistering (sometimes blood-filled), swelling, then crusting while it heals over 2–4 weeks.
• Long term: the treated area is commonly lighter or darker than the surrounding skin.

Imiquimod and fluorouracil

• Short term: redness, swelling, erosions, crusting and itch. These were more common with creams than with PDT (3).
• Occasionally: local infection or flu-like symptoms.
• Long term: uncommon. Scarring may follow a severe reaction.

Photodynamic therapy

• Short term: redness, swelling and crusting for 1–2 weeks. Cold sore flare-ups can occur in people prone to them.
• Long term: pigment change or scarring is uncommon. Serious reactions were rarer with PDT than with creams (9).

How much does it cost?

Costs vary depending on the treatment selected, the size and location of the skin cancer, and whether Medicare or PBS rebates apply. Exact fees are discussed during consultation.

Surgical excision

Surgical removal is performed by a doctor and remains the standard treatment for many skin cancers. For details of surgical removal and wound repair, see our excision page.

Where tumour characteristics or anatomical location indicate increased complexity, referral to a plastic surgeon or Mohs micrographic surgeon may be recommended. Decisions regarding repair technique and referral are guided by the type of skin cancer, its location, reconstructive needs and patient preference.

An out-of-pocket fee generally applies in addition to the Medicare rebate. Fees vary according to complexity and repair type. Exact costs are discussed during consultation.

Cryotherapy

Cryotherapy is generally a lower-cost in-clinic procedure. In some biopsy-confirmed cases, Medicare rebates may fully cover the treatment. Eligibility depends on clinical and billing criteria.

Topical therapy

For selected superficial skin cancers, prescription topical treatments may be recommended following clinical assessment.

Some medications may be subsidised under the Pharmaceutical Benefits Scheme (PBS) in defined circumstances. Eligibility varies depending on diagnosis and patient status.

Certain combination topical treatments are prepared by compounding pharmacies and are not PBS-subsidised.

Out-of-pocket costs vary depending on eligibility, prescription requirements and treatment duration. Expected costs are discussed during consultation.

Photodynamic therapy

PDT costs vary depending on treatment area, preparation requirements and light activation method. Medicare rebates do not generally apply. Compared with other non-surgical treatments, PDT is typically a higher-cost option. At Spot Check, non-melanoma skin cancer treatment is charged as two full-price sessions, and field treatment as one full-price session. See our non-surgical treatment fees.

Aftercare and follow-up

• Excision: wound care and suture removal as advised.
• Cryotherapy: healing over 2–4 weeks.
• Creams: a visible reaction for several weeks. Strict sun protection is needed.
• PDT: avoid direct sunlight on the treated area for about a week after each session, then use ongoing sun protection. Visible changes may affect work or social plans for 1–2 weeks. Skin-cancer treatment includes a second planned session and a clinical clearance review. The clinic will confirm the dates for your treatment plan.

After any non-surgical skin-cancer treatment, a clinical review with dermoscopy is needed to check clearance. The clinic will arrange the review date. Most recurrences appear within the first year (11), but ongoing skin checks are recommended because recurrence can occur later (5).

References

1. Szeimies RM, Ibbotson S, Murrell DF, et al. A clinical study comparing methyl aminolevulinate photodynamic therapy and surgery in small superficial basal cell carcinoma (8–20 mm), with a 12-month follow-up. J Eur Acad Dermatol Venereol. 2008;22(11):1302–11. doi:10.1111/j.1468-3083.2008.02803.x
2. Bath-Hextall F, Ozolins M, Armstrong SJ, et al. Surgical excision versus imiquimod 5% cream for nodular and superficial basal-cell carcinoma (SINS): a multicentre, non-inferiority, randomised controlled trial. Lancet Oncol. 2014;15(1):96–105. doi:10.1016/S1470-2045(13)70530-870530-8)
3. Arits AH, Mosterd K, Essers BA, et al. Photodynamic therapy versus topical imiquimod versus topical fluorouracil for treatment of superficial basal-cell carcinoma: a single blind, non-inferiority, randomised controlled trial. Lancet Oncol. 2013;14(7):647–54. doi:10.1016/S1470-2045(13)70143-870143-8)
4. Roozeboom MH, Arits AH, Mosterd K, et al. Three-year follow-up results of photodynamic therapy vs. imiquimod vs. fluorouracil for treatment of superficial basal cell carcinoma: a single-blind, noninferiority, randomized controlled trial. J Invest Dermatol. 2016;136(8):1568–74. doi:10.1016/j.jid.2016.03.043
5. Jansen MHE, Mosterd K, Arits AH, et al. Five-year results of a randomized controlled trial comparing effectiveness of photodynamic therapy, topical imiquimod, and topical 5-fluorouracil in patients with superficial basal cell carcinoma. J Invest Dermatol. 2018;138(3):527–33. doi:10.1016/j.jid.2017.09.033
6. Basset-Seguin N, Ibbotson SH, Emtestam L, et al. Topical methyl aminolaevulinate photodynamic therapy versus cryotherapy for superficial basal cell carcinoma: a 5 year randomized trial. Eur J Dermatol. 2008;18(5):547–53. doi:10.1684/ejd.2008.0472
7. Salim A, Leman JA, McColl JH, et al. Randomized comparison of photodynamic therapy with topical 5-fluorouracil in Bowen’s disease. Br J Dermatol. 2003;148(3):539–43. doi:10.1046/j.1365-2133.2003.05033.x
8. Morton C, Horn M, Leman J, et al. Comparison of topical methyl aminolevulinate photodynamic therapy with cryotherapy or fluorouracil for treatment of squamous cell carcinoma in situ: results of a multicenter randomized trial. Arch Dermatol. 2006;142(6):729–35. doi:10.1001/archderm.142.6.729
9. Collier NJ, Haylett AK, Wong TH, et al. Conventional and combination topical photodynamic therapy for basal cell carcinoma: systematic review and meta-analysis. Br J Dermatol. 2018;179(6):1277–96. doi:10.1111/bjd.16838
10. Ahmady S, Nelemans PJ, Kelleners-Smeets NWJ, et al. Surgical excision versus topical 5% 5-fluorouracil and photodynamic therapy in treatment of Bowen’s disease: a multicenter randomized controlled trial. J Am Acad Dermatol. 2024;90(1):58–65. doi:10.1016/j.jaad.2023.08.076
11. Moermans MMG, Ahmady S, Nelemans PJ, et al. Surgical excision versus topical 5% 5-fluorouracil and photodynamic therapy in the treatment of Bowen’s disease: long-term results of a multicenter randomized controlled trial. J Am Acad Dermatol. 2026;94(5):1447–53. doi:10.1016/j.jaad.2025.12.034
12. Rosenberg AR, Tabacchi M, Ngo KH, et al. Skin cancer precursor immunotherapy for squamous cell carcinoma prevention. JCI Insight. 2019;4(6):e125476. doi:10.1172/jci.insight.125476

1. Loranger N, Trepanowski N, Shah P, et al. Topical combined 5-fluorouracil and calcipotriene for actinic keratosis and superficial keratinocyte carcinoma: modified Delphi expert panel recommendations from ITSCC. J Am Acad Dermatol. 2026;95(1):112–20. doi:10.1016/j.jaad.2026.03.088