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Non-surgical treatment is reserved for selected superficial non-melanoma skin cancers — superficial BCC, SCC in situ (Bowen's disease) and, in selected cases, nodular BCC. Options include laser-assisted photodynamic therapy (LA-PDT), Efudix and Aldara, with surgery reserved for higher-risk or deeper lesions.

Skin Cancer and Skin Medicine

Non-Surgical Treatment of Non-Melanoma Skin Cancer

Non-surgical treatment is reserved for selected superficial non-melanoma skin cancers — superficial BCC, SCC in situ (Bowen's disease) and, in selected cases, nodular BCC. Options include laser-assisted photodynamic therapy (LA-PDT), Efudix and Aldara, with surgery reserved for higher-risk or deeper lesions.

Red light therapy device applied to a patient's arm — the LED activation step used in laser-assisted photodynamic therapy.
Photo by Julius Toltesi on Unsplash

Doctor-led options for selected superficial basal cell carcinoma (sBCC) and Bowen’s disease (SCC in situ) — including laser-assisted photodynamic therapy, Efudix, and Aldara.

Book a 20-minute appointment with Dr Chris

Which non-melanoma skin cancers can be treated non-surgically?

Non-surgical treatment is generally reserved for selected superficial cancers, most commonly:

  • Superficial Basal Cell Carcinoma (sBCC)
  • Squamous Cell Carcinoma in situ (SCCis, also known as Intraepidermal Carcinoma or Bowen’s disease)
  • Nodular Basal Cell Carcinoma (nBCC): specifically via advanced protocols like LA-PDT.*

Suitability depends on a professional assessment of the lesion’s depth, site (high-risk areas may require surgery), your medical history, and your personal priorities regarding cosmesis and downtime.

If you are unsure of a lesion, the first step is always a professional skin check.

*nBCC indication for LA-PDT is sometimes considered an “off-label” treatment depending on depth histology and other clinical factors.

How we choose the safest option

  1. Confirm the diagnosis

    Clinical examination and dermoscopy, followed by biopsy/histology if there is any uncertainty.

  2. Assess appropriateness

    Determine whether the lesion is thin or superficial enough for non-surgical methods.

  3. Select the pathway

    We weigh clearance rates, recurrence risk, and cosmetic outcomes against your lifestyle and preferences.

Treatment comparison at a glance

FeatureLA-PDT (laser-assisted)Efudix (5-fluorouracil)Aldara (imiquimod)
Indicated forsBCC, SCCis, nBCC* 8–13SCCis 3sBCC 2
Effectiveness~94–100% 8–1270% 18~80% (non-facial sBCC) 18,19
DeliveryIn-clinic, doctor-ledAt-home, self-applied 3At-home, self-applied 2
Typical course1–2 sessionsTwice daily for 6 weeks5 days a week for 6 weeks
MechanismLaser ablation + light-activated cell deathTopical chemotherapy 3Immune-system stimulant 2
Visible reactionRed, weeping areaRed, weeping areaRed, weeping area
Systemic (whole-body) side effectsNone5–10% may develop flu-like illness, abdominal cramps, persistent vomiting, bloody diarrhoea or alopecia; rare bone-marrow suppression, very rarely life-threatening 14,15,175–10% may develop flu-like illness, headaches, dizziness, insomnia or diarrhoea 16,17
Stopped early due to severe side effectsNone~5% 17~3% 17
DowntimeShort (days)Prolonged (weeks–two months)Prolonged (weeks–two months)
Cosmetic outcomeExcellent 8–12Good (risk of pigment changes)Good (risk of pigment changes)

*nBCC indication for LA-PDT may be considered off-label depending on clinical selection. The pivotal imiquimod (Aldara) superficial-BCC trials excluded facial lesions, so face-specific cure rates are not well established. 19

Detailed efficacy of LA-PDT by cancer type

Precise ablation combined with fractional “micro-channelling” and PDT allows significantly higher success rates than traditional topical methods: 8–12

100%
Superficial BCC
up to 100% clearance 9; 97.1% recurrence-free long-term 8
93.8%
SCC in situ
clearance for Bowen’s disease 10
98.97%
Nodular BCC
cure rate when laser ablation is combined with PDT 11

Treatment options in detail

1) Laser-Assisted Photodynamic Therapy (LA-PDT)

LA-PDT is an advanced alternative that many patients find more convenient than long topical courses. It combines precise laser ablation of the visible tumour with light-activated, targeted cell death to “mop up” any remaining cancerous cells.

  • The process: The cancer is first precisely ablated with an erbium laser. A fractional laser then creates microscopic “wells” across the tumour bed and a normal-appearing margin to enhance drug penetration, followed by a photosensitising cream and red-LED light activation.
  • The advantage: A doctor-led, in-clinic session that avoids weeks of self-application and delivers potentially surgery-level clearance with superior cosmetic results.

Learn more about LA-PDT for non-melanoma skin cancer →

2) Efudix (5-fluorouracil cream)

A prescription chemotherapy cream applied at home. It is effective for treating “fields” of damaged skin but requires a strict daily regimen and causes a prolonged inflammatory reaction as abnormal cells are cleared. Systemic side effects (flu-like illness, abdominal symptoms) occur in roughly 5–10% of patients.

Learn more about Efudix (5-fluorouracil) →

3) Aldara (imiquimod cream)

An immune-response modifier that stimulates your body’s own defences to attack the cancer. Like Efudix, it requires six or more weeks of application and typically involves significant localised skin irritation during the treatment phase. Systemic side effects (flu-like illness, headaches) occur in roughly 5–10% of patients.

Learn more about Aldara (imiquimod) →

When surgery is safer

Non-surgical treatment is not appropriate when there is high risk or a need for absolute margin control. Surgery can be safer when:

  • The cancer is high risk, either by location or histology.
  • Prior non-surgical treatments have failed.
  • A pathologist needs to verify that all margins are clear — particularly for lesions that can spread, such as invasive squamous cell carcinoma or melanoma.

Frequently asked questions

  • Is non-surgical treatment as effective as surgery?
    For selected superficial cancers, success rates are very high — up to 100% in some LA-PDT cases. However, surgery remains the gold standard for deeper lesions (or lesions that can metastasise, such as invasive squamous cell carcinoma or melanoma) because it allows a pathologist to verify that all margins are clear.
  • Why consider LA-PDT over Efudix or Aldara?
    LA-PDT is completed in-clinic, removing the need for six weeks of daily cream application. Healing usually occurs within a few days, whereas creams can cause visible inflammation for a month or more.
  • Will I need a biopsy first?
    Often, yes. A biopsy helps us confirm the exact type and depth of the cancer, ensuring we perform the safest and most effective treatment for you.

Book your assessment

The first step toward non-surgical treatment is a comprehensive assessment to confirm your diagnosis and discuss the best personalised treatment for you.

Book a 20-minute appointment with Dr Chris

References

  1. Shumack SP. Non-surgical treatments for skin cancer. Australian Prescriber (2011).
  2. DermNet NZ. Imiquimod.
  3. DermNet NZ. Fluorouracil (5-FU) cream.
  4. DermNet NZ. Basal cell carcinoma.
  5. Griffin LL, Lear JT. Photodynamic therapy and non-melanoma skin cancer. Cancers (Basel) (2016).
  6. Choi SH, et al. Efficacy of ablative fractional laser-assisted photodynamic therapy for the treatment of actinic cheilitis — 12-month results of a prospective, randomized, comparative trial. Br J Dermatol (2015).
  7. Steeb T, et al. Laser-assisted photodynamic therapy — mechanistic and comparative context. J Am Acad Dermatol (2019).
  8. Shokrollahi K, et al. Combined carbon dioxide laser with photodynamic therapy for nodular and superficial basal cell carcinoma. Ann Plast Surg (2014).
  9. Genouw E, et al. Laser-assisted photodynamic therapy for superficial basal cell carcinoma and Bowen disease — a randomized intrapatient comparison between continuous and fractional ablative CO2 laser. J Eur Acad Dermatol Venereol (2018).
  10. Ko DY, et al. A randomized trial comparing methyl aminolaevulinate PDT with and without Er:YAG ablative fractional laser in Asian patients with lower extremity Bowen disease — 12-month follow-up. Br J Dermatol (2014).
  11. Smucler R, Vlk M. Combination of Er:YAG laser and photodynamic therapy in the treatment of nodular basal cell carcinoma. Lasers Surg Med (2008).
  12. Lippert J, et al. Fractional carbon dioxide laser improves nodular basal cell carcinoma treatment with photodynamic therapy. Dermatol Surg (2013).
  13. DermNet NZ. Photodynamic therapy.
  14. Kishi P, Price CJ. Life-Threatening Reaction with Topical 5-Fluorouracil. Drug Safety Case Reports (2018).
  15. Cohen PR. Topical 5-fluorouracil 5% cream associated with severe neutropenia — case and review of systemic reactions. Dermatol Online J (2018).
  16. Pasadyn SR, et al. Topical Imiquimod Induces Severe Weakness and Myalgias After Three Applications — A Case Report. J Clin Aesthet Dermatol (2019).
  17. Love WE, Bernhard JD, Bordeaux JS. Topical imiquimod or fluorouracil therapy for basal and squamous cell carcinoma — a systematic review. Arch Dermatol (2009).
  18. Jansen MHE, 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).
  19. Raasch B. Management of superficial basal cell carcinoma — focus on imiquimod. Clin Cosmet Investig Dermatol (2009). Pivotal imiquimod sBCC efficacy (~78–82%) applies to lesions not on the face or neck.
  20. Thomson J, et al. Interventions for basal cell carcinoma of the skin. Cochrane Database of Systematic Reviews (2020).

In-clinic, doctor-led

Laser-Assisted PDT for Non-Melanoma Skin Cancer

Two-step laser ablation plus light-activated cell death — up to ~94–100% clearance for selected superficial BCC, SCC in situ and selected nodular BCC.

Learn more →

Pre-cancer field therapy

Laser-Assisted PDT for Actinic Keratosis

Field treatment for sun-damage pre-cancer — laser-driven cream uptake plus LED activation in a single in-clinic session.

Learn more →

Topical chemotherapy

Efudix (5-fluorouracil)

Prescription "field treatment" cream for actinic keratosis and SCC in situ (Bowen’s disease). Applied at home over 4–6 weeks.

Learn more →

Immune-activating cream

Aldara (imiquimod)

Prescription immune-activating cream for selected superficial BCC, SCC in situ and actinic keratosis. Applied at home over 6 weeks.

Learn more →

AK treatment overview

Actinic Keratosis Treatment Options

Field treatments for sun-damaged skin and actinic keratosis — laser-assisted PDT, Efudix (5-fluorouracil), Aldara (imiquimod) and cryotherapy.

Learn more →

Medically reviewed by Dr Christopher Irwin, MBChB, FRACGP, MMed (Skin Cancer), FACAM, ASCD · Last reviewed 2026-06-06 · Editorial policy