Electrochemotherapy for cancers affecting the skin

Electrochemotherapy is a treatment that combines chemotherapy with small electrical pulses. You have an anaesthetic before you have the treatment.

Doctors use electrochemotherapy to treat some cancers that start in the skin. Or cancers that start elsewhere in the body and have spread to the skin. The area a cancer has spread to is called a secondary cancer or a metastasis. Areas of cancer that have spread to the skin are called skin metastases.

What is electrochemotherapy?

Chemotherapy uses anti cancer drugs to destroy cancer cells. These drugs are also called cytotoxic drugs. Electrochemotherapy is a way of getting the chemotherapy into cancer cells.

Your doctor gives you chemotherapy and then puts a special probe into the cancer on the skin. The probe gives out small electrical pulses. These change the outside of the cancer cells which helps the chemotherapy get into them.

Who can have electrochemotherapy?

A cancer that hasn’t spread is called a primary cancer. Doctors can use electrochemotherapy to treat primary:

• basal cell skin cancer
• squamous cell skin cancer

Doctors can also use electrochemotherapy to treat skin metastases from skin cancers including:

• squamous cell skin cancer
• melanoma skin cancer
• Merkel cell skin cancer
• basal cell skin cancer – but it is very rare for this type of skin cancer to spread

It can also be used to treat skin metastases from other types of cancer. This includes:

• Kaposi’s sarcoma
• breast cancer
• vulval cancer
• sarcoma
• head and neck cancers

Unfortunately, if the cancer has spread elsewhere in the body, it means the cancer is advanced. And the aim of electrochemotherapy is to help control the cancer and reduce any symptoms.

Before you have electrochemotherapy

You usually have a pre operative assessment and some tests. This is to make sure you are well enough to have the anaesthetic and the treatment.

On the day of electrochemotherapy

Your anaesthetist may give you a general anaesthetic before electrochemotherapy. This means you are asleep during the treatment. Or you might have a local anaesthetic to numb the area. You sometimes have a drug to make you sleepy (sedation) as well as the local anaesthetic.

Which type of anaesthetic you have can depend on:

• the size of the area being treated
• the number of areas being treated
• if you can have a local anaesthetic injection to the area
• your general health

Your doctor and anaesthetist will talk to you about which is the best type of anaesthetic to have.

Having the chemotherapy

After your anaesthetic, your doctor gives you the chemotherapy. This is either as an injection into:

• the cancer or skin metastasis (intratumoural)
• your bloodstream (intravenously) through a small tube in your vein called a cannula

Your doctor will talk to you about which is the best option. But it can depend on the size and number of areas being treated.

Injection into the tumour

After you’ve had the anaesthetic, your doctor injects the chemotherapy straight into the cancer or skin metastases. They give you the electrical pulses immediately afterwards. This is because the chemotherapy is already in the right place.

Injection into a vein

After you’ve had the anaesthetic, your doctor injects the chemotherapy into your bloodstream. They give you the electrical pulses 8 minutes later. This gives the chemotherapy enough time to get to the cancer or skin metastases.

Types of chemotherapy

There are different chemotherapy drugs you can have with electrochemotherapy. But you usually have treatment with a chemotherapy drug called bleomycin. Sometimes your doctor might use a different chemotherapy called cisplatin.

Having the electrical pulses

The electrical pulses comes from a special machine. Attached to the machine is a probe. The probe is the size of a large pen and has electrodes on the end. Your doctor puts the electrodes into the cancer or skin metastasis. The electrodes then send electrical pulses to the cells.

How long it takes to have the treatment depends on the size of the skin cancer. Or the size and number of skin metastases. Some people may need more than one treatment.

What happens after electrochemotherapy

If you had a general anaesthetic you go to the recovery area until you are awake enough. You are then taken back to the ward.

Back on the ward, your nurse checks you regularly. This includes checking your blood pressure and pulse. They also look at the area you had treated. It is normal for this area to be:

• swollen
• bruised
• painful

How you look after the area depends on whether you had a dressing on before the treatment or not. And in some areas, it may be difficult to keep a dressing on.

If you didn’t have a dressing

You don’t normally need one afterwards. This means you can wash the area normally. Using a sensitive or unperfumed soap or shower gel is best. This is because normal or perfumed soaps and shower gels may irritate the skin. Body lotion can also cause irritation. Gently pat the area dry with a towel after washing.

If you had a dressing

You can usually continue using the same type of dressings after the procedure. Follow the same instructions for looking after the area as before. Your nurse or doctor will tell you if you need to do anything different. If you have a district nurse, they will continue to look after the wound.

Side effects of electrochemotherapy

You have a lower dose of chemotherapy than if you are having the chemotherapy on its own. This is because the chemotherapy can easily get into the cancer cells. Lower doses of chemotherapy usually mean fewer side effects.

The chemotherapy might make you feel sick afterwards. But this is usually mild and you can have anti sickness medicines to help.

Other side effects are usually from the electrical pulses and not the chemotherapy drugs. These can include:

Pain

The main side effect is pain in the area where the electrodes touches the skin. This is usually mild and lasts for a couple of days. Rarely some people have more severe pain that can last between two and four weeks. Your doctor will give you some painkillers if you need them. 

Muscle contractions

Some people have muscle contractions during the treatment. Your doctor can slightly alter the way they give the treatment if this is uncomfortable.

Infection

Infection in the area you have treatment is rare. You might get a slight temperature after the treatment. But your doctor will give you antibiotics to reduce the chance of an infection. Tell them if there is any leakage of fluid (discharge) from the area. Or if it becomes:

• red
• swollen
• painful

Changes to skin colour

You might notice the colour of your skin changes where you had treatment. It might be darker or lighter. This usually goes with time but can be permanent for some people.

Skin breakdown

The area where you have treatment can form an ulcer or the skin might breakdown. If this happens you might need regular dressing changes until it heals. This can take a couple of weeks. Your hospital or GP surgery will arrange this.

Research into electrochemotherapy

Researchers in Europe are looking how well electrochemotherapy works for other cancers. This includes:

• different types of women’s cancers – these are also called gynaecological cancers
• primary liver cancer
• cancer that has spread to the liver

They are also looking at:

• if a lower dose of bleomycin works as well as the standard treatment
• combining bleomycin with other chemotherapy drugs

Where can I get electrochemotherapy treatment?

Electrochemotherapy is only available in some hospitals in the UK. This means you may not be able to have treatment at your locally. And you may need to travel to another hospital to have it.

Talk to your doctor if you are interested in having this treatment. They can tell you if it is suitable for you and where it is available.