Skin cancer (non-melanoma)

Type of non-melanoma skin care

The two main types of non-melanoma skin cancer form in cells in the top layer of your skin (the epidermis). They are described below.

Basal cell carcinoma

Basal cell carcinoma (BCC) is a type of cancer that starts in the basal cells which form the bottom layer of your epidermis. It’s the most common form of skin cancer. 

BCCs grow slowly and don’t usually spread to other parts of your body, but they can grow into the healthy tissues surrounding the site of the cancer. These types of cancer are most common in middle-aged and elderly people, although they are becoming more common in younger people. 

Squamous cell carcinoma

Squamous cell carcinoma (SCC) is a type of cancer that starts in the flattened (squamous) cells which form the top layer of your epidermis.

Squamous cell carcinomas (SCCs) usually grow more quickly than basal cell carcinomas (BCCs) and may spread into other parts of your body. You’re also more likely to get an SCC as you get older .

Symptoms of non-melanoma skin cancer

The symptoms of skin cancer vary a lot between people. If you have skin cancer, you’re likely to notice an abnormal change to an area of your skin. This might be a new lump on your skin, a scaly, itchy or crusty raised area of skin or a scab that doesn’t heal. Basal cell carcinomas and squamous cell carcinomas have some differences in how they may look.

Basal cell carcinomas may look like:

• small, pale, slow-growing lumps or ulcers, often with small blood vessels around them
• a scaly, red plaque (bumpy patch of skin)

Squamous cell carcinomas may look like:

• a lump with hard, scaling or crusting skin on top
• a small, red lump which quickly gets bigger

With either type of non-melanoma skin cancer, you may notice the lump or area of skin ulcerates (breaks the skin) and crusts or bleeds. This may heal, and then ulcerate again repeatedly.

A new mole or change in an existing mole (for example, a change in size, shape or colour) can be the first sign of melanoma. This is a more serious type of skin cancer.

It’s important to get any unusual change to your skin checked out with a doctor, particularly if it’s not healing or getting worse over time.

Diagnosis of non-melanoma skin cancer

Your doctor will ask you about your symptoms and examine you. They may ask you questions about your medical history, and about how much exposure you’ve had to the sun or sunbeds in the past.

Your doctor may suspect you have a non-melanoma skin cancer just from how it looks. But you’ll need to have a biopsy to confirm the diagnosis. This is where a sample of tissue is taken and sent to a laboratory to be tested for cancer cells.

A biopsy can often involve removing the whole area of skin that your doctor thinks may be cancerous, along with some healthy skin (an excision biopsy). For many people, this may be all that’s needed – so diagnosis and treatment can be done at the same time. Sometimes, your doctor may remove just a sample of the affected skin. You’ll then need further treatment once your diagnosis is confirmed.

If you have a basal cell carcinoma (BCC), your doctor may be able to do the excision biopsy themself. In certain circumstances – for instance, if your BCC is large or in an awkward place – they may refer you to a dermatologist or plastic surgeon. A dermatologist is a doctor who specialises in skin conditions. You’ll also be referred to a specialist if your doctor suspects you have a squamous cell carcinoma.

You won’t usually need any further tests if you’ve been diagnosed with a non-melanoma skin cancer. But if you have a particularly aggressive type of cancer, your doctor may recommend tests to check if it has spread.

Treatment of non-melanoma skin cancer

Most of the time, non-melanoma skin cancers can be treated with minor surgery. But there are alternatives to surgery that may be more suitable for some people.

The treatment you have will depend on:

• the type of skin cancer you have
• your general health
• the position and size of your cancer, and how deeply it has grown into your skin and surrounding tissues
• whether or not the cancer has spread to other parts of your body

Your doctor will discuss your treatment options with you.

Surgery

Excision

An excision is a procedure to remove the cancer, along with some of the surrounding healthy skin to make sure it’s completely removed. This is the most common treatment both for basal skin carcinoma and squamous cell carcinoma, and often it’s the only treatment that’s needed. A small wound can be closed with stitches, but if you have a large area of skin removed, you may need a skin graft. See our FAQs below for more information about skin grafts and skin flaps.

Mohs surgery

This is a more specialised type of surgery. You may have it for a basal cell carcinoma or squamous cell carcinoma in an area that’s difficult to treat, such as your head or neck. You may also have Mohs surgery if your cancer has come back. In Mohs surgery, your surgeon will remove layers of the affected skin in stages. They’ll look at the removed layer under a microscope straight away to check if all the cancer has been removed. This is repeated until all the cancer has been taken away.

Curettage and electrocautery

This treatment is sometimes offered if you have basal cell carcinoma or a low-risk squamous cell carcinoma. It involves This treatment is sometimes offered if you have basal cell carcinoma or a low-risk squamous cell carcinoma. It involves cutting away the affected part of your skin, then using an electric needle to destroy any cancer cells left behind. The technique is usually repeated three times during one appointment.

Non-surgical treatments

Non-surgical treatments can be an option for some people with low-risk non-melanoma skin cancer – mainly basal cell carcinomas.

Non-surgical treatments include the following.

• Cryotherapy – this involves using liquid nitrogen to freeze the affected area of your skin and destroy the cancerous cells.
• Creams that you apply to your skin – either imiquimod (a medicine that stimulates your immune system), or fluorouracil (a type of chemotherapy).
• Photodynamic therapy – this involves using light therapy to kill cancer cells, in combination with a medicine to make your skin more sensitive to the light.
• Radiotherapy  –  this uses radiation to destroy cancer cells.

Advanced skin cancer

You may be offered radiotherapy and/or chemotherapy alongside other treatments if you have a squamous cell carcinoma that has spread to other parts of your body.

Causes of non-melanoma skin cancer

Over-exposure to ultraviolet (UV) radiation from the sun or sunbeds is one of the main causes of all types of skin cancer.

In non-melanoma skin cancer, having a lot of exposure to the sun over time puts you at greater risk of developing a cancer. In contrast, having intermittent, intense periods of exposure, especially in childhood, is a greater risk factor for melanoma.

You’re at greater risk of non-melanoma skin cancer if you:

• burn easily – usually if you have pale skin and fair hair
• have had a lot of exposure to the sun; for instance, if you work outdoors, have outdoor hobbies, regularly sunbathed or you live in a country near the equator
• are older – because the older you are, the more exposure to the sun you’ve had

You may also be at greater risk of squamous cell carcinoma (SCC) in particular if you have a weakened immune system. This could be because you take medicines that suppress your immune system or you have a disease that affects your immune system.

Sometimes, SCC can develop if you have had skin damaged in other ways. For instance, damage from other forms of radiation, burns or persistent ulcers and wounds in the skin.

Prevention of non-melanoma skin cancer

The following tips may help to protect your skin from burning and reduce your risk of developing skin cancer.

• Cover up with suitable clothing, including a wide-brimmed hat and ultraviolet-protective sunglasses.
• Stay in the shade or cover up between 11am and 3pm, when sunlight is most intense, rather than relying on sunscreens.
• Use high-factor sunscreen if you are out in strong sunlight, with a sun protection factor (SPF) of at least 30, and a star rating of 4 or 5.
• Don’t use sunbeds to get a suntan.

If you have patches of sun-damaged skin, known as an actinic keratosis, it’s important to get this treated to reduce the chance of it turning into a squamous cell carcinoma.