Types of non-melanoma skin cancer
Skin cancer can form in any of the skin cells in the top layer of your skin (the epidermis). The two main types of non-melanoma skin cancer are described below.
Basal cell carcinoma
Basal cell carcinoma (BCC) is a type of cancer that starts in the basal cells lining the bottom layer of your epidermis. It’s the most common form of skin cancer – more than three-quarters of all skin cancers in the UK are BCCs, with around 75,000 diagnosed each year.
BCCs grow slowly and don’t usually spread to other parts of the body, though 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, and often appear on the face.
Squamous cell carcinoma
Squamous cell carcinoma (SCC) is a type of cancer that starts in the squamous cells lining the top layer of your epidermis. About 25,000 SCCs are diagnosed in the UK every year.
SCCs usually grow more quickly than BCCs and may spread into other parts of your body. It’s not common for an SCC to spread though, unless you have other risk factors – for instance, you’re on immune suppression after having a transplant. Like BCCs, SCCs usually occur on places where your skin has been most exposed to the Sun.
Symptoms of non-melanoma skin cancer
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 scab that doesn’t heal or a scaly or crusty raised area of skin. Basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) have some differences in how they may look.
Basal cell carcinomas (BCCs) may look like:
- small lumps or ulcers with a pearly appearance, often with small blood vessels around them
- a scaly, red plaque (bumpy patch of skin)
- a waxy, shiny area of skin, that looks a bit like a scar
Squamous cell carcinoma (SCC) may look like:
- a lump with scaling or crusting skin on top
- a small, red lump which quickly gets bigger
- an area of skin that doesn’t heal but is usually a bit raised
You may notice the lump or area of skin ulcerates (breaks the skin) and crusts or bleeds.
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. Read our information on melanoma for more details on what to look out for.
It’s important to get any unusual changes 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 GP will ask you about your symptoms and do a thorough examination of your skin. 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 GP will often be able to tell if you have a non-melanoma skin cancer just from how it looks. But you’ll need to have a biopsy to confirm the diagnosis.
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 is 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 GP may be able to do the biopsy themselves. 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 will also be referred to a specialist if your GP suspects you have a squamous cell carcinoma (SCC).
You won’t usually need any further tests if you’ve been diagnosed with a non-melanoma skin cancer. 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
- if the cancer has spread to other parts of your body
Your doctor will discuss your treatment options with you.
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 (BCC) and squamous cell carcinoma (SCC), 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 for more information about skin grafts and skin flaps.
This is a more specialised type of surgery. You may have it for a BCC or SCC in an area that’s difficult to treat, such as your head or neck or if your cancer has come back. In Mohs surgery, your surgeon will remove layers of the affected skin in stages. They will 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 removed.
Curettage and electrodessication
This treatment is sometimes offered if you have BCC or a low-risk SCC. 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 can be an option for some people with low-risk non-melanoma skin cancer – mainly basal cell carcinomas (BCCs). Because SCCs can be more aggressive, they can usually only be treated with surgery.
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.
- Radiotherapy – this uses radiation to destroy cancer 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.
Advanced skin cancer
You may be offered radiotherapy and/or chemotherapy alongside other treatments if you have an SCC that has spread to other parts of your body.
If you have BCC that has spread to other areas of the body, you may be offered a gene-targeted treatment called vismodegib. This is only used in highly specialised centres and only after discussions at multi-disciplinary meetings.
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. Having intermittent, intense periods of exposure 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 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, but these cases are rare.
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 high UVA protection (at least 4 stars).
- Don’t use sunbeds unless you’ve been advised to use them for a skin condition.
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 an SCC.
FAQ: How is skin replaced after the cancer has been removed?
When you have skin cancer surgically removed, some of your healthy skin may have to be removed too. If this is a large area and can’t heal on its own or with stitches, you may need to have the skin replaced with a skin graft or skin flap.
A skin graft is a thin layer of skin taken from another area of your body and placed over the area where the cancer was removed. The area where your skin is taken from depends on factors such as the colour and texture of your skin and the skin thickness that’s needed. A graft is usually held in place with stitches and a dressing will be placed over it.
The area that the healthy skin was taken from will either be closed with stitches or left to heal by itself under a special dressing. The area where your skin is replaced will be delicate as it heals, so you will need to take special care of it. You can take paracetamol if you need pain relief. After it’s healed, the skin may look different from your surrounding skin and may be a slightly different colour.
A skin flap is a thicker layer of skin than a graft. It’s taken from an area close to where your cancer has been removed. The blood supply to the skin flap is left intact – this will help it to heal. The flap is held in place with stitches and a dressing will be placed over it. Skin flaps may give a better cosmetic result because they use skin that is similar to the colour, type and thickness of the skin that has been removed.
Your surgeon will discuss which option is best for you.
FAQ: How serious is non-melanoma skin cancer?
The most serious type of skin cancer is melanoma. Non-melanoma skin cancers can usually be cured and are very rarely life-threatening. But exactly how serious a skin cancer is will depend on the type of cancer it is and if it’s spread by the time it’s diagnosed.
Basal cell carcinomas (BCCs) can almost always be cured. They can be more difficult to treat if they’ve been left for a long time or if they’re in an awkward place. There is also quite a high risk of developing subsequent BCCs (recurrence) after you’ve been treated. But it’s extremely rare for BCCs to spread (metastasise). Most squamous cell carcinomas (SCCs) are also low-risk and can usually be cured. However, a very small number of SCCs can spread to other parts of the body. These cancers can be life-threatening. Because they can potentially be more dangerous, you should get an urgent referral to a specialist if your GP suspects you may have an SCC.
- Basal cell carcinoma. BMJ Best Practice. bestpractice.bmj.com, last updated 22 August 2016
- Squamous cell carcinoma. BMJ Best Practice. bestpractice.bmj.com, last updated 29 November 2016
- Dermatology. Oxford handbook of general practice (online). Oxford Medicine Online. oxfordmedicine.com, published April 2014
- Skin cancers – recognition and referral. Prevalence. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published November 2015
- Skin cancers. Oxford handbook of oncology (online). Oxford Medicine Online. oxfordmedicine.com, published September 2015
- Basal cell carcinoma. British Association of Dermatologist. www.bad.org.uk, updated May 2015
- Squamous cell carcinoma. British Association of Dermatologists. www.bad.org.uk, updated April 2015
- Melanoma and pigmented lesions. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised March 2017
- Improving outcomes for people with skin tumours including melanoma (update). The management of low-risk basal cell carcinomas in the community. National Institute for Health and Care Excellence (NICE), May 2010. www.nice.org.uk
- Biopsy of skin. DermNet New Zealand. www.dermnetnz.org, published September 2016
- Ways to enjoy the sun safely. Cancer Research UK. www.cancerresearchuk.org, last reviewed 28 April 2017
- Sunbeds and cancer. Cancer Research UK. www.cancerresearchuk.org, last reviewed 24 March 2015
- Surgery for mole removal. Macmillan Cancer Support. www.macmillan.org.uk, reviewed 30 December 2016
- Skin cancer statistics. Cancer Research UK. www.cancerresearchuk.org, accessed 20 July 2017
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Reviewed by Pippa Coulter, Specialist Health Editor, Bupa Health Content Team, September 2017
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