Overview
Skin cancer is one of the most common cancers in the world. Non-melanoma skin cancer refers to a group of cancers that slowly develop in the upper layers of the skin.
The term non-melanoma distinguishes these more common types of skin cancer from the less common skin cancer known as melanoma, which can be more serious.
In the UK, around 147,000 new cases of non-melanoma skin cancer are diagnosed each year. It affects more men than women and is more common in the elderly.
Symptoms of non-melanoma cancer
The first sign of non-melanoma skin cancer is usually the appearance of a lump or discoloured patch on the skin that continues to persist after a few weeks, and slowly progresses over months or sometimes years. This is the cancer, or tumour.
In most cases, cancerous lumps are red and firm and sometimes turn into ulcers, while cancerous patches are usually flat and scaly.
Non-melanoma skin cancer most often develops on areas of skin regularly exposed to the sun, such as the face, ears, hands, shoulders, upper chest and back.
When to get medical advice
See your GP if you have any skin abnormality, such as a lump, ulcer, lesion or skin discolouration that hasn't healed after four weeks. While it's unlikely to be skin cancer, it's best to get it checked.
Types of non-melanoma skin cancer
Non-melanoma skin cancers usually develop in the outermost layer of skin (epidermis), and are often named after the type of skin cell from which they develop.
The two most common types of non-melanoma skin cancer are:
- basal cell carcinoma (BCC) – also known as a rodent ulcer, BCC starts in the cells lining the bottom of the epidermis and accounts for about 75 in 100 skin cancers
- squamous cell carcinoma (SCC) – starts in the cells lining the top of the epidermis and accounts for about 20 in every 100 skin cancers
Basal cell carcinoma
Basal cell carcinoma (BCC) usually appears as a small, shiny pink or pearly-white lump with a translucent or waxy appearance. It can also look like a red, scaly patch.
There's sometimes some brown or black pigment within the patch.
The lump slowly gets bigger and may become crusty, bleed or develop into a painless ulcer.
Squamous cell carcinoma
Squamous cell carcinoma (SCC) appears as a firm pink lump with a rough or crusted surface. There can be a lot of surface scale and sometimes even a spiky horn sticking up from the surface.
The lump is often tender to touch, bleeds easily and may develop into an ulcer.
For both SCC and BCC there can sometimes be considerable skin damage if the tumour is not treated
There's a very small risk of squamous cell carcinoma spreading to other parts of the body, such as the lymph nodes (small glands found throughout the body)
Bowen's disease
Bowen's disease is a precancerous form of Squamous Cell Carcinoma SCC sometimes referred to as squamous cell carcinoma in situ. It develops slowly and is easily treated.
The main sign is a red, scaly patch on the skin that may itch. It most commonly affects elderly women and is often found on the lower leg. However, it can appear on any area of the skin.
Although not classed as non-melanoma skin cancer, Bowen's disease can sometimes develop into squamous cell carcinoma if left untreated.
Actinic keratoses
Actinic keratoses, also known as solar keratoses, are dry, scaly patches of skin caused by damage from years of sun exposure.
The patches can be pink, red or brown, and can vary in size from a few millimetres to a few centimetres across.
The affected skin can sometimes become very thick, and occasionally the patches can look like small horns or spikes.
Like Bowen's disease, actinic keratosis isn't classed as non-melanoma skin cancer, but there's a small risk that the patches could develop into squamous cell carcinoma if untreated.
What causes non-melanoma skin cancer?
Overexposure to ultraviolet (UV) light is the main cause of non-melanoma skin cancer. UV light comes from the sun, as well as from artificial tanning sunbeds and sunlamps.
Other risk factors that can increase your chances of developing non-melanoma skin cancer include having:
- a previous non-melanoma skin cancer
- a family history of skin cancer
- pale skin that burns easily
- a large number of moles or freckles
- medication that suppresses your immune system
- a co-existing medical condition that suppresses your immune system
Diagnosing non-melanoma skin cancer
Your GP can examine your skin for signs of skin cancer. They may refer you to a skin specialist (dermatologist) or a specialist plastic surgeon if they're unsure or suspect skin cancer.
You'll have an urgent referral if you have squamous cell skin cancer.
Basal cell skin cancers usually don't need an urgent referral, but you will still be referred to a specialist.
Find out more about NHS waiting times.
The specialist will examine your skin and may carry out a biopsy to confirm a diagnosis of skin cancer.
A biopsy is a procedure where some of the affected skin is removed so it can be examined.
Treating non-melanoma skin cancer
Surgery is the main treatment for non-melanoma skin cancer. It involves removing the cancerous tumour and some of the surrounding skin.
Other treatments for non-melanoma skin cancer include freezing (cryotherapy), anti-cancer creams, radiotherapy and a form of light treatment called photodynamic therapy (PDT).
The treatment used will depend on the type, size and location of the non-melanoma skin cancer you have.
Treatment for non-melanoma skin cancer is usually successful as, unlike most other types of cancer, there's a considerably lower risk that the cancer will spread to other parts of the body.
Basal cell carcinoma doesn't usually spread to other parts of the body. There's a small risk (up to 5%) of squamous cell carcinoma spreading to other parts of the body, usually the lymph nodes (small glands found throughout your body).
However, for both BCC and SCC there can sometimes be considerable skin damage if the tumour isn't treated.
At least 9 out of 10 (90%) non-melanoma skin cancer cases are successfully cured.
Complications
If you've had non-melanoma skin cancer in the past, there's a chance the condition may return.
The chance of non-melanoma skin cancer returning is increased if your previous cancer was large in size and high grade (severe).
If your cancer team feels there's a significant risk of your non-melanoma skin cancer returning, you'll probably need regular check-ups to monitor your health.
It's also important to be aware that if you've had a non-melanoma skin cancer, your risk of developing another one in the future is increased because these cancers are often multiple.
This means it's important to regularly examine your skin to check for new tumours.
Preventing non-melanoma skin cancer
Non-melanoma skin cancer isn't always preventable, but you can reduce your chances of developing it by avoiding overexposure to UV light.
You can protect yourself from sunburn by using high-factor sunscreen, dressing sensibly in the sun, and limiting the amount of time you spend in the sun during the hottest part of the day.
Sunbeds and sunlamps should also be avoided.
Regularly checking your skin for signs of skin cancer can help lead to an early diagnosis and increase your chances of successful treatment.
Read more about sunscreen and sun safety.
Diagnosis
A diagnosis of non-melanoma skin cancer will usually begin with a visit to your GP, who will examine your skin and decide whether you need further assessment by a specialist.
Some GPs take digital photographs of suspected tumours so they can email them to a specialist for assessment.
Biopsy
If skin cancer is suspected, you may be referred to a skin specialist (dermatologist) or specialist plastic surgeon. The specialist should be able to confirm the diagnosis by carrying out a physical examination.
However, they'll probably also perform a biopsy, a minor surgical procedure where either part or all of the tumour is removed and studied under a microscope.
This is usually carried out under a local anaesthetic, which means you'll be conscious but the affected area will be numbed, so you won't feel any pain.
A biopsy allows the dermatologist or plastic surgeon to determine the type of skin cancer you have and whether there's any chance of it spreading to other parts of your body.
Skin cancer can sometimes be diagnosed and treated at the same time. The tumour can be removed and tested, and you may not need further treatment because the cancer is unlikely to spread.
It's usually several weeks before you receive the results of a biopsy.
Further tests
If you have basal cell carcinoma, further tests aren't usually required as it's very unlikely that the cancer will spread.
However, you may have a second basal cell carcinoma on a different area of skin, so it makes sense to have all of your skin examined by the skin expert.
In rare cases of squamous cell carcinoma, further tests may be needed to make sure the cancer hasn't spread to the lymph nodes or another part of your body.
These tests may include a physical examination of your lymph nodes. If cancer has spread, it may cause your glands to swell.
If the dermatologist or plastic surgeon thinks there's a significant risk of the cancer spreading, it may be necessary to perform a biopsy on a lymph node. This is called a fine needle aspiration (FNA).
During FNA, cells are removed using a needle and syringe so they can be examined.
Finding cancerous cells in a nearby lymph node would suggest the squamous cell carcinoma has started to spread to other parts of your body.
Staging skin cancer
Staging is used to describe how far a tumour has spread. The stage of your cancer will help determine your recommended treatment.
For non-melanoma skin cancer, this only applies to squamous cell carcinoma, as there's no staging system for basal cell carcinoma.
Treatment
Main treatments for non-melanoma skin cancer
Non-melanoma skin cancer can usually be effectively treated.
The treatment you have will depend on:
- the type of skin cancer
- where the cancer is
- if it has spread
- your general health
Surgery is the main treatment for non-melanoma skin cancer. Radiotherapy, targeted medicines, photodynamic therapy and chemotherapy are also sometimes used.
The specialist care team looking after you will:
- explain the treatments, benefits and side effects
- work with you to create a treatment plan that's best for you
- discuss the chances of the skin cancer coming back and how it will be treated if it does
You'll have regular check-ups during and after any treatments.
Depending on the stage of your non-melanoma, you may have tests and scans.
If you have any symptoms or side effects you're worried about, talk to your specialists. You do not need to wait for your next check-up.
Surgery
Surgery is the main treatment for non-melanoma skin cancer, especially if it's found early.
You may also need surgery if the skin cancer has spread to other areas of your body or if it's come back again after being removed.
Several types of surgery can be used to treat non-melanoma skin cancer, including:
- cutting out the cancer and some surrounding healthy skin (excisional biopsy)
- freezing the affected skin, which forms a scab that drops off a few weeks later (cryosurgery)
If a large area of skin is removed, skin may need to be taken from another part of your body and used to cover the area where the skin cancer was. This is known as a skin graft.
Find out more
Radiotherapy
Radiotherapy uses high-energy rays of radiation to kill cancer cells.
It may sometimes be recommended if:
- the cancer covers a large area
- the location of the cancer makes surgery difficult
- you're too unwell to have surgery
- the cancer has spread to your lymph glands (part of the immune system)
Sometimes radiotherapy is used after surgery to help reduce the chance of the cancer coming back.
Find out more
Targeted medicines and immunotherapy
Targeted medicines aim to stop the cancer growing.
Immunotherapy medicines help your immune system find and kill cancer cells.
There are different types that come as a skin cream, tablets or liquid that's given directly into a vein.
Targeted medicines or immunotherapy may be used if:
- you have skin cancer in more than one place
- the cancer has spread to deeper layers of skin or other parts of your body
- you're unable to have other treatments, such as surgery or radiotherapy
Find out more
Photodynamic therapy
Photodynamic therapy uses light-sensitive medicine and a light source to kill cancer cells.
It's carried out in hospital and is sometimes used to treat non-melanoma skin cancer if it's not too thick and has not spread deeper into the skin.
The light-sensitive medicine can be given as a cream, tablet or injection.
After the cancer cells have absorbed the medicine, a lamp or laser is shone on the affected area. The light reacts with the medicine and kills the cancer cells.
Find out more
Chemotherapy
Chemotherapy uses medicines to kill cancer cells.
A chemotherapy cream is sometimes used to treat skin cancers that only affect the top layer of skin.
You'll usually need to use the cream for 3 to 4 weeks. Your specialist team will be able to give you more advice about how to use it.
Chemotherapy given into a vein (intravenous chemotherapy) is rarely used to treat skin cancer.
Find out more