Non-melanoma skin cancer

Skin cancer is one of the most common types of cancer. There are over 100,000 new cases of non-melanoma skin cancer each year. It’s more common in men and older people.

Non-melanoma cancer is when cells in the top layer of skin (epidermis) start to grow abnormally and in an uncontrolled way. It’s the most common type of skin cancer, whereas melanoma is less common but can be more serious.

There are different types of non-melanoma skin cancer, depending on which cells they start in:

• Basal cell carcinoma (BCC) – the most common, about three in four cases of skin cancer are BCC, which is slow growing and very rarely spreads
• Squamous cell carcinoma (SCC) – the second most common, about one in five skin cancers are SCC, which is usually slow growing but can spread
• Other types are rare and are treated differently

Most non-melanoma cancer can be treated effectively.

Non-melanoma skin cancers tend to develop on skin that’s exposed to the sun.

Basal cell carcinoma (BCC)

A BCC is usually:

• A small red, pink or pearly-white lump
• Dome shaped
• Translucent or waxy in appearance

It can slowly get bigger, become crusty, bleed or develop into an ulcer.

Squamous cell carcinoma (SCC)

An SCC typically:

• Develops on the face as a hard pink or red lump
• Has a scaly surface and sometimes a spiky horn protruding out
• Is tender
• Bleeds easily and can develop into an ulcer

In people with dark or black skin, they’re more likely to develop in areas not usually exposed to the sun – such as the torso or genitals.

If you notice anything unusual about your skin that doesn’t go away after four weeks, you should see your GP. If your GP suspects a BCC or SCC after examining your skin, they’ll usually refer you to a dermatologist (a skin specialist) who’ll conduct a biopsy – a small tissue sample from the lump is taken for analysis under a microscope.

No further tests are usually needed to diagnose a BCC or SCC. Blood tests, an X-ray or other scans are only necessary if your doctor thinks an SCC may have spread.

BCCs usually develop due to UV light exposure which damages the DNA in your skin cells. This means you’re more at risk if you:

• Live in a sunny climate
• Work outside a lot
• Use tanning sunbeds or lamps – these give out UV light
• Have fair skin – people with fair skin have less melanin in their skin which protects against UV damage (and also makes the skin darker)

SCCs can also be caused by too much UV light exposure, but other causes include:

• Smoking
• Drinking too much alcohol
• A weakened immune system or taking immunosuppressant medication – medications that suppress the immune system and may be required after an organ transplant for example
• An injury, burn or scar tissue – an SCC can develop on damaged skin, particularly in older people

Depending on the size, location and depth of the tumour, treatments include:

• Surgery, curettage or electrocautery – methods to cut out the tumour
• Mohs’ micrographic surgery (MMS) – a technique used to cut out the tumour but preserve as much healthy skin as possible, such as if a tumour is near an eye
• Cryosurgery – to freeze the lump and kill the cancer cells
• Photodynamic therapy (PDT) – a special kind of laser therapy that kills the cancer cells
• Anti-cancer creams – to kill the cancer cells directly or encourage your immune system to kill them
• Radiotherapy if the tumour is large or difficult to operate on
• Electrochemotherapy – if other methods haven’t worked, electrical pulses directed at the tumour encourage the medicine to enter tumour cells

Protecting yourself from the sun can help prevent skin cancer from developing or returning, and leading a healthy lifestyle can help protect against SCC – eg stopping smoking and cutting down on alcohol.