Overview of Non-Melanoma Skin Cancer

Diagnosing basal cell, squamous cell, actinic keratoses and other skin cancers.

Overview of Non-Melanoma Skin Cancers

Medically reviewed by Dr. C.H. Weaver M.D. Medical Editor (08/2018)

Non-melanoma skin cancer refers to all types of skin cancer other than melanoma. Although there are several different types of non-melanoma skin cancer, the two most common types are basal cell carcinoma and squamous cell carcinoma.

Basal Cell Carcinoma

Basal cell carcinoma accounts for roughly 80% of all cases of non-melanoma skin cancer.[1] It most commonly develops on sun-exposed skin, with the head (particularly the nose) and neck being the most common sites. The appearance of basal cell carcinoma varies. It often appears as a raised bump with a smooth, pearly or waxy appearance. It may also look like a firm, flat scar.[2] Basal cell carcinoma very rarely metastasizes, but it can cause extensive local damage to the skin and surrounding tissues.

Squamous Cell Carcinoma

Squamous cell carcinoma accounts for roughly 20% of all cases of non-melanoma skin cancer.[3] Squamous cell carcinoma commonly involves the head or neck. The tumor may appear as a red bump or as a rough or scaly area on the skin.[2] Squamous cell carcinoma is more likely than basal cell carcinoma to spread to lymph nodes or distant parts of the body, though this happens infrequently.

Other Types of Non-Melanoma Skin Cancer

  • Kaposi’s sarcoma
  • Merkel cell carcinoma
  • Cutaneous lymphoma
  • Adnexal carcinoma

Actinic Keratoses

Actinic keratoses, also known as solar keratoses because of their link with sun exposure, are a type of precancerous change to the skin.[2] They often appear as rough scaly patches on the skin or as a cracked and peeling area on the lower lip. Actinic keratoses are a warning sign that the skin has been damaged. Without treatment, some actinic keratoses will develop into squamous cell carcinoma.

Diagnosis of Non-Melanoma Skin Cancer

A change to the skin is likely to be the first sign of skin cancer. This may be a sore that doesn’t heal, a new growth, or a change in an old growth.

When non-melanoma skin cancer is suspected, a patient will commonly undergo a complete skin examination. Information about medical history and history of sun exposure will also be collected. If the skin inspection identifies areas that are suspicious for cancer, a physician will conduct a biopsy to remove a sample of the tissue for further examination. A biopsy allows the physician to determine whether cancer is present.

There are several different types of skin biopsies:[2]

  • Shave biopsy–a razor is used to shave off the abnormal area
  • Punch biopsy–a circle of tissue is removed from the abnormal area using a special instrument
  • Excisional biopsy–a scalpel is used to remove the abnormal area

A physician may also examine lymph nodes, since squamous cell carcinoma sometimes spreads to lymph nodes.

Staging of Non-Melanoma Skin Cancer

Stage describes the extent of cancer. Determining cancer stage allows a physician to pick the most appropriate treatment. Skin cancer stage is based on the size of the cancer, the depth of the cancer, and the extent of spread to lymph nodes and beyond.[2]

Stage 0: The cancer involves only the top layer of the skin. This is also called carcinoma in situ.

Stage I: The cancer is 2 cm in diameter or smaller.

Stage II: The cancer is larger than 2 cm in diameter.

Stage III: The cancer has spread below the skin to cartilage, muscle, bone, or nearby lymph nodes, but has not spread to other parts of the body.

Stage IV: The cancer has spread to other parts of the body.

Prognosis of Non-Melanoma Skin Cancer

Because non-melanoma skin cancer very rarely metastasizes, the prognosis is generally very good. There are certain cancer characteristics, however, that are linked with an increased risk of cancer recurrence or metastasis.

Characteristics that are linked with an increased risk of cancer recurrence or metastasis include large tumor size (greater than two centimeters) or greater tumor depth; poorly defined tumor border; tumor location on the head or neck; a suppressed immune system; tumor invasion near a nerve; tumor location at a site of previous radiation therapy; or an aggressive tumor growth pattern. Recurrent tumors also have a higher risk of recurrence or metastasis. For patients with squamous cell carcinoma, high-risk tumor locations also include the genitals and sites of chronic inflammation or scarring.[4]

During the first five years after a diagnosis of non-melanoma skin cancer, between 30% and 50% of patients will develop another non-melanoma skin cancer.[4] Individuals who have had non-melanoma skin cancer are also at increased risk of developing melanoma.[5]

Treatment Overview

Surgery is the mainstay of treatment for non-melanoma skin cancers. There are several different types of surgery, and the choice of which to use will depend in part on the location and characteristics of the cancer. Other treatment options include radiation therapy, photodynamic therapy, and topical therapy. For more detailed information about treatment of non-melanoma skin cancer, go to Treatment of Non-melanoma Skin Cancer

Skin cancer is often divided into two broad categories: melanoma and nonmelanoma.

Non-melanoma skin cancer refers to several different types of skin cancer, but the most common types are basal cell carcinoma and squamous cell carcinoma.

Basal cell carcinoma accounts for roughly 80 percent of all cases of nonmelanoma skin cancer.[1] Basal cell carcinoma most commonly develops on sun-exposed skin, with the head (particularly the nose) and neck being the most common sites. This type of skin cancer very rarely metastasizes (spreads beyond the skin), but it can cause extensive local damage to the skin and surrounding tissues.

Squamous cell carcinoma accounts for roughly 20 percent of all cases of nonmelanoma skin cancer.[2] Squamous cell carcinoma is more likely than basal cell carcinoma to spread to lymph nodes or distant parts of the body, though this happens infrequently. Squamous cell carcinoma may be preceded by a precancerous condition known as actinic keratoses (also known as solar keratoses). Actinic keratoses often appear as rough scaly patches on the skin. An alarming trend in both melanoma and nonmelanoma skin cancers is that the frequency of these cancers is increasing—including the frequency in children and young adults.[3],[4] This increasing frequency is likely due to changing patterns of sun exposure. Sun exposure is an important risk factor for both melanoma[5] and nonmelanoma skin cancer.[2],[3]### References

[1] Rubin AI, Chen EH, Ratner D. Basal-Cell Carcinoma. New England Journal of Medicine. 2005;353:2262-2269.

[2] National Cancer Institute. Skin Cancer (PDQ®): Treatment. Patient Version. Available at: (accessed April 17, 2006)

[3] Alam M, Ratner D. Cutaneous Squamous-Cell Carcinoma. New England Journal of Medicine. 2001;344:975-983.

[4] National Comprehensive Cancer Network. Basal Cell and Squamous Cell Skin Cancers. Clinical Practice Guidelines in Oncology – v.2.2005. © National Comprehensive Cancer Network, Inc. 2001, 2002, 2003, 2004, 2005. NCCN and NATIONAL COMPREHENSIVE CANCER NETWORK are registered trademarks of National Comprehensive Cancer Network, Inc.

[5] Rosenberg CA, Khandekar J, Greenland P et al. Cutaneous Melanoma in Postmenopausal Women After Nonmelanoma Skin Carcinoma: The Women’s Health Initiative Observational Study. Cancer. 2006;106:654-63.

Reference:

[1] Rubin AI, Chen EH, Ratner D. Basal-Cell Carcinoma.New EnglandJournal of Medicine. 2005;353:2262-2269.

[2] Alam M, Ratner D. Cutaneous Squamous-Cell Carcinoma. New EnglandJournal of Medicine. 2001;344:975-983.

[3] Christenson LJ, Borrowman TA, Vachon CM et al. Incidence of Basal Cell and Squamous Cell Carcinomas in a Population Younger Than 40 Years. JAMA. 2005;294:681-690.

[4] Strouse J, Fears T, Tucker M, Wayne A. Pediatric Melanoma: Risk Factor and Survival Analysis of the Surveillance, Epidemiology and End Results Database. Journal of Clinical Oncology. 2005; 23: 4735-4741.

[5] Miller AJ, Mihm MC. Mechanisms of Disease: Melanoma. New England Journal of Medicine. 2006;355:51-56.

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