Non-melanoma Skin Cancer: How to Identify and Treat It

Several types of tumors can form in the skin. The most aggressive and hard-to-treat type is melanoma. The other types are together called non-melanoma skin cancer (NMSC). NMSC is often easy to treat and leads to good outcomes. There are also several things you can do to lower your risk of developing this cancer.

How many people get NMSC?

This cancer is extremely common — more people have NMSC than all other cancers combined. In the United States, about 3.3 million people are diagnosed with this condition each year. Additionally, at least 6.4 million cases of NMSC occur annually throughout the world.

The number of skin cancer diagnoses has been increasing in recent years, likely because people live longer and spend more time in the sun. Additionally, doctors have become better at detecting these tumors. However, the number of deaths due to NMSC has been dropping as more effective treatments are developed.

Types of non-melanoma skin cancer

Skin cancer develops when cells in the skin grow out of control and produce too many copies of themselves. Different types of NMSC grow from different types of skin cells.

About eight out of 10 skin cancers are basal cell carcinomas (BCCs). Basal cells are located in the deepest part of the epidermis (top layer of skin). They help make new skin cells. BCCs most often develop on the face, neck, arms, or hands, because these locations get the highest amount of sun exposure. They aren’t likely to metastasize (spread to other areas of the body).

Most other types of skin cancer are squamous cell carcinomas (SCCs). These tumors develop from squamous cells, found on the outer surface of the skin. They are also commonly found in parts of the body exposed to sunlight, such as the ears, lips, neck, and backs of the hands. SCCs may also develop in areas of scar tissue or regions of burned or damaged skin. SCCs are slightly more likely to metastasize, but they can generally be fully removed and treated.

Other types of NMSC are much rarer. They include:

Squamous cell carcinoma in situ, also called Bowen’s disease — This is a very early form of SCC that has just started growing. It may form in sun-exposed areas or the skin of the genitals.

Keratoacanthoma — This type of cancer looks similar to SCC. While it sometimes goes away on its own, other times it can grow larger and metastasize.

Cutaneous lymphoma — This cancer forms in immune cells within the skin. Cutaneous lymphomas tend to grow slowly.

Merkel cell carcinoma — This type of cancer forms from cells in the skin that make hormones. It often grows very quickly. Merkel cell carcinoma is most often found in the skin of the head and neck.

Kaposi’s sarcoma — This cancer can grow in the skin as well as within internal organs or the tissue that lines the nose, mouth, and throat. It most often occurs in people with weakened immune systems due to an HIV infection or immunosuppressant medications.

Skin cancer risk factors and prevention

Things that can increase your chances of developing NMSC include:

• Spending a lot of time in sunlight or tanning beds.
• Experiencing many sunburns in the past.
• Having lighter-colored skin and freckles, light green or blue eyes, or blond or red hair.
• Being diagnosed with certain genetic conditions, such as basal cell nevus syndrome.
• Experiencing inflammation in the skin.
• A history of radiation treatments.
• Having had skin cancer in the past.
• Having a family history of skin cancer.

One of the best ways to reduce your risk of skin cancer is to limit how often your skin is exposed to the sun. Wear sunscreen and protective clothing, including in the winter and on cloudy days. When you’re outside, seek out shade whenever possible and avoid being outdoors during the hottest, brightest times of the day.

Signs and symptoms of non-melanoma skin cancer

NMSC can take on many forms. Talk to your doctor if you experience any skin changes, including:

• Skin sores that don’t get better.
• Reddish or brownish raised patches.
• Scaly or rough areas of skin.
• Smooth, shiny, raised spots of skin.
• Regions of skin that look scarred and feel hard.

Different types of NMSC can have contrasting appearances. BCCs are often shiny or pearly bumps, while SCCs may form large, rough, reddish patches.

Non-melanoma skin cancer treatments

BCC and SCC are often treated with surgery. This may be a simple excision procedure in which a doctor cuts out the cancerous area along with a small region of surrounding healthy skin. Other types of surgical procedures may also be used — doctors may shave or cut off the skin in layers, or kill cancer cells with cold temperatures or lasers. These procedures can often be done in a doctor’s office without using general anesthesia that puts you to sleep.

Surgery may be the only treatment necessary, especially if the cancer is small and hasn’t spread. In some cases, people may need to use other treatments, such as:

Radiation therapy — High-energy beams or particles can be used to kill cancer cells.

Photodynamic therapy (PDT) — This treatment involves applying a drug to the skin and then activating it with a special type of light.

Chemotherapy — These medications come in cream or lotion form that can be rubbed on the skin.

Immunotherapy — These drugs boost the immune system’s ability to fight cancer.

Targeted therapy — BCC may be treated with targeted therapy drugs that prevent cancer cells from sending signals to each other.

Retinoids — These medications, similar to vitamin A, can sometimes help treat SCC.

Outlook and survival

Treatments often work well to remove NMSCs. In particular, BCC and SCC can often be cured, especially if they are detected early.

It is rare for people to die from BCC or SCC. When these cancers do cause fatalities, it is often in elderly adults who have very large tumors that have started spreading. Having a weakened immune system due to certain health conditions or treatments may also raise your risk of experiencing a poor outcome.

The bottom line

Non-melanoma skin cancer is extremely common, especially if you have spent significant time outside. Talk to your doctor or dermatologist about any skin changes to catch cancer early and have the best possible chance of having a good outcome.