Non-melanoma skin cancer

Non-melanoma skin cancer is a common skin cancer that starts in the top layer of your skin.

Various types of skin cancer fall into this category, although the majority of cases are either basal cell carcinoma (BCC) or squamous cell carcinoma (SCC).

While risk factors include age, sun exposure and having pale skin, it’s possible to reduce your risk of non-melanoma skin cancer by staying out of the sun and applying sunscreen regularly.

Non-melanoma skin cancer is relatively easy to treat, with the approach to treatment depending on the type of skin cancer you have, the stage of the cancer and your personal circumstances.

If you have a diagnosis of non-melanoma skin cancer, or are worried about changes to your skin, we have a range of specialists who can help you. Call or book online directly to arrange an appointment with one of our expert consultants, who will support you through your treatment journey from start to finish.

This page explains what non-melanoma skin cancer is, the key signs and symptoms to look out for, and how it is treated.

The main types of non-melanoma skin are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), both named after the types of skin cells where the cancer originates. A non-melanoma skin cancer can also be a mixture of both these types.

Basal cell carcinoma

Otherwise known as a rodent ulcer, basal cell carcinoma (BCC) is the most common type of non-melanoma skin cancer, accounting for approximately 72% of all cases. This type of skin cancer starts in your basal cells, found in the deepest part of the outer layer of your skin called the epidermis.

With the leading cause of basal cell carcinoma being sun exposure, BCC is typically found in areas of skin with high sun exposure, such as your nose, forehead, cheeks, back and lower legs.

There are different types of basal cell carcinoma, each with their own look and behaviour. Some of the more common subtypes include:

• Nodular basal cell carcinoma (nCBB)
• Superficial basal cell carcinoma (sBCC)
• Morphoeic basal cell carcinoma (mBCC)
• Pigmented basal cell skin cancer (pBCC)

While it’s possible to have more than one basal cell carcinoma at any one time, it’s rare for this type of skin cancer to spread to another part of the body.

Squamous cell carcinoma

Squamous cell carcinoma, or SCC, is the second most common type of non-melanoma skin cancer, accounting for 23% of all cases of non-melanoma skin cancer.

Squamous cell carcinoma begins in keratinocytes in your epidermis and typically develops on areas of skin exposed to the sun, such as your head, neck, hands and forearms. You can also develop SCCs on scars, areas of previously burnt skin and ulcerated skin.

Squamous cell skin cancer often doesn’t spread further than the deeper layers of your skin, and very rarely spreads to lymph nodes and other parts of your body.

Merkel cell carcinoma

This aggressive yet rare form of non-melanoma skin cancer starts in the Merkel cells that sit between your epidermis and dermis.

Merkel cell carcinoma usually appears as a fast-growing, painless, firm lump that’s either red or violet in colour, and can be found on areas of your skin exposed to the sun, such as your head, neck, arms, legs and trunk.

Sebaceous gland carcinoma

Sebaceous gland carcinoma is a rare type of skin cancer that starts in the sebaceous glands that produce natural oils in your skin.

As sebaceous glands are all over your body, you can get sebaceous gland cancer in any part of your body, although most commonly develops in the upper eyelid. This type of skin cancer usually appears as a firm, painless lump with a yellowish tinge.

Kaposi’s sarcoma

A rare condition, Kaposi’s sarcoma (KS) is a skin cancer affecting your soft tissue.

Kaposi’s sarcoma starts in the endothelial cells lining your blood and lymph vessels, and is most commonly found on the skin, but can also affect your lymph nodes, lungs, bowel, liver and spleen.

Unlike other cancers that originate in one place and spread to other parts of your body (metastasise), KS can start in different parts of your body at the same time.

Kaposi’s sarcoma is mainly caused by the human herpesvirus 8 (HHV8), a virus that is usually sexually transmitted, but can also pass into your blood by sharing needles.

If you have Kaposi’s sarcoma on your skin, you’ll first notice small, flat lesions on your skin that resemble a bruise. They won’t itch or cause pain, and may seem harmless at first.

Over time, these lesions may start to stand up on your skin and start to grow into each other. They may also start to turn different colours, such as brown, blue, red or purple, or may form nodules that ulcerate and bleed.

T cell lymphoma of the skin

Otherwise known as primary cutaneous lymphoma, T cell lymphoma is a non-Hodgkin lymphoma that affects white blood cells known as lymphocytes.

As a cancer of the lymphatic system, T cell lymphomas of the skin develop when abnormal lymphocytes in your skin multiply and become cancerous.

This type of skin cancer starts as flat, red, itchy patches on your skin, and may appear lighter or darker than the surrounding skin if you have darker skin. It may resemble other common skin conditions, such as eczema or psoriasis.

Non-melanoma skin cancer describes a group of skin cancers that slowly develop in the upper layers of your skin, such as your basal cells or squamous cells.

On the other hand, melanoma develops in the melanocytes of your skin, found deep in your skin between a layer of basal cells. These cells are responsible for producing melanin, a pigment that gives skin its colour and helps protect your body from ultraviolet (UV) radiation from the sun.

Too much UV radiation causes sunburn and damages the genetic material in the DNA of your skin cells. Over time, too much damage can cause abnormal melanin cells to multiply and become cancerous.

Melanoma is less common than non-melanoma, but is more serious as it typically spreads faster than non-melanoma skin cancers.

While non-melanoma can develop in anyone, there are a range of factors that may make you more likely to develop non-melanoma skin cancers.

Age

Age is strongly correlated with the onset of non-melanoma skin cancer, with 48% of new cases in 2018 occurring in people aged over 75.

While non-melanoma skin cancer can occur in young people, the rate of new cases starts to increase around the age of 35 and steadily increase with each age bracket, reflective of the DNA damage that takes place in skin cells over time.

Ultraviolet (UV) radiation exposure

Whether it’s from the sun or a tanning bed, ultraviolet radiation is one of the leading causes of non-melanoma skin cancer.

Any amount of UV light damages the DNA in your skin cells, with more time spent in the sun or on a tanning bed resulting in more damage. Notably, if you have a history of sunburn, your risk of skin cancer is increased, especially if you were sunburnt several times in your childhood.

Skin colour

Non-melanoma skin cancer is more common in people with white or fair skin, as they have less melanin in their skin to protect them from UV rays.

People with black and brown skin are less likely to get skin cancer due to the high amounts of melanin in their skin, but aren’t completely free from risk.

Previous skin cancer

If you’ve previously had skin cancer, there’s a risk that you may develop skin cancer again.

As researchers believe this is due to sun damage causing further mutations to skin cell DNA, you should cover up in the sun and reapply sun cream regularly, while keeping an eye out for signs of skin cancer.

Skin conditions

Various skin conditions have been shown to increase the likelihood of developing non-melanoma skin cancer. These include:

Solar keratosis

Solar keratosis, or actinic keratosis, is caused by years of sun exposure and has been linked to non-melanoma skin cancer. This skin condition causes small, scaly red patches of skin to areas typically exposed to the sun, such as your face, hands, or scalp if you’re bald.

Solar keratosis is a sign that your skin has already been damaged and over time can turn into squamous cell carcinoma. To mitigate this risk, take care in the sun and make sure you reapply suncream often.

Xeroderma pigmentosum

A rare inherited genetic condition, xeroderma pigmentosum means your skin can’t repair itself from sun damage. As a result, you’re more likely to develop skin cancer, and should aim to avoid sun exposure and other sources of UV light.

Gorlin syndrome

Gorlin syndrome, otherwise known as naevoid basal cell carcinoma syndrome, is a rare and inherited condition that can cause basal cell carcinoma.

Weakened immune system

If you have a weakened immune system, your risk of skin cancer is increased.

This may be the case if you:

• Have HIV or AIDS
• An inflammatory disease, such as inflammatory bowel disease
• Are taking immunosuppressants

Human papilloma virus

Human papilloma virus, more commonly known as HPV, is a common virus with various strains responsible for different conditions, such as cervical cancer, genital warts and epidermodysplasia verruciformis.

If you have a condition associated with HPV, you’re at a higher risk of developing non-melanoma skin cancer, as HPV plays a role in skin cancer development. This is particularly true if you have Bowen’s disease (a very early form of skin cancer) or Kaposi sarcoma.

Chemicals

Contact with the following carcinogens – substances with potential to cause cancer – can increase your risk of developing non-melanoma skin cancer:

• Arsenic
• Benmzoyl peroxide
• Coal tar
• Creosote
• Phorbal esters
• Petroleum products
• Shale oil
• Soot

The main symptoms of non-melanoma skin cancer is a new growth or unusual patch on your skin.

As non-melanoma cancer is easier to treat if caught early, contact your consultant as soon as possible if this new growth:

• Is getting bigger
• Has changed in texture of colour
• Is hurting or itches
• Bleeds, crusts or scabs for more than four weeks

This can appear anywhere on your body, but typically develops in areas of your skin exposed to the sun, such as your:

• Head, face and ears
• Neck and shoulders
• Back
• Hands
• Lower legs

Cancer stages tell you how big your tumour is and whether it has spread, and can help your consultant determine the best approach to treatment.

As basal cell carcinoma rarely spreads, you’re less likely to have your tumour staged. Squamous cell carcinomas can spread so are more likely to be staged, but this is also rare.

If your non-melanoma skin cancer starts in your eyelid, your consultant will stage your cancer slightly differently to non-melanomas starting elsewhere in your body.

Stage 0

Also known as carcinoma in situ, stage 0 means your skin cells have started to turn into cancer, but the cancer hasn’t yet spread to surrounding areas of your skin.

Stage 0 squamous cell carcinoma is also known as Bowen’s disease and may be described as pre-cancerous or pre-malignant by your consultant.

Stage 1

For most non-melanoma skin cancers, stage 1 means your cancer is 2cm or less across.

If the cancer starts in your eyelid, stage 1 means your cancer has not spread to your lymph nodes or other parts of your body and can be split into two groups.

Stage 1A means your cancer is less than 10mm across and has spread into the edge of your eyelid or eyelid tissue, whereas stage 1B means your cancer is larger than 10mm but no larger than 20mm and hasn’t spread further.

Stage 2

Stage 2 for most non-melanoma cancers means your cancer is between 2mm to 4mm across.

For non-melanomas in your eyelid, you can fall into one of two groups depending on the size of your tumour and the spread within eyelid tissue.

Stage 2A means either the cancer is between 10mm-20mm across in size and has spread within your eyelid tissue, or is no larger than 30mm and may have started to spread within your eyelid tissue.

Stage 2B for non-melanomas on your eyelid means the cancer is any size and has grown into surrounding tissue such as the eye, sinuses, tear ducts or brain.

Stage 3

Stage 3 can mean different things for non-melanoma skin cancer. At this stage, your cancer might:

• Be larger than 4cm across
• Have spread into nearby bones, causing minor damage
• Have grown into the space around a nerve, known as a perineural invasion
• Have spread into your subcutaneous tissue (the layer of fat beneath your skin)
• Be smaller than 4cm, but has spread to a lymph node smaller than 3cm on the same side of your body as the cancer

At this stage, your cancer wouldn’t have spread through the outside covering of your lymph nodes.

Stage 3 non-melanoma in your eyelid can be any size and may have spread further into your eyelid tissue, to other nearby tissues and to nearby lymph nodes. Stage 3A means the cancer has spread to a lymph node nearby that’s no larger than 3cm, whereas stage 3B means the lymph node is larger than 3cm.

Stage 4

Stage 4 skin cancer means your cancer has spread to your lymph nodes and may have spread:

• Through the outside covering of one of your lymph nodes
• To more than one lymph node
• To bone marrow, causing damage to the bone
• To another part of your body, such as your lungs

At your initial consultation, your consultant will ask you about your symptoms and examine any abnormalities on your skin. They’ll go on to ask questions about your medical history, any prevalence of skin cancer in your family, if you use tanning beds and if you’ve been sunburnt in the past.

If at your initial consultation, your specialist suspects you may have non-melanoma skin cancer, they’ll arrange for you to have a biopsy to confirm the diagnosis.

Excision biopsy

Excision biopsies are usually performed if your cancer is small and easy to access, and depending on the stage can both diagnose and treat your cancer at the same time.

If your consultant performs an excision biopsy, they’ll apply a local anaesthetic to the affected area and remove cancerous skin by cutting it away, before sending it to a lab for a pathologist to analyse. They’ll also remove along some healthy tissue to be sure they’ve removed all the cancer.

If you’re in the very early stages of non-melanoma skin cancer, the cancerous cells will be removed as part of this procedure, although your consultant may want you in for further testing to check the cancer hasn’t spread further.

Punch or shave biopsy

If your consultant suspects your skin cancer has started to spread, or the affected area is too large for an excision biopsy, your consultant may perform a punch or shave biopsy.

Both procedures involve taking a sample of your skin, removing a small circle in a punch biopsy or a slice of the top layer of your skin or lesion in a shave biopsy.

Scans

If you’re diagnosed with non-melanoma skin cancer, your consultant will want to know how far the cancer has spread and how deep the cancer is in your skin.

To determine the stage of your cancer, you may have one or more of the following tests:

• CT scan
• MRI scan
• Blood tests
• Ultrasound
• PET scan

The main approach to treating non-melanoma skin cancer is surgery, although your consultant will tailor your cancer treatment plan to your circumstances.

Your cancer treatment plan will depend on:

• The type of skin cancer you have
• Where your cancer is
• If it has spread, and if so, how far it has spread
• Your general health

Surgery

Surgery is the main approach to treating non-melanoma skin cancer, and can be used as a stand-alone form of treatment if your skin cancer is caught early enough.

If your cancer is small enough, your consultant may be able to remove your cancer through an excisional biopsy, where cancerous tissue is cut out of your skin along with some healthy tissue.

If your cancer has started to spread, you may need to have more surgery to remove the affected tissue. In this case, your consultant may create a skin graft by taking some skin from another area of your body to cover the area of skin removed where the cancer was.

In some cases, your consultant may consider cryosurgery, where liquid nitrogen is applied to your skin where the cancerous tissue is. This freezes the cancerous cells, causing them to scab over and eventually drop off.

Another approach is curettage and electrocautery, where your consultant cuts away cancerous tissue using a ring-shaped blade known as a curette before using an electric needle to kill any cancer cells in the surrounding tissue. To be certain all the cancerous tissue is gone, you may need to undergo this procedure two or three times.

Radiotherapy

You may need radiotherapy to treat your non-melanoma skin cancer if:

• Your cancer is too large and covers too much tissue
• The location of your cancer is too difficult to operate on
• You’re too unwell for surgery
• The cancer has spread to your lymph glands

Radiotherapy may also be used after surgery to lower the risk of your cancer returning.

Photodynamic therapy (PDT)

Photodynamic treatment targets and kills cancer cells through a combination of light and light-sensitising drugs known as photosensitisers.

When the drug is applied to your skin, your consultant will wait for your cancer cells to absorb the drug before shining a very bright light on the affected area. Under the light the drug will start to react, producing a type of oxygen that kills surrounding cells.

This approach to treatment may be used if you have a basal cell carcinoma, Bowen’s disease or solar keratosis that isn’t too deep in your skin, and if surgery could cause changes to your appearance.

Targeted drugs and immunotherapy

Targeted cancer drugs treat non-melanoma skin cancer by targeting the mutations in cancer cells that cause them to metastasise, while immunotherapies help your immune system attack the cancer. This approach is typically used if you can’t have surgery or radiotherapy.

The type of drug and the dosage your consultant prescribes will depend on the type of skin cancer you have and where it is in your body. Your consultant will provide more information when detailing your cancer treatment plan, including how the drug will be administered and the side-effects you may experience.

Chemotherapy

Chemotherapy is rarely used to treat skin cancer and is typically only used to treat cancers affecting your top layer of skin.

For non-melanoma skin cancers, cytotoxic – or more simply, anti-cancer – drugs are applied in a cream topically to the areas of cancer on your skin to destroy cancer cells. You’ll usually need to apply the cream once or twice a day for three to four weeks, and once your consultant has shown you how, you can carry out this method of treatment at home.

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times and locations to fit your routine
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standards and delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to learn more about treatment for skin cancer, book your appointment online or call a member of our team today.

1. Non-melanoma skin cancer, NHS
2. Skin cancer (non-melanoma), NHS Inform
3. Skin cancer, Cancer Research UK
4. Non-melanoma skin cancer incidence statistics, Cancer Research UK
5. Non-melanoma skin cancer, Patient.info