Skin cancer - non-melanoma

This section provides information about non-melanoma. This includes its causes, risk factors, symptoms, how it is diagnosed and the different types of treatment available.

About non-melanoma cancer

Non-melanoma is a skin cancer that’s different to melanoma. Melanoma is a less common form of skin cancer that more often develops from a mole, and is sometimes called cutaneous malignant melanoma.

Non-melanoma skin cancer fall into two types – basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), which are both named after the skin cell types from which the cancers develop.

A non-melanoma skin cancer can also be a mixture of both these types. Here you can find out more about these different types of non-melanoma skin cancers, their risk factors, how they’re diagnosed and treated.¹

Facts about non-melanoma skin cancer

• In the UK, around 102,000 cases of non-melanoma skin cancer are diagnosed each year
• Most non-melanoma skin cancers are caused by over exposure to the sun
• Fair-skinned people, or those who are more likely to burn than tan, are more at risk of a non-melanoma skin cancer.²

¹ Cancer Research UK, Types of skin cancer https://www.cancerresearchuk.org/about-cancer/type/skin-cancer/
about/types-of-skin-cancer 
² Cancer Research UK, About skin cancer (non-melanoma) https://www.cancerresearchuk.org/about-cancer/skin-cancer/risks-causes

Types of non-melanoma cancer

The two main types of non-melanoma skin cancer are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

Basal cell carcinoma
This type of skin cancer accounts for 3 in 4 non-melanomas, and it’s so-called because it develops from basal cells, which are in the deepest layer of the epidermis and around the hair follicles.

BCC might also be called a rodent ulcer. The most common type of BCC starts as a lump that enlarges. The edges have a shiny or pearly appearance, often with a sunken middle area, which may become crusty or develop into an ulcer. A basal cell carcinoma doesn’t usually hurt unless it is pressed, but can be itchy and may bleed if scratched.

BCC mostly develops in areas that are exposed to the sun, which includes the nose, forehead, cheeks, back or lower legs. This type of skin cancer is most often diagnosed in people who are in middle or old age.

It’s rare for a BCC to spread to other parts of the body, but having one cancer can increase your risk of getting another.

Squamous cell skin cancer
This type of skin cancer accounts for 1 in 5 non-melanomas, and develops from cells called keratinocytes, which are found in the epidermis.

Like BCC, SCC often develops in areas that have been exposed to the sun, including the head, neck, hands and forearms. In a small number of cases, SCC can develop around the vulva or anus, and can also develop in scars, ulcerations or skin areas that have been burnt.

SCC may look like a crusty, scaly ulcer, or it could be bumpy and hard. It can be faster growing than BCC, but don’t often spread to other organs.

In rare case, SCC can spread to nearby lymph nodes or other organs to cause a secondary cancer.

Causes and risk factors

Non-melanoma skin cancer and the sun
The leading cause of skin cancers is exposure to the sun, which may be long-term exposure, or short periods of intense exposure to ultraviolet light.

In fact, it is the ultraviolet light from sunlight or lamps than damages the skin cells, often years before a cancer develops. 

Several factors affect your risk from sun exposure:

• the amount of time you spend outdoors
• your natural skin colour
• how much you use sunbeds (a source of artificial UV radiation).

If you have a history of sunburn or exposure to sunlight then there’s an increased risk of BCC, and the risk is especially high if you’ve had several episodes of sunburn in childhood.

The risk of SCC is mainly connected with overall sun exposure throughout your life, which is also a factor with BCC, but to a lesser degree. This means outdoor workers such as farmers, gardeners and building site labourers can have an increased risk of non-melanoma skin cancer.

Fair skinned people with light coloured hair and eyes, or those people who are more likely to burn than tan, are more at risk of skin cancer. This is because fairer skin makes less of the protective pigment called melanin.

Albinism is an inherited genetic condition where the skin makes no melanin at all, so there is a higher than average risk of skin cancer because the skin has no natural protection against the sun.

We know that using sunbeds (a source of artificial UV radiation) can cause melanoma, but there is now evidence that they may increase the risk of non-melanoma skin cancer too, in particular squamous cell skin cancers.

Age
BCC and SCC develop very slowly. As you get older you have more time to build up sun damage to your skin. So the older you are, the more likely you are to develop a non-melanoma skin cancer. But skin cancers can develop in younger people too.

If you’ve had skin cancer before
Your risk of getting a non-melanoma skin cancer increases by about 10 times if you’ve had one before, compared to if you’ve never had a skin cancer before.

If you’ve had a melanoma, then you have a three times higher than average risk of developing a non-melanoma skin cancer.

And, if you’ve had a non-melanoma skin cancer before, you may also be at increased risk of developing a second cancer, other than skin cancer.

Also, some studies show that people who’ve had a non-melanoma skin cancer have about double the risk of melanoma compared to the general population.

Family history
Most non-melanoma skin cancers don’t run in families, but some research suggests a few families seem to have a higher number of skin cancers than normal.

People with a family history of melanoma may have an increased risk of BCC. And, if you have a parent who’s had squamous cell skin cancer, you have a two to three times higher than average risk of getting one yourself.

People from fair skinned families will be more at risk, because their skin is more sensitive to UV rays. And there may be inherited genes that increase the risk of skin cancer in some families.

Skin conditions
The following skin conditions can increase the risk of developing a skin cancer:

Psoriasis is not a risk in itself, but some of the treatments (such as ultraviolet light) may increase your risk.

Scarring from burns or skin ulcers, can make your skin more at risk from sun damage, which may increase your risk of non-melanoma skin cancer.

Solar keratosis, also called actinic keratosis, is a skin condition caused either by years of exposure to the sun, or by a period of intense sun (or artificial ultraviolet radiation) exposure on fair skin.

Xeroderma pigmentosum is a rare inherited genetic skin condition, which also has a rare variant of this condition called xeroderma pigmentosum that doesn’t show up until adolescence. With this condition, the skin can’t repair damage from the sun, so all sun exposure and other sources of UV light should be avoided. However, even with these precautions, people with this rare condition may often get skin cancers on exposed skin.

Gorlin syndrome, also called naevoid basal cell carcinoma syndrome, is a rare inherited genetic condition that causes multiple BCCs to develop.

Eczema, its commonest type called atopic dermatitis, may increase the risk of non-melanoma skin cancer, and some people with chronic eczema who have ultraviolet light treatment with a drug called methoxsalen (a type of psoralen) means an increased risk of non-melanoma skin cancer.

However, another type of eczema, called contact dermatitis, may actually slightly reduce the risk of non-melanoma skin cancer.

Past radiation exposure
If you’ve had radiotherapy before, the area that was treated will be more at risk of non-melanoma skin cancer. Also, if you’ve been exposed to any kind of radiation through your job or lifestyle, you may have a slightly increased risk of non-melanoma skin cancer.

Weakened immune system
If you’ve had an organ transplant or a bone marrow transplant and are taking drugs to stop rejection, you have an increased risk of developing skin cancer, and the risk increases the longer you take these drugs. However, this risk may be less important than the illness you had treatment for originally – but it helps to know so that you can watch for any symptoms of skin cancer early on, when it is easier to treat.

People with HIV or AIDS, who also have a weakened immune system, may also have an increased risk of non-melanoma skin cancer.

People with diseases such as inflammatory bowel disease or rheumatoid arthritis can have an increased risk of skin cancer, which may be due to the condition itself and/or the medications taken to suppress the immune system.

Human papilloma virus (HPV)
This is common virus has several different strains, and some studies show that a number of non-melanoma skin cancers contain DNA from certain types of HPV. Also, one study has shown that people with genital warts (caused by HPV types 6 and 11) may have an increased risk of basal cell skin cancer.

Chemical contact
Prolonged or frequent skin contact with certain chemicals may increase your risk of non-melanoma skin cancer, and these include coal tar, soot, pitch, creosote, shale oils, arsenic and petroleum products, such as mineral oil or motor oil.

Non-melanoma cancer symptoms and diagnosis

As a rule, if you notice anything unusual on your skin that doesn’t go away in a month, go to see your doctor about the spot or mark.

Perhaps take a photograph of any unusual spots that develop so you can see any changes over time. Keep in mind that there are many skin conditions that are not cancer, especially in older people.

Checking for signs of skin cancer
Usually, the signs of non-melanoma skin cancer are quite visible. That’s because they occur mostly on skin that’s exposed to the sun.

To help you spot skin cancers early, it helps to be aware of how your skin normally looks, so you can recognise any changes more easily.

Get your partner or a close friend to check your back or other areas that you can’t easily see.

Where non-melanoma skin cancers develop
Non-melanoma skin cancer can develop on any site but develops most commonly on sun exposed skin. You should show your doctor any area of your skin that is damaged and does not heal up.

The symptoms of non-melanoma skin cancer may be similar to symptoms of other skin conditions. It is worth having any symptom checked by your GP. Your doctor won’t think you are bothering them for something trivial. They can decide whether your symptoms need to be investigated further.

How non-melanoma skin cancers appear
They can appear as:

• a spot or sore that doesn’t heal in 4 weeks
• a spot or sore that continues to itch, hurt, scab, crust or bleed for more than 4 weeks
• areas where the skin has broken or turned into an ulcer, that doesn’t heal in 4 weeks.

How to detect basal cell carcinoma
Basal cell carcinoma is common on the face, scalp, ears, hands, shoulders and back, and may:

• be small and slow growing
• look like a flat, red spot that is scaly and crusty
• be smooth and pearly
• look waxy or shiny
• appear as a firm, pink or red lump
• bleed sometimes
• develop a crust or scab
• appear to heal but never completely heal
• be itchy
• develop into a painless ulcer.³

How to detect squamous cell carcinoma 
Squamous cell carcinoma is often found on the face, neck, lips, ears, hands, shoulders, arms and legs and may:

• look scaly
• have a hard, crusty cap
• make the skin raised in the area of the cancer
• feel tender to touch
• bleed sometimes.⁴

Whatever your symptoms, if you find any unusual growth, spot or sore on your skin that doesn’t go away in a month, get it checked by your doctor as soon as possible. The earlier you act, the easier it will be to treat.

³ Macmillan Cancer Support, Symptoms of skin cancer https://www.macmillan.org.uk/Cancerinformation/
Cancertypes/Skin/Symptomsdiagnosis/Symptoms.aspx
⁴ Macmillan Cancer Support, Symptoms of skin cancer

Treating non-melanoma cancer

If you’ve been diagnosed with skin cancer on your face, you can have it surgically removed under a local anaesthetic.

Facial skin cancer removal
Surgical removal of a skin cancer on the face can usually carried out under local anaesthetic and doesn’t involve a stay in hospital. The cancer is removed, leaving a small margin of normal skin, and then sent to be examined under the microscope. After this, the remaining gap is sewn together or patched with skin from near the cancer, enabling the wound to heal up in the most aesthetic way possible.

Mohs surgery
Developed by a surgeon called Frederic Mohs in the 1940s, this surgery is a highly specialised treatment for the total removal of skin cancers, in which the microscope is used to determine the extent of the tumour and its location. 

Benefits of treatment 
The benefits are that a likely or obvious facial skin cancer is removed.If skin cancers on the face are left behind they can often cause quite a lot of destruction of the skin and underlying structures and can sometimes spread to the rest of the body.

Safety of the treatment
As the treatment is usually carried out under local anaesthetic, it is very safe.Rare complications include occasional bruising or infection and sometimes bleeding.It is uncommon for the skin cancer not to be completely removed.

Paying for your treatment 
You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself.

Check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy.

If you are paying for your own treatment the cost of the procedure will be explained and confirmed in writing when you book the operation.

Ask the hospital for a quote beforehand, and ensure that this includes the consultants’ fees and the hospital charge for your procedure.

Want to know more?
If you’d like to read more about skin cancer, treatment or protecting against skin cancer, please visit nhs.uk.