Nonmelanoma Skin Cancer

Nonmelanoma skin cancers are types of skin cancer that form in the top layer of your skin. Unlike melanoma — an aggressive form of skin cancer — nonmelanoma skin cancers usually grow slowly and rarely spread to other parts of your body. Most cases develop after years of exposure to ultraviolet (UV) rays from the sun. This is the kind of light that causes sunburn.

Skin cancer is one of the most common types of cancer. Nonmelanoma skin cancer affects more than 3 million people in the United States each year. Catching skin changes early and getting treatment right away are the best ways to keep your skin healthy.

Types of nonmelanoma skin cancer

The two most common types of nonmelanoma skin cancer are:

• Basal cell carcinoma
• Squamous cell carcinoma

There are also several rare types of skin cancer that aren’t melanomas. These include:

• Angiosarcoma (forms in blood or lymph vessel walls)
• Atypical fibroxanthoma (rare, typically in older patients on the head or neck)
• Cutaneous lymphomas (cutaneous T-cell or B-cell lymphoma, which start in immune cells)
• Dermatofibrosarcoma protuberans (a slow-growing cancer of connective tissue)
• Merkel cell carcinoma (a very aggressive neuroendocrine skin cancer)
• Sebaceous carcinoma (starts in oil glands)

Signs and symptoms of nonmelanoma skin cancer

The first sign of nonmelanoma skin cancer is often a new bump, lump or sore that doesn’t heal. These usually appear on sun-exposed areas of skin, but they can develop anywhere on your body.

Here’s what you might notice:

• Firm, flat, rough or scaly patch of skin
• Shiny or pearly bump
• Growth or wartlike spot with raised edges and a flat center
• Bump or patch with visible blood vessels (thin branching lines under your skin)
• Open sore that doesn’t heal, or that heals and comes back
• Discolored area that looks red, pink, yellow, brown, blue or black
• Itchiness
• Soreness or tenderness
• Bleeding easily or a crust that forms after a small bump or scrape

If you see any of these changes, contact a healthcare provider. They can check your skin and, if needed, do a test to confirm what’s going on.

Nonmelanoma skin cancer causes

Nonmelanoma skin cancer happens when certain abnormal skin cells grow too quickly in the top layer of your skin (the epidermis). This is the part you can touch and see. The cancer usually starts in basal cells, but it can also begin in squamous cells.

Your skin constantly sheds old cells and grows new ones underneath. You can see this when your skin flakes — those are dead cells leaving the surface.

Sometimes, something goes wrong in this process. Changes in your DNA (the instructions inside your cells) can tell skin cells to keep making copies when your body doesn’t need them. This can lead to a buildup of cells called tumors.

The most common cause of these DNA changes is too much ultraviolet (UV) light from the sun or tanning beds.

Can it spread?

While rare, nonmelanoma skin cancer can spread (metastasize). It doesn’t spread as quickly or as often as melanoma. Prompt treatment almost always prevents these cancers from spreading or becoming serious.

Risk factors

Nonmelanoma skin cancer can affect anyone, but some things can raise your risk. You may be more likely to develop it if you:

• Spend a lot of time in the sun without sunscreen or protective clothing, or use tanning beds often
• Have a light skin tone
• Had several bad or blistering sunburns
• Are 65 years of age or older
• Had skin cancer before, or have a family history of it
• Have old scars or areas of long-term skin irritation
• Have a weakened immune system
• Had radiation treatments, especially as a child
• Work with or had exposure to certain chemicals, like arsenic
• Have an inherited condition, like xeroderma pigmentosum or Gorlin syndrome
• Smoked

Is nonmelanoma skin cancer deadly?

Nonmelanoma skin cancer isn’t usually as dangerous as melanoma, but it can still cause problems without treatment.

If left alone, the cancer can grow deeper into your skin and nearby tissues. This can lead to damage, scarring or changes in how your skin looks. In rare cases, the cancer can spread to nearby lymph nodes or other parts of your body.

Even after treatment, nonmelanoma skin cancer can sometimes come back, especially if the first tumor wasn’t fully removed.

How doctors diagnose nonmelanoma skin cancer

A healthcare provider will start with a physical exam. They’ll look closely at the area of skin that concerns you and ask about your medical history. They may also ask questions like:

• When did you first notice the spot or bump?
• Has it changed in size, color or shape?
• Does it itch, bleed or hurt when you touch it?
• Does anyone in your family have skin cancer?

To confirm the diagnosis, your provider may order tests, like:

• Skin biopsy: Your provider removes a small sample of skin and sends it to a lab. A specialist looks at the cells under a microscope to check for cancer.
• Imaging tests: These tests take pictures of your skin and nearby tissues to see whether the cancer has spread.

Stages of nonmelanoma skin cancer

Healthcare providers use stages to describe how much cancer there is and whether it has spread. The stage helps guide treatment and shows how serious the cancer is.

Not every case of nonmelanoma skin cancer is formally staged. Many small cancers are treated and cured before staging is needed. When staging does apply, there are five main stages:

• Stage 0: The cancer is only on the surface of your skin. It hasn’t spread deeper or to other areas.
• Stages 1 and 2: The cancer is still in your skin but may be larger or growing into deeper skin layers. It hasn’t spread to lymph nodes or other organs.
• Stage 3: The cancer has spread to nearby tissues or lymph nodes.
• Stage 4: The cancer has spread to other parts of your body. This is the most advanced stage.

Your healthcare provider will explain your stage and what it means for your treatment plan. Knowing the stage helps you and your care team decide on the best next steps.

Nonmelanoma skin cancer treatment

Surgery is the most common treatment for nonmelanoma skin cancer. During surgery, your provider removes the cancer and a small amount of healthy skin around it to make sure all the cancer cells are gone.

Common types of surgery include:

• Excision: Your provider removes the cancer and a small border of normal skin.
• Mohs surgery: Your surgeon removes the cancer in one thin layer at a time and checks each layer under a microscope. This continues until no cancer cells are left.

Other treatments for when surgery isn’t an option may include:

• Cryotherapy: Freezing the tumor to kill abnormal cells
• Radiation therapy: Using focused energy beams to destroy cancer cells
• Photodynamic therapy: Applying a light-sensitive medicine to your skin, then using special light to destroy cancer cells
• Topical medications: Applying prescription creams, like 5-fluorouracil or imiquimod, to your skin to treat small or early cases

For more advanced or returning cancers, your provider may suggest targeted therapy or immunotherapy to help your body fight cancer cells.

Your treatment plan will depend on the cancer’s size, type and location, as well as your overall health. Your care team will help choose the option that’s right for you.

When should I see my healthcare provider?

If you notice changes to your skin that aren’t getting better, see a healthcare provider. It’s always worth having it looked at — even if it’s a false alarm — to protect your health and catch problems early.

Checking your skin regularly can help you spot changes between provider visits. It might feel awkward at first to examine your skin in a mirror. But this is one of the best ways to protect your health.

Sometimes, it can help to take a photo of any spots you’re concerned about, so that you can watch the spot for changes over time.

Contact your provider if you:

• Notice a new or changing spot, lump, bump or sore that doesn’t heal or keeps coming back
• Have pain, itching or bleeding in an existing spot

What can I expect if I have nonmelanoma skin cancer?

Most people with nonmelanoma skin cancer have an excellent outlook, especially when found and treated early.

Recovery is usually quick. You might notice some minor scarring or skin discoloration at the treatment site. Your care team will let you know how to take care of your skin as you heal.

Because these cancers can come back, your provider will recommend regular follow-up visits and ongoing skin self-exams to watch for new changes.

Can nonmelanoma skin cancer be prevented?

You can’t prevent every case of nonmelanoma skin cancer. But you can lower your risk and catch early signs before they become serious.

To protect your skin:

• Use a broad-spectrum sunscreen (SPF 30 or higher) every day, even when it’s cloudy.
• Reapply sunscreen every two hours, or after swimming or sweating.
• Wear protective clothing, a wide-brimmed hat and sunglasses.
• Avoid tanning beds.
• Stay in the shade between 10 a.m. and 4 p.m. (when the sun is strongest).

To catch skin cancer early:

• Check your skin often for new or changing spots, sores that don’t heal or unusual growths.
• See a dermatologist once a year for a full-body skin exam, or more often if you’re at a higher risk.