Nonmelanoma Skin Cancer: Overview

What is nonmelanoma skin cancer?

Cancer is made of changed cells that grow out of control. The changed (abnormal) cells often grow to form a lump or mass called a tumor. Cancer cells can also grow into (invade) nearby areas. And they can spread to other parts of the body. This is called metastasis.

Skin cancer is a disease that begins in the cells of the skin. Nonmelanoma skin cancer is the most common type of cancer in the U.S. The most common type of nonmelanoma skin cancers are called keratinocyte cancers. These cancers have 2 main types called basal cell skin cancer and squamous cell skin cancer. Basal cell skin cancer is much more common than squamous cell skin cancer. Both types are most often caused by ultraviolet (UV) light from the sun damage over time.

There are other less common types of nonmelanoma skin cancer. These include:

• Merkel cell carcinoma

• Cutaneous T-cell lymphoma

• Kaposi sarcoma

Who is at risk for nonmelanoma skin cancer?

A risk factor is anything that may increase your chance of having a disease. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer. Some risk factors may not be in your control. But others may be things you can change. 

The most common risk factors for nonmelanoma skin cancer include:

• Greater amount of time spent in the sun

• The use of tanning beds, booths and sunlamps

• Certain features, such as fair skin, light hair (red or blond), and light eyes (green, blue, or gray)

• Lots of freckles and skin burns easily in the sun

• Personal history of skin cancer or pre-cancer

• Older age

• Being a man

• Weakened immune system

• Exposure to large amounts of arsenic

• Past radiation treatment

• Scars, burns, or inflamed skin

• Smoking

• HPV (human papillomavirus) infection

• Certain rare inherited conditions, such as xeroderma pigmentosum

• Medicines that can increase skin sensitivity to sunburns

Talk with your healthcare provider about your risk factors for nonmelanoma skin cancer and what you can do about them.

Can nonmelanoma skin cancer be prevented?

There is no sure way to prevent nonmelanoma skin cancer. But there are some things that may help lower your risk for it, such as:

• Wearing sunscreen with an SPF of 30 or higher

• Not using tanning beds, booths or sunlamps

• Limiting your sun exposure when UV (ultraviolet) light is strongest, between 10 a.m. and 4 p.m.

• Wearing sunglasses (100% UVA/UVB protection)

• Wearing clothing to shade your face, neck, and cover your body

• Doing skin checks

• Treating skin pre-cancers early

You may be able to spot skin cancer early when it’s easier to treat by doing a regular skin self-exam. If you are at risk, see a dermatologist regularly. That may also allow you to detect skin cancers when they're easier to treat. Become familiar with the way your skin and moles look. Talk with your healthcare provider about any bumps, spots, or other marks that appear on your skin. Show your provider any area of skin that doesn’t look normal.

What are the symptoms of nonmelanoma skin cancer?

Nonmelanoma skin cancer often develops in areas exposed to the sun, such as the head, face, neck, rim of your ear, arms, hands, trunk of your body (chest, abdomen, and back), and legs. But it can start anywhere on the body. It may appear as a new growth. Or it may occur as a change in the size or in the color of a growth you already have. These changes can happen slowly or quickly. 

Here are some possible signs of the most common nonmelanoma skin cancers:

• A small, raised bump that is shiny or pearly

• A small, flat spot that is scaly, irregularly shaped, and pale, pink, or red

• Sores that don't heal

• A growth with raised edges, a lower area in the center, and brown, blue, or black areas

• A wart-like growth that might bleed or crust over

• Scaly patches or bumps that are often red or purple and itch

Many of these may be caused by other health problems. But it is important to see a healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

How is nonmelanoma skin cancer diagnosed?

Diagnosing skin cancer starts with checking out a bump, spot, or other mark on your skin. If your healthcare provider thinks you may have nonmelanoma skin cancer, you will need certain exams and tests. Your healthcare provider may ask you to see a skin specialist provider called a dermatologist. Your healthcare provider will ask you about your health history, your symptoms, risk factors, and family history of disease. They will also give you a physical exam. You will likely have a biopsy.

A biopsy is the only way to confirm cancer. Small pieces of tissue are taken out and checked in a lab for cancer cells. Your results will come back in about 1 week.

If your healthcare provider is concerned that your skin cancer is more aggressive, you may have other tests. These help your healthcare providers learn more about the cancer. They can help determine the stage of the cancer. The stage is how much and how far the cancer has spread (metastasized) in your body. It's one of the most important things to know when deciding how to treat the cancer.

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Ask your provider to explain the stage of your cancer to you in a way you can understand.

How is nonmelanoma skin cancer treated?

Your treatment choices depend on the type of nonmelanoma skin cancer, how large the skin cancer is, where it is, and what stage it is. It also depends on the test results. The goal of treatment may be to cure you, control the cancer, or help ease problems caused by the cancer. Talk with your healthcare team about your treatment choices, the goal of treatment, and the possible risks and side effects. Other things to think about are if the cancer can be removed with surgery and your overall health.

Types of treatment for cancer are either local or systemic. Local treatments remove, destroy, or control cancer cells in one area. Systemic treatment is used to destroy or control cancer cells that may have traveled through your body. Surgery and radiation are local treatments. When taken by pill or injection, chemotherapy is a systemic treatment. You may have one or a combination of treatments.

Nonmelanoma skin cancer may be treated with:

• Surgery

• Creams applied to the affected area

• Chemotherapy

• Targeted therapy

• Radiation therapy

• Photodynamic therapy

• Immunotherapy

Talk with your healthcare providers about your treatment options. Make a list of questions. Think about the benefits and possible side effects of each option. Talk about your concerns with your healthcare provider before making a decision.

What are the treatment side effects?

Cancer treatment such as radiation therapy can damage normal cells. This can cause side effects like red, dry, burning skin in the area being treated, risk of infection, and hair loss and rash in the treatment area. 

Surgery is the most common way to treat nonmelanoma skin cancer. There are many methods of surgery that can be used to remove the cancer. Side effects from surgical procedures depend upon the type of procedure. They may include bruising, risk of infection, scarring, pain, redness, or swelling at the site.  

Talk with your healthcare provider about side effects you might have and ways to manage them. There may be things you can do and medicines you can take to help prevent or control side effects.

Coping with nonmelanoma skin cancer

Most nonmelanoma cancers are not life-threatening and can be treated by a dermatologist. However, people may worry or feel stressed when dealing with nonmelanoma cancer. Getting treatment for cancer can be tough on the mind and body. Keep talking with your healthcare team about any problems or concerns you have. Work together to ease the effect of cancer and its symptoms on your daily life.

Here are some tips:

• Talk with your family or friends.

• Ask your healthcare team or social worker for help.

• Speak with a counselor.

• Talk with a spiritual advisor, such as a minister or rabbi.

• Ask your healthcare team about medicines for depression or anxiety.

• Keep socially active.

• Join a cancer support group.

Cancer treatment is also hard on the body. To help yourself stay healthier, try to:

• Eat a healthy diet, with a focus on high-protein foods.

• Drink plenty of water, fruit juices, and other liquids.

• Keep physically active.

• Rest as much as needed.

• Talk with your healthcare team about ways to manage treatment side effects.

• Take your medicines as directed by your team.

When should I call my healthcare provider?

Your healthcare provider will talk with you about when to call. You may be told to call if you have any of the below:

• New symptoms or symptoms that get worse

• Signs of an infection, such as a fever

• Side effects of treatment that affect your daily function or don’t get better with treatment

Ask your healthcare provider what signs to watch for and when to call. Know how to get help after office hours and on weekends and holidays.

Next steps

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions, especially after office hours and on weekends and holidays.