Non-Melanoma Skin Cancers: The Basics
Non-melanoma skin cancer is caused by skin cells growing out of control. The two main types of non-melanoma skin cancer are basal cell and squamous cell. The other types are:
- Cutaneous B and T cell lymphomas.
- Dermatofibrosarcoma protuberans.
- Merkel cell carcinoma.
- Sebaceous gland carcinoma.
- Kaposi's sarcoma.
The rest of the article will focus on basal and squamous cell.
Exposure to ultraviolet rays from the sun is the leading cause of non-melanoma skin cancer. Other risks include:
- Fair skin.
- Exposure to chemicals like radium and arsenic.
- Immunosuppression from medicines or HIV.
- Chronic wounds and burns.
- Genetic syndromes.
- Having many moles.
- Older age.
- History of non-melanoma skin cancer (either yourself or a family member).
The best way to screen for skin cancer is with a full skin check. During routine physicals, your skin may be checked. It is also important to check your own skin. You will notice any changes early if you do your own checks.
Moles that cause concern are those that present with the “ABCDE” traits.
- Asymmetry: one side of the mole is not the same as the other.
- Border Irregularity: the border (edges of the mole) should be well-defined. Blurry or uneven borders are not normal.
- Color: if the mole has many colors or if the color has changed.
- Diameter: any mole that is larger than the diameter of a pencil eraser.
- Evolution: any change in appearance, color, shape, or height over time needs to be looked at.
Signs of Non-Melanoma Skin Cancer
Any mole or skin change with the “ABCDE” traits can be a sign of non-melanoma skin cancer. Basal cell carcinomas often look like a pearly or crusty patch that does not heal. They don’t often hurt and grow slowly. Squamous cell carcinomas are small, painless, raised and crusty. Both types of lesions can bleed and both are often found on areas of the body exposed to the sun.
Diagnosis of Non-Melanoma Skin Cancer
When your health care provider suspects a non-melanoma skin cancer, a biopsy will be performed. A pathology report will be completed by a dermatopathologist and sent to your provider. A pathology report describes all of the aspects of the skin cancer.
The TNM system is also used to describe squamous cell non-melanoma cancers. This includes:
- Size and location of the tumor.
- Whether cancer cells are found in the lymph nodes.
- Whether cancer cells are found in other areas of the body.
Staging ranges from I (limited disease) to IV (more advanced disease).
There are a number of treatments used and what is used depends on where the cancer is, the age of the patient, the extent of the disease, and if the spot has been treated before. Treatments are:
- Cryotherapy: the freezing of the lesion with liquid nitrogen.
- Excisional surgery: the surgical removal of the lesion.
- Curettage and Electrodessication: the scraping of the lesion and then the use of an electrical current to stop the bleeding.
- Moh’s Surgery: the removal of a lesion and while trying to lessen skin loss.
- Radiation therapy: the use of high energy x-rays to kill cancer cells.
- Topical Treatments: chemotherapies and medicines that are put on the skin.
- Photodynamic Therapy: the use of a topical agent being put on the lesion followed by exposure to a wavelength of light which kills the cancer cells.
- Chemotherapy: may be used if the cancer returns or spreads to other organs.
This article is a basic introduction to non-melanoma skin cancer. You can learn more about your type of skin cancer and treatment by using the links below.
American Cancer Society. (2020) Basal and squamous cell skin cancer. Retrieved from: https://www.cancer.org/cancer/basal-and-squamous-cell-skin-cancer.html
Della Vittoria Scarpati, G., Perri, F., Pisconti, S., Costa, G., Ricciardiello, F., Del Prete, S., ... & Addeo, R. (2016). Concomitant cetuximab and radiation therapy: a possible promising strategy for locally advanced inoperable non-melanoma skin carcinomas. Molecular and clinical oncology, 4(4), 467-471.
Griffin, L. L., Ali, F. R., & Lear, J. T. (2016). Non-melanoma skin cancer. Clinical medicine, 16(1), 62-65.
Lucena SR et al. Combined treatments with photodynamic therapy for non-melanoma skin cancer. Journal of Molecular Science. 2015; 16(10):25912-25933.
McLaughlin-Drubin, M. E. (2015, April). Human papillomaviruses and non-melanoma skin cancer. In Seminars in oncology (Vol. 42, No. 2, pp. 284-290). WB Saunders.
National Cancer Institute. (2020) Skin cancer treatment. Retrieved from: https://www.cancer.gov/types/skin/hp/skin-treatment-pdq#link/_369
National Comprehensive Cancer Network (2019). Basal cell skin cancer. Retrieved from: https://www.nccn.org/professionals/physician_gls/pdf/nmsc.pdf
National Comprehensive Cancer Network (2020). Squamous cell skin cancer. Retrieved from: https://www.nccn.org/professionals/physician_gls/pdf/squamous.pdf
Torri, V. (2016). Chemotherapy and Molecular Therapy in Non-Melanoma Skin Cancer. Current Cancer Therapy Reviews, 12(3), 166-171.