Complete Guide to Non-Melanoma Skin Cancer

Whether you’ve just been diagnosed or are already being treated for skin cancer, you can help your doctor take better care of you by sharing any new or changing symptoms. What you say today will help shape your treatment plan.

Ask Your Doctor . . .

Newly diagnosed:

What type of skin cancer do I have?

What stage is my skin cancer?

What are my treatment options?

What treatment do you recommend?

Should I make an appointment with a specialist?

Already being treated:

What side effects should I expect?

If my first treatment doesn’t work, what else do you recommend?

How often should I come back to be checked for skin cancer?

What can I do to protect my skin in the future?

TIP: Always share with your doctor any updates since your last visit—from new medicines to major life changes. These can impact your health. And be honest about how you’re feeling and whether you’re following your treatment plan. Your doctor can’t help you if he doesn’t know what’s really going on.

Skin cancer is the most common type of cancer. More than 3 million Americans are diagnosed with it each year.

About 80% of skin cancers are called basal cell carcinomas. This type of cancer develops in the lower epidermis, which is the top layer of skin. Basal cell carcinoma typically grows slowly and doesn’t spread to other parts of your body. It can usually be removed with surgery. It is the most common type of skin cancer in Asian, Hispanic and Caucasian people.

Almost 20% of skin cancers are called squamous cell carcinomas. This type of cancer develops in the upper epidermis. Squamous cell carcinoma is more likely to grow quickly and/or spread than basal cell carcinoma. But it can usually be removed with surgery. It is the most common type of skin cancer in African-American and Indian people.

Both of these cancers are typically grouped together under the label “Non-Melanoma Skin Cancers” to separate them from melanoma, a type of skin cancer that develops in cells called melanocytes. Melanoma is more likely to spread and is treated differently than carcinoma.

Non-melanoma skin cancers, or carcinomas, usually form where you get the most sun, like your face, neck, back, chest, arms and legs. This kind of skin cancer doesn’t typically cause pain so it can be easy to ignore.

Your first symptoms of carcinoma will likely include:

• a sore that doesn’t heal
• an area of skin that is bleeding or crusting
• a patch of skin that is raised, smooth, shiny or pearly
• a bump that is white, yellow, waxy or dark (in people with dark skin, more than 50% of basal cell carcinomas are dark in color)

Don’t just dismiss discolored patches of skin, bumps or sores that don’t heal as a normal part of aging. Take note of any suspicious areas on your skin and ask your doctor to check them.

Risk Factors for Carcinoma

Anyone can get skin cancer but certain things, called risk factors, mean that you are more likely to develop the disease. Carcinoma risk factors include:

• Fair complexion: pale skin, blonde or red hair, blue or green eyes
• History of sunburn: blistering sunburns as a child or teenager
• History of sun exposure: from the sun or from tanning beds
• Chronic scarring, trauma and inflammation: this is the most common risk factors for squamous cell carcinoma in people with skin of color
• Personal history: 35% to 50% of people who are diagnosed with one basal cell carcinoma will develop another skin cancer within 5 years
• Weak immune system: a weakened immune system because of disease or because of a medicine that suppresses the immune system
• Environmental factors: exposure to radiation or arsenic from working in a factory, for example
• Age: your risk increases with age

Having one or more risk factors for carcinoma doesn’t mean that you will get cancer. It just means that you’ll want to talk to your doctor about what you can do to prevent skin cancer and have regular skin checks to look for symptoms.

Your treatment plan will depend on the stage of your cancer (how deep it is and whether it has spread), the location, your overall health, and the risks, benefits and side effects of each treatment.

Surgery

Your treatment will usually begin with surgery to remove the carcinoma. You may not need any further treatment if your carcinoma is at an early stage. (Keep in mind that the actual tumor could be much larger than the lesion you see on your skin.)

There are several surgical options that your doctor will consider, including:

• Simple excision—The carcinoma will be cut from your skin, including areas of healthy skin around it, to make sure all the cancer has been removed.
• Mohs micrographic surgery—This is a special type of surgery for skin cancer where the carcinoma is shaved off in layers. Your doctor will look at each layer under a microscope until she’s sure the entire tumor has been removed.
• Electrodesiccation and curettage—Your doctor will remove the cancer with a special tool called a curette. Then another tool will send an electric current into your skin to kill any other cancer cells.
• Cryotherapy—Liquid nitrogen is applied to early stage carcinomas to freeze and kill the cancer cells. This is similar to how your doctor would remove a wart.
• Photodynamic therapy—In this two-step process, a medicine is applied to the cancerous lesion. Then the lesion is exposed to a special light that reacts with the medicine to destroy the abnormal cells.

Other Treatments

If your cancer cells have spread, or surgery cannot fully remove your carcinoma, your doctor will suggest one or more of the following treatments:

• Lymph node dissection—This is a surgery to remove your lymph nodes in the area near your carcinoma. Your doctor may suggest this if your cancer has spread to your lymph nodes.
• Chemotherapy (chemo)—This uses one or a combination of medicines to kill cancer cells. Chemotherapy for skin cancer is usually applied directly to the skin as a cream or lotion. 
• Radiation therapy—This uses high-energy radiation to kill cancer cells. From outside your body, your doctor aims the rays at your skin where the cancer cells are located. Each treatment only lasts a few minutes.
• Immunotherapy—This uses medicines to help your body’s immune system better find and destroy cancer cells. A topical medicine called imiquimod is sometimes used for early-stage basal cell carcinoma. Immunotherapy for skin cancer is usually applied directly to your skin as a cream.
• Targeted therapy—This uses medicines that can kill some cancer cells without harming healthy cells. Examples include vismodegib and sonidegib, which are sometimes used to treat basal cell cancers that have spread or come back after surgery.

Because having one non-melanoma skin cancer, or carcinoma, increases your risk for developing another, ongoing care and prevention is important. You can make small changes to your daily life to help decrease your risk or catch new carcinomas early.

Examine your skin

WHY: Catching a carcinoma early will make it easier to treat.

HOW TO START: Make a note of all your moles, freckles and age spots. Check your skin every month for changes or new spots. Use a mirror to look at all of your skin from your head to your toes.

Avoid sun exposure

WHY: UV rays can damage your skin and increase your risk of developing skin cancer.

HOW TO START: The sun’s rays are strongest between 10 a.m. and 4 p.m. Avoid spending time outside during these hours. If you have to be outdoors, stay in the shade as much as possible and keep your skin covered with tight-woven clothing.

Use sunscreen carefully

WHY: If you don’t follow sunscreen directions, you may not get the protection you need.

HOW TO START: Choose a broad-spectrum sunscreen that blocks both UVA and UVB rays. Apply a generous amount—at least a palm full—to all exposed areas of skin 30 minutes before going outside. Reapply every two hours or after sweating or swimming.

Cover your head and eyes

WHY: You can’t apply sunscreen to your scalp or eyes so you need to protect them in other ways.

HOW TO START: Wear a hat with a wide brim to protect your face, neck and ears. Wear sunglasses with UV protection to shield your eyes. Look for the words “blocks 99% to 100% of all UV light” or “UV absorption up to 400nm” on the label.

Avoid tanning beds

WHY: There is no such thing as a “safe” tan. Even if you never get a burn from a tanning bed, the UV radiation is still damaging your skin.

HOW TO START: Use bronzing cosmetics or sunless tanning lotions if you want to darken your skin. But you will still need to protect your skin with sunscreen or clothing. (Do not take “tanning pills;” they are not approved by the FDA. Avoid sunless tanning booths/ spray tans that don’t provide protection for your eyes, nose and mouth.)