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Skin Cancer (Non-Melanoma) - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Non-Melanoma Skin Cancer. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

About the skin

The skin is the largest organ. It protects the body against infection and injury and helps regulate body temperature. The skin also stores water and fat and produces vitamin D.

The skin is made up of three main layers:

  • The epidermis. The outer layer of skin.

  • The dermis. The inner layer of skin.

  • The hypodermis. The deep layer of fat.

See the Medical Illustrations section for a drawing of these layers.

About skin cancer

Cancer begins when healthy cells change and grow uncontrollably, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

Doctors diagnose more than two million Americans with skin cancer each year, making it the most common type of cancer. If skin cancer is found early, it can usually be cured with a relatively simple surgery. As a result, skin cancer is responsible for less than 1% of all cancer deaths.

Types of skin cancer

There are three main types of skin cancer:

  • Basal cell carcinoma. Basal cells are the round cells found in the lower epidermis. About 80% of skin cancers develop from this type of cell. These cancers are described as basal cell carcinomas. Basal cell carcinoma most often develops on the head and neck. It is mainly caused by sun exposure or develops in people who received radiation therapy as children. This type of skin cancer usually grows slowly and rarely spreads to other parts of the body.

  • Squamous cell carcinoma. Most of the epidermis is made up of flat, scale-like cells called squamous cells. Approximately 20% of skin cancers develop from these cells, and these cancers are called squamous cell carcinomas. Squamous cell carcinoma is mainly caused by sun exposure, but it can develop on skin that has been burned, damaged by chemicals, or exposed to x-rays. Other areas where squamous cell carcinoma is commonly found include the lips; sites of a chronic inflammatory skin condition; and skin outside the mouth, anus, and a woman’s vagina. Squamous cell carcinoma rarely spreads to other parts of the body, but it is more likely to spread than basal cell carcinoma.

  • Melanoma. Where the epidermis meets the dermis, there are scattered cells called melanocytes. These cells produce the pigment melanin that gives skin color. Melanoma starts in melanocytes, and it is the most serious type of skin cancer. For more information about melanoma, please visit the melanoma section.

Basal cell carcinoma and squamous cell carcinoma are generally grouped together and called “non-melanoma skin cancer” to distinguish them from melanoma. Melanoma develops from very different cells and is treated differently because it is more likely to spread than other skin cancers. Typically, non-melanoma skin cancer can be treated with a relatively simple surgery. If the cancer is very small, medicated creams prescribed by a doctor, cauterization (burning), cryosurgery (freezing), or laser surgery may be used. Learn more in the Treatment Options section.

There are a few other rarer types of skin cancer, including keratoacanthomas, Merkel cell carcinoma, cutaneous (skin) lymphomas, Kaposi sarcoma, skin adnexal tumors, and sarcomas, all of which are classified as non-melanoma skin cancers. However, this section focuses on basal cell and squamous cell skin cancers.

Looking for More of an Overview?

If you would like additional introductory information, explore this related item. Please note this link will take you to another section on Cancer.Net:

  • ASCO Answers Fact Sheet: Read a one-page fact sheet (available as a PDF) that offers an easy-to-print introduction to basal cell carcinoma.

The next section in this guide is Statistics, and it helps explain how many people are diagnosed with this disease and general survival rates. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Skin Cancer (Non-Melanoma) - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will find information about how many people are diagnosed with these types of non-melanoma skin cancer each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

It is estimated that more than two million people in the United States are diagnosed with non-melanoma skin cancer each year. Basal cell carcinoma is far more common than squamous cell carcinoma. 

In general, basal cell carcinoma and squamous cell carcinoma are typically curable and are not traditionally included in overall cancer statistics. Despite this, about 2,000 people die from non-melanoma skin cancer each year, while 9,940 people die every year from melanoma.

Cancer statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer in the United States each year, so the actual risk for a particular individual may be different. It is not possible to tell a person how long he or she will live with non-melanoma skin cancer. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts & Figures 2015 and the ACS website.

The next section in this guide is Medical Illustrations and it offers drawings of body parts often affected by this disease. Or, use the menu on the left side of your screen to choose another section to continue reading this guide.

Skin Cancer (Non-Melanoma) - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will find a basic drawing of the structures and layers that make up the skin. To see other pages, use the menu on the side of your screen.

Anatomy of the Skin

Larger image

The next section in this guide is Risk Factors and Prevention, and it explains what factors may increase the chance of developing this disease. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Skin Cancer (Non-Melanoma) - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a person’s risk of developing skin cancer:

  • Sun exposure. Exposure to ultraviolet (UV) radiation from the sun plays a major role in the development of skin cancer. People who live at high altitudes or in areas with bright sunlight year-round have a higher risk of developing skin cancer, as do those who spend a lot of time outside during the midday hours.

    Exposure to ultraviolet B (UVB) radiation appears to be more closely linked with skin cancer, but newer research suggests that ultraviolet A (UVA) may also play a role in the development of basal cell carcinoma, squamous cell carcinoma, and melanoma. Whereas UVB radiation causes sunburn and does not penetrate through car windows or other types of glass, UVA is able to pass through glass and may cause aging and wrinkling of the skin in addition to skin cancer. Therefore, it is important to protect your skin from both UVA and UVB radiation (see Prevention below).

  • Artificial tanning. People who use tanning beds, tanning parlors, or sun lamps have an increased risk of developing all types of skin cancer. Recreational sun tanning should also be avoided to reduce the risk of skin cancer.

  • Fair skin. People with a fair complexion, blond or red hair, blue eyes, and freckles are at increased risk for developing skin cancer, as are people whose skin has a tendency to burn rather than tan.

  • Precancerous skin conditions. Rough, red or brown scaly patches on the skin, called actinic keratoses and Bowen's disease, are usually more common in areas exposed to the sun. These areas can change into squamous cell cancers in a small minority of people. The more actinic keratoses a person has, the higher the risk that they will develop into a squamous cell carcinoma. Using a broad-spectrum sunscreen throughout the year that protects against both UVA and UVB radiation and has a sun protection factor (SPF) of at least 30 helps decrease the risk of developing actinic keratoses. See the Prevention section below for more information about protecting your skin from the sun.

  • Gender. The number of older white men and younger women who have developed skin cancer in recent years has increased.

  • Age. Most basal cell and squamous cell carcinomas typically appear after age 50. However, in recent years, the number of skin cancers in people age 65 and older has increased dramatically. Younger people can also develop non-melanoma skin cancer, especially if they have an inherited (genetic) syndrome that puts them at high risk, fair skin, or been exposed to significant amounts of radiation or UV radiation from the sun.

  • A history of sunburns or fragile skin. Skin that has been burned, sunburned, or injured from disease has a higher risk of skin cancer. Squamous cell and basal cell carcinoma occur more often in people with higher lifetime exposure to the sun or other sources of UV radiation.

  • Previous skin cancer. People who have had any form of skin cancer have a higher risk of developing another skin cancer. Thirty-five percent (35%) to 50% of people diagnosed with one basal cell carcinoma will develop a new skin cancer within five years. Therefore, people who have had one skin cancer need ongoing, follow-up care to watch for additional cancers. See the Follow-Up Care section for more information.

  • Inherited syndromes. Certain rare genetic conditions are associated with an increased risk of developing basal cell carcinoma. These conditions include nevoid basal cell carcinoma syndrome, which is also called Gorlin’s syndrome, and the very rare Rombo, Bazex-Dupré-Christol, epidermolysis bullosa simplex, and Dowling-Meara syndromes, among others. Rare syndromes associated with an increased risk of squamous cell carcinoma include xeroderma pigmentosum, albinism, epidermolysis bullosa simplex, dyskeratosis congenita, and multiple self-healing squamous epitheliomata.

  • Weakened or suppressed immune system. People with weakened immune systems due to a stem cell transplant or diseases such as HIV/AIDS and certain types of leukemia have a higher risk of developing skin cancer, particularly squamous cell carcinoma. The same is true for people taking immunosuppressive drugs.

  • Medications. In addition to medications that suppress the immune system, certain steroids and medications that make the skin very sensitive to sunburns, such as vandetanib (Caprelsa), vemurafenib (Zelboraf), and voriconazole (Vfend), have all been shown to increase a person’s risk of developing squamous cell carcinoma.

  • Previous treatment with radiation therapy. When a person receives radiation therapy as a cancer treatment, he or she has a higher risk of developing basal cell carcinoma. This risk increases over time, especially after 10 to 20 years. As a result, children who receive radiation therapy have a six times higher risk for developing a basal cell carcinoma.

  • Human papillomavirus (HPV). Research indicates that infection with this virus is a risk factor for squamous cell carcinoma, particularly if the person’s immune system becomes suppressed. HPV is most commonly passed from person to person during sexual activity. There are different types, or strains, of HPV. Some strains are more strongly linked with certain types of cancers.

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause this type of cancer. Although there is no proven way to completely prevent this disease, you may be able to lower your risk. Talk with your doctor for more information about your personal risk of cancer.

Reducing exposure to UV radiation, particularly by reducing sun exposure, lowers the risk of developing skin cancer significantly. This is important for people of all ages and is especially important for people who have other risk factors for basal cell and squamous cell carcinoma (see above).

Sun damage builds up over time, so it is important to take the following steps to reduce sun exposure and avoid sunburn:

  • Limit or avoid direct exposure to the sun between 10:00 AM and 4:00 PM.

  • Wear sun-protective clothing, including a wide-brimmed hat that shades the face, neck, and ears. Clothes made from fabric labeled with UV protection factor (UPF) may provide better protection. UV-protective sunglasses are also recommended.

  • Use a broad spectrum sunscreen throughout the year that protects against both UVA and UVB radiation and has a sun protection factor (SPF) of at least 30. Reapply at least one ounce of sunscreen to your entire body every two hours or every hour after heavy perspiration or being in the water.

  • Avoid recreational sunbathing and do not use sun lamps, tanning beds, or tanning salons.

  • Examine the skin regularly. This should include examinations by a health care professional, as well as self-examinations. Learn more about how to do a self-examination.

Learn more about protecting your skin from the sun in this additional article on Cancer.Net.

Limiting your sun exposure may reduce your body’s production of vitamin D, although some research suggests less than 15 minutes of sunlight exposure may be enough for most people to produce an adequate amount of vitamin D. People with limited sun exposure should talk with their doctor about how to include good sources of vitamin D in their diet, including the use of supplements. Your levels of vitamin D can be checked through a simple blood test by your doctor.

The next section in this guide is Screening, and it describes the early warning signs of skin cancer and how to perform a self-examination. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Skin Cancer (Non-Melanoma) - Screening

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will find out more about the early detection of skin cancer and what to look for during a self-examination. To see other pages, use the menu on the side of your screen.

Early detection and recognition of skin cancer are very important. Recognizing the early warning signs of skin cancer and doing regular self-examinations of your skin will help find skin cancer early when the disease is highly curable.

Self-examinations should be performed in front of a full-length mirror in a brightly lit room. It helps to have another person check the scalp and back of the neck. For people with fair skin, non-melanoma skin cancer most often begins in places that are frequently been exposed to the sun. For people with darker skin, squamous cell carcinoma occurs primarily in areas infrequently exposed to the sun, such as the lower legs.

Include the following steps in a skin self-examination:

  • Examine the front and back of the entire body in a mirror, then the right and left sides, with arms raised.

  • Bend the elbows and look carefully at the outer and inner forearms, upper arms (especially the hard-to-see back portion), and hands.

  • Look at the front, sides, and back of the legs and feet, including the soles and the spaces between the toes.

  • Part the hair to lift it and examine the back of the neck and scalp with a hand mirror.

  • Check the back, genital area, and buttocks with a hand mirror.

Talk with your doctor if your hairdresser or barber has noticed a suspicious lesion on your scalp or under your beard, or if you find any of the following during a self-examination:

  • A growth on the skin that matches any symptom listed in the next section of this guide

  • New growth on the skin

  • A suspicious change in an existing mole or spot

  • A sore that doesn't heal within two weeks

The next section in this guide is Symptoms and Signs, and it explains what body changes or medical problems this disease can cause. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Skin Cancer (Non-Melanoma) - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

People with a basal cell or squamous cell carcinoma may experience the following symptoms. Sometimes, people with non-melanoma skin cancer do not show any of these symptoms or signs. Or, these symptoms may be caused by a medical condition that is not cancer. The skin features that people with basal cell or squamous cell carcinoma frequently develop are listed below.  

Changes in the skin are the main warning sign for skin cancer. Each type of skin cancer can appear differently, so it is important to talk with your doctor when you notice a change in your skin.

For basal cell carcinoma, two or more of the following features may be present:

  • An open sore that bleeds, oozes, or crusts and remains open for several weeks

  • A reddish, raised patch or irritated area that may crust or itch, but rarely hurts

  • A shiny pink, red, pearly white, or translucent bump

  • A pink growth with an elevated border and crusted central indentation

  • A scar-like, white, yellow, or waxy area, often with a poorly defined border

See pictures of these features of basal cell carcinoma. (Please note this will take you to a separate website.)

Squamous cell carcinoma can often crust, bleed, and appear as:

  • A wart-like growth

  • A persistent, scaly red patch with irregular borders that may bleed easily

  • An open sore that persists for weeks

  • An elevated growth with a rough surface and a central depression

See pictures of these signs of squamous cell carcinoma. (Please note this will take you to a separate website.)

Some types of skin cancer spread along the nerves and can cause itching, pain, numbness, tingling, or a feeling like there is ants crawling under the skin. Other signs may include lumps or bumps under the skin in areas such as the neck, armpit, or groin.

If you are concerned about one or more of these symptoms or signs, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This may include when you first noticed the skin feature, how long it has been there, and any other symptoms you may be experiencing. This is to help find out the cause of the problem, called a diagnosis.

If skin cancer is diagnosed, relieving symptoms is an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis, and it explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Skin Cancer (Non-Melanoma) - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will find a description of the common test doctors use to find out whether a suspicious mole, slow-healing sore, or other skin feature is cancerous. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose cancer and find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition

  • Type of cancer suspected

  • Signs and symptoms

  • Previous test results

Because non-melanoma skin cancer rarely spreads, a biopsy is often the only test needed to diagnose and find out the stage (extent) of cancer. A biopsy is the removal of a small amount of tissue for examination under a microscope. During this procedure, the suspected skin lesion is removed, usually after a local anesthetic helps numb the area. The doctor also removes an area of healthy tissue around the lesion, which is called the margin.

The sample removed during the biopsy is then analyzed by a pathologist who determines if it is a skin cancer. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

Your doctor will review the results of the biopsy with you. No further treatment beyond the biopsy may be necessary if the entire cancer was removed. However, if cancer cells were found in the margins of the removed tissue, additional treatment will usually be recommended.

Learn more about what to expect when having a biopsy

The next section in this guide is Stages, and it explains the system doctors use to describe the extent of the disease. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Skin Cancer (Non-Melanoma) - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery.

Basal cell and squamous cell carcinoma usually do not spread to other parts of the body. On rare occasions, a person’s lymph nodes may be removed to find out if the cancer has metastasized. Lymph nodes are tiny, bean-shaped organs that help fight infection. The doctor may recommend other tests, including blood tests, chest x-rays, and imaging scans of the lymph nodes and nerves, liver, bones, and brain, but this is also uncommon.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Skin Cancer (Non-Melanoma) - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will learn about the different ways doctors treat these types of skin cancer. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (best known treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Your doctor can help you review all treatment options. For more information, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams also include a variety of other health care professionals, including physician assistants, nurses, social workers, pharmacists, counselors, dietitians, and others.

Descriptions of the most common treatment options for non-melanoma skin cancer are listed below. Treatment options and recommendations depend on several factors, including the size and location of the skin cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Surgery and other procedures

Surgery is the removal of the tumor and surrounding tissue during a medical procedure. Many skin cancers can be removed from the skin quickly and easily during a simple surgical procedure, and often no additional treatment is needed.

Different types of surgical procedures are used depending on the size of the lesion and where it is located. Most of these surgical procedures use a local anesthetic to numb the skin beforehand and can be done outside of a hospital by a dermatologist, general surgeon, plastic surgeon, nurse practitioner, or physician assistant. A dermatologist is a doctor who specializes in diseases and conditions of the skin.

Surgeries and other procedures for skin cancer include:

  • Curettage and electrodessication. During this common procedure, the skin lesion is removed with a curette, which is a sharp, spoon-shaped instrument. The area is then treated with an electric current that helps control bleeding and destroys any remaining cancer cells. This is called electrodessication. Many people have a flat, pale scar after this procedure.

  • Mohs surgery. This technique, also known as complete margin assessment surgery, involves removing the visible tumor, in addition to small fragments around the edge of the area where the tumor was located. Each small fragment is examined under a microscope until all of the cancer is removed. This is typically used for larger tumors, those located in the head and neck region, and for cancers that have come back in the same place.

  • Freezing. This procedure, which is also called cryotherapy, uses liquid nitrogen to freeze and destroy abnormal cells. It is usually used to treat precancerous skin conditions. The liquid nitrogen will sting when it is first applied to the skin, and then the skin will blister and shed off. More than one freezing may be needed. Sometimes this procedure leaves a pale scar.

  • Laser therapy. A narrow beam of high-intensity light can destroy precancer that is located only in the outer layer of the skin. 

  • Grafting. When a large tumor is removed, surgeons may use skin from another part of the body to close the wound and reduce scarring.

  • Reconstructive surgery. Since skin cancer often develops on a person’s face, a reconstructive (plastic) surgeon or facial specialist may be part of the health care team. Before any surgery for skin cancer, talk with your doctor about whether changes to your appearance are likely.

Learn more about the basics of cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. Radiation therapy may be used instead of surgery for skin cancer that is located in a hard-to-treat place, such as on the eyelid, the tip of the nose, or the ear. Sometimes radiation therapy may be recommended after surgery to help prevent the skin cancer from coming back.

The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. Several treatments may be needed to eliminate the cancer. A less common type of radiation treatment for skin cancer is brachytherapy. This involves placing the radiation source very close to or inside of the skin cancer.

Radiation therapy is not recommended as a treatment option for people with nevoid basal cell carcinoma syndrome.

The side effects from radiation therapy may include a rash, skin infections, itchy or red skin, or a change in the color of the skin. However, these side effects can usually be prevented by applying a corticosteroid or antibiotic on the skin. If side effects develop, most go away a few weeks after treatment has finished. Learn more about the basics of radiation therapy.

Topical treatments

To treat precancerous skin conditions or a cancerous lesion located only in the top layer of the skin, doctors may prescribe chemotherapy as a cream or lotion. Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. These drugs are generally applied to the skin daily for several weeks. They may cause skin inflammation or irritation, which will go away once treatment is finished.

Topical diclofenac (Solaraze), fluorouracil (Efudex), and ingenol mebutate (Picato) are approved for the treatment of precancerous actinic keratosis. All of these creams can cause irritation, burning, redness, and stinging during treatment. These symptoms usually go away soon after treatment has been completed. These creams do not cause scars to form, which is why many doctors use them to treat the face or other areas where cosmetic results are important.

For small basal cell cancers not located on the face, topical imiquimod (Aldara), which stimulates the immune system, may be recommended. The cream must be applied once a day, five days a week for six to 12 weeks. Topical fluorouracil is also approved by the U.S. Food and Drug Administration (FDA) to treat superficial (very thin) basal cell carcinomas. It should be applied twice daily for three to six weeks. Some irritation and redness in the area of the basal cell carcinoma is expected with this treatment.

Photodynamic therapy is a combination treatment for actinic keratosis. First a topical medication called aminolevulinic acid is applied over areas with many actinic keratosis. Then this area is exposed to a special light-emitting device for several minutes to a few hours. The aminolevulinic acid makes the skin very sensitive so the procedure can be painful. Your doctor may recommend taking painkillers before the procedure. In addition, the chemical makes the skin very sensitive to the sun, so it is important to avoid sun exposure and wear protective glasses, clothing, and sunscreen for a few days after the procedure. The skin will remain very red and irritated for a few days, but the actinic keratoses quickly disappear once the redness goes away.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process.

People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as topical medications, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.    

Metastatic skin cancer

In rare cases, non-melanoma skin cancer can grow deeper into the skin and can spread to other parts of the body. When cancer has spread to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about getting a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials studying new treatments.

Surgery alone cannot eliminate skin cancer that has metastasized. To control distant spread, a person’s health care team may recommend chemotherapy, radiation therapy, and/or targeted therapy. Palliative care will also be important to help relieve symptoms and side effects.

Chemotherapy usually consists of treatment with drugs such as taxanes (docetaxel or paclitaxel) and platinums (carboplatin or cisplatin). These drugs are delivered through an intravenous (IV) tube placed into a vein using a needle to reach cancer cells throughout the body. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. The main side effects of these drugs include fatigue, low blood cell counts, and changes in sensation in the tips of the fingers or toes. Learn more about the basics of chemotherapy and preparing for treatment.

For people with basal cell carcinoma that cannot be treated with surgery or radiation therapy, targeted therapy using a class of drugs known as hedgehog pathway inhibitors is another treatment option. The FDA has approved two drugs in this class: sonidegib (Odomzo) and Vismodegib (Erivedge). By blocking this pathway, these drugs may stop or slow the growth of basal cell carcinoma. The main side effects of this type of treatment include hair thinning or hair loss, muscle cramps, dry skin, and loss of taste, which can lead to weight loss. In addition, pregnant women should not take sonidegib. Learn more about targeted therapy.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED. 

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with this fear. 

If a skin cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence). Certain parts of the body, such as the ears and lips, are more prone to develop recurrent skin cancers. In addition, people whose immune system is suppressed due to a medication or disease are also at higher risk for skin cancer recurrence.

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer often experience emotions such as fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

The next section in this guide is About Clinical Trials, and it offers more information about research studies that are focused on finding better ways to care for people with cancer. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Skin Cancer (Non-Melanoma) - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for people with skin cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the FDA was previously tested in clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and managing the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

Deciding to join a clinical trial

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating skin cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with skin cancer.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Patients who participate in a clinical trial may stop participating at any time, for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trials ends, and/or if the patient chooses to leave the clinical trial before it ends. 

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for non-melanoma skin cancer, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research, and it explains areas of scientific research currently going on for this type of cancer. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Skin Cancer (Non-Melanoma) - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will read about the scientific research being done now to learn more about non-melanoma skin cancer and how to treat it. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about skin cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

  • EGFR inhibitors for advanced or metastatic squamous cell carcinoma. Many squamous cell carcinomas grow uncontrollably because of a tumor protein known as the epidermal growth factor receptor (EGFR). Several clinical trials are investigating whether combining drugs that inhibit EGFR with radiation therapy is an effective treatment option for advanced or metastatic disease.

  • Additional Hedgehog pathway inhibitors for advanced basal cell carcinoma. Researchers are developing new hedgehog pathway inhibitors for advanced basal cell carcinoma that cannot be treated with surgery or radiation therapy.

  • Combining Hedgehog pathway inhibitors with other therapies. Researchers are testing whether combining hedgehog inhibitors with other treatments, such as surgery and radiation therapy, would be beneficial for basal cell carcinomas that are difficult to cure.

  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current skin cancer treatments, in order to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding non-melanoma skin cancer, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Side Effects, and it offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Skin Cancer (Non-Melanoma) - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

There are possible side effects for every cancer treatment, but patients don’t experience the same side effects when given the same treatments for many reasons. That can make it hard to predict exactly how you will feel during treatment.

Common side effects for each treatment option for non-melanoma skin cancer are described in the Treatment Options section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the cancer’s stage, the type of treatment(s), and your overall health.

Talking with your health care team about side effects

Before treatment begins, talk with your doctor about possible side effects of the specific treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them.

And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with cancer. Learn more about caregiving.

In addition to physical side effects, there may be emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of your cancer care

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

The next section in this guide is Follow-up Care, and it explains the importance of check-ups after cancer treatment is finished. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Skin Cancer (Non-Melanoma) - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will read about your medical care after cancer treatment is completed, and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

Care for people diagnosed with cancer doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. An important part of your follow-up care will be regular screening for new skin cancers, which should include whole-body skin examinations by a health care professional. This is because many people treated for one skin cancer develop other skin cancers later.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will also ask specific questions about your health. Some people may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors including the type and stage of cancer originally diagnosed and the types of treatment given.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

For most people with skin cancer, surgery removes only a small part of the skin. However, if surgery was more extensive, there may be some need for rehabilitation services. People who have had multiple surgeries, particularly on their face, may have a substantially altered appearance. Scars from surgery may be itchy, painful, or limit the ability to move nearby skin. This can be improved by a plastic surgeon or a dermatologist. Rarely, the eyelid may be altered. The eyelid may not close well, and the person may need to use drops to moisten the eye.

When extensive facial surgery is necessary, the person will need support and possibly the help of a caregiver during treatment and recovery. Some of these surgeries are done in several steps and may require a long-term absence from work or other activities.

When radiation therapy is used, there is a small possibility that a second cancer may develop, which may not appear for more than 10 years after treatment. Also, the skin may become thin, discolored, and hard many years after finishing radiation therapy. This can be improved with physical therapy and oral or topical medications prescribed by a dermatologist.

Cancer rehabilitation services may be recommended, including physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see a specialist like a dermatologist or oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

Making healthy lifestyle choices

Many people who are treated for skin cancer lead an active, outdoor lifestyle, and it is very important to take steps to protect your skin from further damage. Participating in outdoor activities before 10:00 AM or after 4:00 PM and wearing long sleeves, pants, broad-spectrum sunscreen, sunglasses with UV protection, and a wide-brimmed hat will protect against further skin damage. Learn more about protecting your skin from the sun.

People recovering from skin cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

The next section offers Questions to Ask the Doctor to help start conversations with your cancer care team. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Skin Cancer (Non-Melanoma) - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

Questions to ask before a biopsy

  • What should I expect during and after a skin biopsy?

  • Will the biopsy remove all of the lesion?

  • Will there be a scar?

  • Are there other lesions that should be biopsied?

  • To which laboratory is the biopsy being sent? Is there a pathologist who specializes in skin cancer working there?

Questions to ask after getting a diagnosis

  • What type of skin cancer do I have?

  • Can you explain my pathology report (laboratory test results) to me?

  • Are more tests needed to find out if the cancer has spread?

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?

  • What clinical trials are open to me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • What are the alternatives to the treatment you are suggesting?

  • What are the possible side effects of this treatment, both in the short term and the long term?

  • Who will be part of my health care team, and what does each member do?

  • Who will be coordinating my overall treatment?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • If I’m worried about managing the costs related to my cancer care, who can help me with these concerns?

  • What support services are available to me and my family?

  • Whom should I call for questions or problems?

  • Is there anything else I should be asking?

Questions to ask about having surgery

  • What type of surgery will I have?

  • How long will it take to remove the lesion?

  • Can you describe what my recovery from surgery will be like?

  • Will there be ongoing pain after the removal of the cancer? If so, what types of pain management programs, such as medications or relaxation techniques, are available?

  • What will the scar look like after surgery? How long will it take to heal?

  • Are there any other possible long-term effects of having this surgery?

Questions to ask about planning follow-up care

  • What is the risk of the cancer returning? Are there signs and symptoms I should watch for?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • How often should I have check-ups to watch for other skin cancers?

  • What other follow-up tests will I need, and how often will I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be coordinating my follow-up care?

  • What steps should I take to prevent future skin cancers?

  • What support services are available to me? To my family?

The next section in this guide is Additional Resources, and it offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Skin Cancer (Non-Melanoma) - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Non-Melanoma Skin Cancer. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Non-Melanoma Skin Cancer. Use the menu on the side of your screen to select another section to continue reading this guide.