View All Pages

Skin Cancer (Non-Melanoma) - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/2013

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 Skin Cancer (that is not melanoma). To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

Skin cancer is the most common type of cancer, with doctors finding skin cancer in more than two million Americans each year, resulting in over 3.5 million cases of basal cell and squamous cell cancer and 76,600 cases of melanoma. Reducing exposure to ultraviolet (UV) radiation from sunlight can prevent most skin cancers. If skin cancer is found early, it can usually be cured by relatively simple surgery. Skin cancer is responsible for less than 1% of all cancer deaths.

About the skin

The skin, the body's largest organ, protects against infection and injury and helps regulate body temperature. The skin also stores water and fat and produces vitamin D. Skin is made up of two main layers: the epidermis (outer layer of skin) and the dermis (inner layer of skin). See the Medical Illustrations section for a drawing of these layers.

Types of skin cancer

Cancer begins when normal cells change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). There are three main types of skin cancer:

Basal cell carcinoma. Cells in the lower epidermis are round cells known as basal cells. About 80% of skin cancer develops from this type of cell and is called basal cell carcinoma. 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 metastasizes (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 cancer develops from these cells and is called squamous cell carcinoma. This type of cancer is mainly caused by sun exposure, but it can appear on skin that has been burned, damaged by chemicals, or exposed to x-rays. Sites of a chronic inflammatory skin condition, mucous membranes (skin that lines the mouth, nose, anus, and a woman’s vagina), and the lips are susceptible to squamous cell carcinoma. Squamous cell carcinoma rarely metastasizes, but it is more likely to spread than basal cell carcinoma.

Melanoma. Where the epidermis meets the dermis, there are scattered cells called melanocytes, which 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 cancers to distinguish them from melanoma, which develops from very different cells and is treated differently because it is more likely to spread than other skin cancers. Typically, non-melanoma skin cancers can be treated with relatively simple surgery. If the cancer is very small, medicated creams prescribed by a doctor, 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.

To continue reading this guide, use the menu on the side of your screen to select another section.  

Skin Cancer (Non-Melanoma) - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/2013

ON THIS PAGE: You will find information about how many people learn they have 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 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 more than 9,000 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, but the actual risk for a particular individual may differ. 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.

Source: The American Cancer Society.

To continue reading this guide, use the menu on the side of your screen to select another section.  

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

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/2013

ON THIS PAGE: You will find out more about what factors increase the chance of 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 role in the development of skin cancer. Exposure to ultraviolet B (UVB) radiation from the sun appears more closely associated with skin cancer, but newer information suggests that ultraviolet A (UVA) may also play a role in the development of basal cell and squamous cell carcinoma and melanoma. Whereas UVB radiation causes sunburn and does not penetrate through glass (car windows, etc.), 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).

People who live in areas with bright sunlight year-round (which includes both UVA and UVB radiation) or at high altitudes have a higher risk of developing skin cancer, as do those who spend a lot of time outside during the midday hours. Skin cancer has also been linked to recreational exposure to intermittent UV, whether from the sun or from indoor tanning facilities (which emit mostly UVA radiation).

Artificial tanning. People who use tanning beds, tanning parlors, or sun lamps have an increased risk of all three types of skin cancer. Recreational sun tanning should 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.

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, but 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.

Other medical conditions. People with weakened immune systems (due to a stem cell transplant or diseases such as HIV/AIDS and certain types of leukemia) or those who use certain medications (such as immunosuppressive drugs, certain steroids, and drugs that make the skin sensitive to light) have a higher risk of developing skin cancer, particularly squamous cell cancer. People with some rare genetic conditions, such as xeroderma pigmentosum, nevoid basal cell carcinoma syndrome, or albinism have a much higher risk of developing skin cancer.

Prior treatment with radiation therapy. People who have received radiation therapy for other types of cancer have a higher risk of developing basal cell carcinoma in the area that was exposed to the 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 After Treatment section for more information.

Precancerous skin conditions. Lesions called actinic keratoses (rough, red or brown scaly patches on the skin) or Bowen's disease are usually more common in areas exposed to the sun. Such 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 become a squamous cell carcinoma. Using a broad-spectrum sunscreen throughout the year that protects against both UVA and UVB radiation and has with 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.

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, and some strains are more strongly associated with certain types of cancers.

Prevention

Research continues to look into what factors cause basal cell and squamous cell carcinoma and what people can do to lower their personal risk. There is no proven way to completely prevent non-melanoma skin cancer, but there are steps you can take to lower your skin cancer risk. Talk with your doctor if you have concerns about your personal risk of developing these types of skin cancer.

Reducing exposure to UV radiation, particularly by reducing sun exposure, lowers the risk of developing skin cancer. 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, avoid sunburn, and help prevent skin cancer:

  • Limiting or avoiding sun exposure between 10:00 AM and 4:00 PM, as well as avoiding recreational sunbathing.
  • Wearing sun-protective clothing, including a wide-brimmed hat that shades the face, neck, and ears. Clothes made of fabric labeled with UPF (UV protection factor) may provide better protection. UV-protective sunglasses are also recommended.
  • Using a broad spectrum sunscreen throughout the year that protects against both UVA and UVB radiation and has with 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.
  • Examining the skin regularly (including examinations by a health care professional and self-examinations). Learn more about the signs and symptoms of skin cancer.
  • Avoiding use of sun lamps, tanning beds, and tanning salons.

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 only brief exposure to sunlight (less than 15 minutes) 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.

To continue reading this guide, use the menu on the side of your screen to select another section.  

Skin Cancer (Non-Melanoma) - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/2013

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. If you are concerned about a symptom or skin feature, please talk with your doctor.

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 takes 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 takes 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. Talk with your doctor if you experience any of these symptoms. Your doctor will then ask you questions to help find out the cause of the problem, called a diagnosis. This may include when you first noticed the skin feature, how long it has been there, and any other symptoms you may be experiencing.

If skin cancer is diagnosed, relieving symptoms and side effects 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.

Early detection: Finding skin cancer early

Earlier detection and recognition of skin cancer is the key to improving the chance for successful treatment. Recognizing 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. In people with fair skin, non-melanoma skin cancer most often begins on skin that has frequently been exposed to the sun. However, in 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 beard or if you find any of the following during a self-examination:

  • A growth on the skin that matches any symptom listed above
  • 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 helps explain what tests and scans may be needed to learn more about the cause of the symptoms. Use the menu on the side of your screen to select Diagnosis, or you can select 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, 12/2013

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 metastasized (spread). 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 has been used to numb the area), as well as an area of healthy tissue around the lesion (called the margin). The sample removed during the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease) who determines if it is skin cancer.

Your doctor will review the results of the biopsy with you. No further treatment beyond the biopsy may be necessary if the entire cancer is removed. However, if the cancer is present at the edges of the tissue removed during the biopsy, additional treatment will usually be necessary.

Learn more about what to expect when having a biopsy

The next section helps explain the different stages for this type of cancer. Use the menu on the side of your screen to select Stages, or you can select 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, 12/2013

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 determine 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 (chance of recovery).

Basal cell and squamous cell carcinoma rarely spread to other parts of the body. On rare occasions, the patient’s lymph nodes (tiny, bean-shaped organs that help fight infection) may be removed to determine if the cancer has metastasized. The doctor may perform other tests, including blood tests, chest x-rays, and imaging scans of the liver, bones, and brain, but this is uncommon.

Information about the cancer’s stage will help the doctor recommend a treatment plan.  The next section helps explain the treatment options for this type of cancer. Use the menu on the side of your screen to select Treatment Options, or you can select 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, 12/2013

ON THIS PAGE: You will learn about the different ways doctors use to treat people with 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 proven 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 treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Your doctor can help you review all treatment options. For more information, see the 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.

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 type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about 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

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

Curettage and electrodessication. During this common procedure, the skin lesion is removed with a curette, which is a sharp, spoon-shaped instrument. The area can then be treated with electrodessication, which uses an electric current to control bleeding and destroy any remaining cancer cells. Many people have a flat, pale scar after this procedure.

Mohs surgery. This technique 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 in hard-to-reach places, and for cancer that have recurred (come back) in the same place.

Freezing. Used most often on precancerous skin conditions, this procedure (called cryotherapy) uses liquid nitrogen to freeze and destroy abnormal cells. At first it stings, then the skin will blister and shed off. This procedure will sometimes leave a pale scar. More than one freezing may be needed.

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 both close the wound and reduce scarring. 

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

Learn more about cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy rays or other particles to kill 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 in places that are hard to treat, such as skin cancer that is located on the eyelid, tip of the nose, and 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 and for certain types of squamous cell carcinoma.

The side effects from radiation therapy may include a rash, itchy or red skin, or a change in the color of the skin. However, these side effects can usually be prevented with the use of a topical corticosteroid or antibiotic. If side effects do develop, most go away a few weeks after treatment has finished. Learn more about 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 kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. These drugs are usually applied to the skin daily for several weeks. They may cause inflammation, which goes away once treatment is finished.

Topical fluorouracil (Efudex), diclofenac (Solaraze), and ingenol mebutate (Picato) are creams that are approved for the treatment of 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 recommend use them to treat the face or other areas where cosmetic results are important.

For small basal cell cancers not on the face, topical imiquimod (Aldara), a topical immune system stimulant, has also been approved. The cream must be applied once a day, five days a week for six to 12 weeks. Topical fluorouracil is also approved for superficial (very thin) basal cell carcinomas, and it is 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 in which a topical medication (aminolevulinic acid) is applied over areas with many actinic keratoses and then 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.

Learn more about chemotherapy and preparing for treatment. 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 can help a person at any stage of illness. 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, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, and 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 supportive 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 is addressed as quickly as possible. Learn more about palliative care.    

Recurrent skin cancer

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

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious 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 the 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, including whether the cancer’s stage has changed. After testing is done, you and your doctor will talk about your treatment options. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

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.

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 seeking 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 is not effective to treat skin cancer that has metastasized. To control this distant spread, a person’s health care team may recommend chemotherapy, radiation therapy, or targeted therapy.

Chemotherapy usually consists of treatment with drugs such as taxanes (paclitaxel or docetaxel) and platinums (carboplatin or cisplatin). These chemotherapies are delivered intravenously (using an IV), and their main side effects include fatigue, low blood cell counts, and changes in sensation in the tips of the fingers or toes.

For people with metastatic 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. Vismodegib (Erivedge), the drug in this class approved by the U.S. Food and Drug Administration (FDA), blocks the PTCH1 genetic mutation, which seems to drive the uncontrolled growth of basal cell carcinoma. This results in dramatic tumor shrinkage in a majority of patients. The main side effects of this treatment include hair thinning, muscle cramps, dry skin, and loss of taste, which can lead to weight loss. 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.

If treatment fails

Recovery from cancer is not always possible. If treatment is not successful, which happens very rarely for people with non-melanoma skin cancer, the disease may be called advanced or terminal cancer. 

This diagnosis is stressful, and this is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and bereavement

The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select 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, 12/2013

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.

Doctors and scientists are always looking for better ways to treat patients with skin cancer. To make scientific advances, doctors create research studies involving volunteers, called 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.

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, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. 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.

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.

For specific topics being studied for non-melanoma skin cancer, learn more in the Latest Research section.

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. 

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.

The next section helps explain the areas of research going on today about this type of cancer. Use the menu on the side of your screen to select Latest Research, or you can select 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, 12/2013

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 drugs that inhibit EGFR are effective against advanced or metastatic disease.

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

Supportive 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.

To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now.

The next section addresses how to cope with the symptoms of the disease or the side effects of its treatment. Use the menu on the side of your screen to select Coping with Side Effects, or you can select another section, to continue reading this guide.  

Skin Cancer (Non-Melanoma) - Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/2013

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 or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

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.

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 psychosocial (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. Learn more about the importance of addressing such needs, 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 After Treatment section or talking with your doctor.

The next section helps explain medical tests and check-ups needed after finishing cancer treatment. Use the menu on the side of your screen to select After Treatment, or you can select another section, to continue reading this guide.  

Skin Cancer (Non-Melanoma) - After Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/2013

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

After treatment for skin cancer ends, talk with your doctor about developing a follow-up care plan. 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 later develop other skin cancers.

Sun protection and avoiding artificial tanning are essential to help prevent melanoma and other skin cancers. Many people who are treated for skin cancer lead an active, outdoor lifestyle, but it is very important to take steps to protect yourself from further skin 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.  

For most people with skin cancer, surgery removes only a small part of the skin, so there is little need for rehabilitation. However, in some cases, there may be some need for rehabilitation services if surgery was more extensive. People who have surgery, particularly multiple surgeries, on their face may have a substantially altered appearance. Rarely, the eyelid may be altered. The eyelid may not close well, and the person may need to use drops to moisten the eye. In those rare cases 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 prolonged absence from work or other activities.

Rarely, when radiation therapy is used, there is the possibility a second cancer may develop, which may not appear for more than 10 years after treatment. Chemotherapy is used extremely rarely in advanced disease. It is unlikely that the chemotherapy for advanced disease would have common late effects. It is important to note that chemotherapy is not curative for advanced squamous cell carcinoma and is unlikely to cause leukemia.

ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

People recovering from skin cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes.

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select 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, 12/2013

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.

Before a diagnosis of skin cancer

  • Can you explain what I can 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 there?

After a diagnosis of non-melanoma skin cancer

  • 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?
  • What are my treatment options?
  • What clinical trials are open to me?
  • 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?
  • Who will be part of my health care team, and what does each member do?
  • Who will be coordinating my overall treatment and follow-up care?
  • What are the possible side effects of this treatment, both in the short term and the long term?
  • Is there going to 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 following surgery? How long will it take to heal?
  • 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 is the likelihood that the cancer will come back?
  • After this treatment, 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?
  • What steps should I take to prevent future skin cancers?
  • What support services are available to me and my family?
  • Whom should I call for questions or problems?

The next section offers some more resources that may be helpful to you. Use the menu on the side of your screen to select Additional Resources, or you can select 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, 12/2013

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. Here are a few sections that may get you started in exploring the rest 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.