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Skin Cancer (Non-Melanoma) - Introduction

Approved by the Cancer.Net Editorial Board, 01/2018

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. Use the menu to see other pages. Think of that menu as a roadmap for this complete guide.

About the skin

The skin is the body’s 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 3 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 out of control, 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 3 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 topical medications, procedures done in the office by a dermatologist, or 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 4 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, although it can be found anywhere on the skin. 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. Around 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, so it may be diagnosed on many regions of the skin. It can also develop on skin that has been burned, damaged by chemicals, or exposed to x-rays. Squamous cell carcinoma is commonly found on the lips; at sites of a long-standing scar; and on the skin outside the mouth, anus, and a woman’s vagina. About 2% to 5% of squamous cell carcinomas spread to other parts of the body, which makes it more likely to spread than basal cell carcinoma.

  • Merkel cell cancer. Merkel cell cancer is a highly aggressive, or fast-growing, rare cancer. It starts in hormone-producing cells just beneath the skin and in the hair follicles. It is usually found in the head and neck region. Merkel cell cancer may also be called neuroendocrine carcinoma of the skin or trabecular cancer.

  • Melanoma. Where the epidermis meets the dermis, there are scattered cells called melanocytes. These cells produce the pigment melanin, which gives skin its 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 “keratinocyte carcinomas,” because they begin in a type of skin cell called a keratinocyte, or “non-melanoma skin cancer” to distinguish them from melanoma. Melanoma is treated differently because it is more likely to spread than other skin cancers. 

Typically, non-melanoma skin cancers can be treated with topical medications, procedures at a dermatologist’s office, or a relatively simple surgery. A dermatologist is a doctor who specializes in diseases and conditions of the skin. If the cancer is very small, medicated creams prescribed by a doctor, cauterization (burning), cryosurgery (freezing), or laser surgery may be used (see Treatment Options). 

There are a few other rare types of skin cancer, including cutaneous (skin) lymphomas, Kaposi sarcoma, skin adnexal tumors, and sarcomas, all of which are classified as non-melanoma skin cancers. The rest of this section focuses on the more common non-melanoma skin cancers.

Looking for More of an Introduction?

If you would like more of an introduction, explore this related item. Please note that this link will take you to another section on Cancer.Net: 

  • ASCO Answers Fact Sheet: Read a 1-page fact sheet that offers an introduction to basal cell carcinoma. This fact sheet is available as a PDF, so it is easy to print out.

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with this disease and general survival rates. You may use the menu to choose a different section to read in this guide.

Skin Cancer (Non-Melanoma) - Statistics

Approved by the Cancer.Net Editorial Board, 01/2019

ON THIS PAGE: You will find information about the number of people who are diagnosed with non-melanoma skin cancer each year. You will read general information on surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

Skin cancer is the most common type of cancer. Because non-melanoma skin cancer/keratinocyte carcinoma is so common and often curable, statistics are estimated. This is because individual cases are not usually reported to cancer registries.

It is estimated that more than 3 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. About 80% of non-melanoma skin cancer is basal cell carcinoma.  

About 2,000 people die from basal cell and squamous cell skin cancer each year. Most of these deaths, which have been declining in recent years, occur in the elderly. About 7,230 people die from melanoma each year. For other, less common types of skin cancer, about 4,420 people die every year.

Approximately 2,000 people in the United States are diagnosed with Merkel cell cancer each year. This number has been rising rapidly the last few decades. Almost all people diagnosed with the disease are older than 70, and 90% of Merkel cell cancer diagnoses occur in white people. Men are twice as likely to be diagnosed with the disease than women. The 10-year survival rate of people with Merkel cell cancer is about 57%. It is much higher if the cancer is found early, before it has spread to the lymph nodes or distant parts of the body. Lymph nodes are tiny, bean-shaped organs that help fight infection.

It is important to remember that statistics for non-melanoma skin cancers are an estimate. The estimate comes from annual data based on the number of people with non-melanoma skin cancer in the United States. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts & Figures 2019, and the ACS website (January 2019).

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by non-melanoma skin cancer. Use the menu to choose a different section to read in this guide. 

Skin Cancer (Non-Melanoma) - Medical Illustrations

Approved by the Cancer.Net Editorial Board, 01/2018

ON THIS PAGE: You will find a basic drawing of the structures and layers that make up the skin. Use the menu to see other pages.

This illustration shows the many layers of the skin. The thin top layer is the epidermis. Under the epidermis is the dermis, which is the inner layer of skin. Under that is the subcutaneous tissue, which is a deep layer of fat. The dermis is largely made up of elastic fibers. It also contains hair follicles, which are nourished by veins and arteries that run throughout the dermis and subcutaneous tissue. Small muscles, called arrector muscles, are connected to the hair follicle, as are sebaceous glands. The shaft of hair grows up out of the hair follicle and through the epidermis, which also contains pores for sweat glands. Copyright 2004 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

See pictures of the features of basal cell carcinoma and of the signs of squamous cell carcinoma. (Please note that these links will take you to a different website.)

The next section in this guide is Risk Factors and Prevention. It explains what factors may increase the chance of developing this disease. You may use the menu to choose a different section to read in this guide.

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

Approved by the Cancer.Net Editorial Board, 01/2018

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. Use the menu to see other pages.

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. 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 non-melanoma skin cancer/keratinocyte carcinoma: 

  • 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. People who spend a lot of time outside during the midday hours also have a higher risk. Recreational suntanning should be avoided to reduce the risk of skin cancer.

    Exposure to ultraviolet type B (UVB) radiation appears to be more closely linked with skin cancer, but newer research suggests that ultraviolet type A (UVA) may also play a role in the development of basal cell carcinoma, squamous cell carcinoma, and melanoma. UVB radiation causes sunburn and does not penetrate car windows or other types of glass. However, UVA can 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).

    Because Merkel cell cancer often occurs on the sun-exposed areas of the head and neck, many doctors think that sun exposure may also be a risk factor for this type of cancer.

  • Artificial tanning. People who use tanning beds, tanning parlors, or sun lamps have an increased risk of developing all types of skin cancer. There is no safe amount of indoor tanning. Any use of indoor tanning devices increases the risk of skin cancer, including melanoma, and this risk increases with more use of indoor tanning. 

  • Fair skin. People with a fair complexion, blond or red hair, blue eyes, and freckles are at increased risk for developing skin cancer. People whose skin has a tendency to burn rather than tan also have an increased risk. Despite this, all people, regardless of skin color, are at risk for developing skin cancer.

  • Race/ethnicity. White people are most likely to develop Merkel cell cancer; however, some black people and people of Polynesian descent develop the disease.

  • Merkel cell polyomavirus (MCV). Research indicates that there is a link between this virus and Merkel cell cancer. MCV is present in up to an estimated 80% of Merkel cell cancers. However, scientists believe MCV is common, while Merkel cell cancer is not. More research is needed to learn the role of MCV in this connection.

  • Precancerous skin conditions. Rough, red, or brown scaly patches on the skin, called actinic keratoses or Bowen's disease, are usually more common in areas exposed to the sun. These areas can change into squamous cell cancers in a small number of people. The more actinic keratoses a person has, the higher the risk that he or she will develop 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 30 or more 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 white women who have developed skin cancer in recent years has increased. Men are also more likely to develop Merkel cell cancer.

  • 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, although this may be due to better screening and patient tracking efforts in skin cancer. Younger people can also develop non-melanoma skin cancer, especially if they have fair skin, an inherited (genetic) syndrome that puts them at high risk, or been exposed to significant amounts of radiation or UV radiation from the sun. Merkel cell cancer is most common in people older than age 70.

  • 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 who have more exposure to the sun or other sources of UV radiation over their lifetime.

  • Previous skin cancer. People who have had any form of skin cancer have a higher risk of developing another skin cancer. From 35% to 50% of people diagnosed with 1 basal cell carcinoma will develop a new skin cancer within 5 years. Therefore, people who have had 1 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 syndrome, and the very rare Rombo, Bazex-Dupré-Christol, and epidermolysis bullosa simplex 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 a weakened immune system due to a stem cell or a solid organ transplant or diseases such as HIV/AIDS and certain types of leukemia have a higher risk of developing skin cancer, particularly squamous cell carcinoma. People taking immunosuppressive drugs have the same higher risk.

  • Arsenic exposure. Exposure to the poison arsenic may increase the risk of Merkel cell cancer.

  • 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. So-called BRAF inhibitors, including dabrafenib (Tafinlar), encorafenib, and vemurafenib, have been shown to increase a person’s risk of developing squamous cell carcinoma by turning on a growth pathway in cells that tend to turn into this type of cancer (for example, cells with an HRAS mutation).

  • 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 6 times higher risk for developing a basal cell carcinoma.

  • Human papillomavirus (HPV). Research shows that this virus is a risk factor for squamous cell carcinoma, particularly if the person’s immune system becomes suppressed. Sexual activity with someone who has HPV is the most common way someone gets HPV. There are different types of HPV, called strains. Research links some HPV strains more strongly with certain types of cancers. There are vaccines available to protect you from some HPV strains.

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause non-melanoma skin cancers. Although there is no proven way to completely prevent these diseases, 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 time spent in the sun and avoiding indoor tanning devices, 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 (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 is SPF 30 or more. Reapply at least 1 ounce of sunscreen to your entire body every 2 hours or every hour after heavy sweating 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 and self-examinations. Learn more about how to do a self-examination.

  • Taking nicotinamide, a form of vitamin B3, as a tablet twice daily showed a reduction in non-melanoma skin cancer by 23% in patients who had 2 or more previous skin cancers.

  • Talk with your doctor about this if you have higher risk for skin cancer.

Learn more about protecting your skin from the sun on Cancer.Net.

Limiting your sun exposure may reduce your body’s production of vitamin D, although some research suggests that most people may only need 15 minutes of sunlight exposure to produce enough 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 by your doctor using a simple blood test.

The next section in this guide is Screening. It describes the early warning signs of skin cancer and how to perform a self-examination. You may use the menu to choose a different section to read in this guide.

Skin Cancer (Non-Melanoma) - Screening

Approved by the Cancer.Net Editorial Board, 01/2018

ON THIS PAGE: You will find out more about screening for skin cancer and what to look for during self-examination. Use the menu to see other pages.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer before signs or symptoms appear. The overall goals of cancer screening are to: 

  • Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

  • Lower the number of people who develop the disease 

Learn more about the basics of cancer screening.

Screening information for non-melanoma skin cancer

Early detection and recognition of skin cancer are very important. More than 75% of non-melanoma skin cancers/keratinocyte carcinomas are diagnosed by patients or their families. Recognizing the early warning signs of skin cancer and doing regular self-examinations of your skin can help find skin cancer early, when the disease is more likely to be cured.

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 exposed to the sun. For people with darker skin, squamous cell carcinoma often occurs in areas that are not as frequently 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 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 2 weeks

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems this disease can cause. You may use the menu to choose a different section to read in this guide.

Skin Cancer (Non-Melanoma) - Symptoms and Signs

Approved by the Cancer.Net Editorial Board, 01/2018

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

People with a basal cell carcinoma, squamous cell carcinoma, or Merkel cell cancer may experience the following symptoms. Sometimes, people with non-melanoma skin cancer/keratinocyte carcinoma do not have any of these changes. Or, the cause of a symptom may be a different medical condition that is not cancer.

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. The skin features that frequently develop are listed below.

For basal cell carcinoma, 2 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 that 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

  • A raised growth with a rough surface and a central depression 

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

Merkel cell cancer often occurs as:

  • Painless, firm, shiny lumps on the skin

  • These lumps can be red, pink, or blue 

Some types of skin cancer spread along the nerves. If this happens, it 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 any changes you experience, 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 figure out the cause of the problem, called a diagnosis.

For most cases of skin cancer, removing the cancer with surgery or using a topical treatment will cure the disease. If the skin cancer cannot be easily treated, relieving symptoms will be 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 the symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. You may use the menu to choose a different section to read in this guide. 

Skin Cancer (Non-Melanoma) - Diagnosis

Approved by the Cancer.Net Editorial Board, 01/2018

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. Use the menu to see other pages.

More than 75% of non-melanoma skin cancers/keratinocyte carcinomas are first noticed by patients or family members, so it is important to bring any suspicious area to a doctor’s attention. Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. Your doctor may consider these factors when choosing a diagnostic test: 

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

Biopsy

Because non-melanoma skin cancer rarely spreads, a biopsy is often the only test needed to diagnose and find out the stage, or 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 numbs 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 how a biopsy is used to make a diagnosis

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. You may use the menu to choose a different section to read in this guide.

Skin Cancer (Non-Melanoma) - Stages

Approved by the Cancer.Net Editorial Board, 01/2018

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. Use the menu to see other pages.

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.

Staging for basal cell and squamous cell carcinoma

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

Staging for Merkel cell cancer

Doctors use the TNM system to describe the stage of Merkel cell cancer. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many? 

  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of Merkel cell cancer for each person.

There are 5 stages: stage 0 (zero) and stages I through IV (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Stage 0: This is called carcinoma in situ. Cancer cells are found only in the top layers of the skin. The cancer does not involve the lymph nodes, and it has not spread.

Stage I: The primary tumor is 2 centimeters (cm) or smaller at its widest part. The cancer has not spread to the lymph nodes or to other parts of the body. 

Stage IIA: The tumor is larger than 2 cm and has not spread to the lymph nodes or other parts of the body. 

Stage IIB: The tumor has grown into nearby tissues, such as muscles, cartilage, or bone. It has not spread to the lymph nodes or elsewhere in the body. 

Stage III: The cancer has spread to the lymph nodes. The tumor can by any size and may have spread to nearby bone, muscle, connective tissue, or cartilage. 

  • Stage IIIA: The tumor is any size or may have grown into nearby tissues. Biopsy or surgery has found that the cancer has spread to nearby lymph nodes. The cancer has not spread to other parts of the body. Or, there is no sign of a tumor, but cancer was found in a nearby lymph node during an exam or with imaging scans. Its presence was confirmed using a microscope.

  • Stage IIIB: The tumor is any size or may have grown into nearby tissues. The cancer has spread through the lymphatic system, either to a regional lymph node located near where the cancer started or to a skin site on the way to a lymph node, called “in-transit metastasis.” In-transit metastasis may have reached these other lymph nodes. The lymphatic system is part of the immune system and drains fluid from body tissues through a series of tubes or vessels. 

Stage IV: The tumor has spread to distant parts of the body, such as the liver, lung, bone, or brain. 

Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017), published by Springer International Publishing. 

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. You may use the menu to choose a different section to read in this guide.

Skin Cancer (Non-Melanoma) - Treatment Options

Approved by the Cancer.Net Editorial Board, 01/2018

ON THIS PAGE: You will learn about the different treatments doctors use for people with these types of skin cancer. Use the menu to see other pages.

This section tells you the treatments that are the standard of care for this type of cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, 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 include a variety of other health care professionals, such as physician assistants, nurses, social workers, pharmacists, counselors, dietitians, and others.

Descriptions of the most common treatment options for basal cell carcinoma, squamous cell carcinoma, and Merkel cell 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. Talk with your doctor about the goals of each treatment 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. Often no other treatment is needed.

Which type of surgical procedure is used depends on the size and location of the lesion. Most of these procedures use a local anesthetic to numb the skin first. They can be done outside of a hospital by a dermatologist, surgical oncologist, general surgeon, plastic surgeon, nurse practitioner, or physician assistant.

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, for those located in the head-and-neck region, and for cancers that have come back in the same place.

  • Wide excision. This involves the removal of the tumor and some surrounding healthy skin and soft tissue, called a margin. When a large tumor is removed, the incision may be too large to close, so surgeons may use skin from another part of the body to close the wound, which is called a skin graft. This helps with healing and reduces 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. When doctors plan treatment, they consider how treatment might affect a person’s quality of life, such as how the person feels, looks, talks, and eats. Before any surgery for skin cancer, talk with your doctor about whether changes to your appearance are possible and whether there may be functional aspects that need to be considered when developing a treatment plan.

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. In general, surgery may be associated with side effects such as pain, scarring, numbness, skin stretching, wound problems, infection, and appearance changes where surgery was performed.  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. It is also used in some people who would like to avoid scarring from surgery. Sometimes radiation therapy may be recommended after surgery to help prevent the skin cancer from coming back.

For Merkel cell cancer, radiation therapy is often given after surgery for stage I and II disease. This is called adjuvant therapy.

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, or 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 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 topical treatments. These may include chemotherapy as a cream or lotion, photodynamic therapy, cryotherapy, or laser therapy. 

  • Chemotherapy. Chemotherapy is the use of drugs to destroy cancer cells, usually by ending the cancer cells’ ability to grow and divide. These drugs are usually applied to the skin every day for several weeks. They may cause skin inflammation or irritation, which will go away after 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, 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, 5 days a week, for 6 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 2 times a day for 3 to 6 weeks. Some irritation and redness in the area of the basal cell carcinoma is expected with this 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.

  • Photodynamic therapy. This is a combination treatment for actinic keratosis. First, a topical medication called aminolevulinic acid (Levulan) is applied over areas with many actinic keratoses. 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 pain medication 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.

  • 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 1 freezing may be needed. Sometimes this procedure leaves a pale scar.

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

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

The U.S. Food and Drug Administration (FDA) has approved avelumab (Bavencio) to treat patients 12 and older with Merkel cell cancer that has spread to another part of the body. This is called metastatic cancer. Avelumab blocks the programmed death-ligand 1 (PD-L1) pathway. By blocking this pathway, the body’s immune system may be able to more effectively fight cancer cells.

Learn more about the basics of targeted treatments.

Immunotherapy (updated 10/2018)

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. There is 1 immunotherapy drug approved by the FDA for the treatment of metastatic or locally advanced squamous cell carcinoma. It is an immune checkpoint inhibitor called cemiplimab-rwlc (Libtayo) that targets the PD-1 pathway.  

Different types of immunotherapy can cause different side effects. The common side effects of cemiplimab-rwlc include fatigue, rash, and diarrhea. It can also cause severe and possibly life-threatening side effects, including problems in the lung, intestines, liver, hormone gland, skin, and kidneys. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatments intended 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 at the same time that they receive treatment to ease side effects. In fact, patients who receive both at the same time 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. 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 spreads to another part in the body from where it started. In these situations, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Surgery alone cannot always eliminate skin cancer that has metastasized. If cancer cannot be removed with surgery, it is called unresectable. To control distant spread, a person’s treatment plan may include chemotherapy, radiation therapy, and/or targeted therapy. Palliative care will also be important to help relieve symptoms and side effects.

Metastatic or unresectable squamous cell carcinoma of the skin is rare, so treatment plans often use the same treatments that have been demonstrated to work in patients with squamous cell carcinoma of the head and neck that may not have originated from the skin. Chemotherapy usually includes taxanes, such as docetaxel (Taxotere) or paclitaxel (Taxol, Onxal), and platinums, such as carboplatin (Paraplatin) or cisplatin (Platinol).

A chemotherapy regimen, or 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, rashes, diarrhea, and changes in sensation in the tips of the fingers or toes. Learn more about the basics of chemotherapy and preparing for treatment.

Targeted therapies may be used for some patients with squamous cell carcinoma, including cetuximab (Erbitux), panitumumab (Vectibix), and erlotinib (Tarceva). These drugs are usually delivered through an intravenous (IV) tube placed into a vein using a needle.

For people with metastatic basal cell carcinoma that cannot be treated with surgery or radiation therapy, targeted therapy may be an option. Vismodegib (Erivedge) and sonidegib (Odomzo) are FDA-approved drugs known as hedgehog pathway inhibitors. They block the PTCH1 genetic mutation, which seems to drive the growth of basal cell carcinoma. This treatment shrinks tumors in many patients. The main side effects of this treatment include hair thinning, muscle cramps, weight loss, dry skin, and loss of taste. 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 the fear of recurrence.

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 new cycle of testing will begin again to learn as much as possible about the recurrence. After this 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 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. It offers more information about research studies that are focused on finding better ways to care for people with cancer. You may use the menu to choose a different section to read in this guide.

Skin Cancer (Non-Melanoma) - About Clinical Trials

Approved by the Cancer.Net Editorial Board, 01/2018

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. Use the menu to see other pages.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for people with non-melanoma skin cancer/keratinocyte carcinoma. 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 tested in clinical trials. 

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. 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 can be some of the first to get a treatment before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study. 

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

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 a way to contribute to the 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. 

Insurance coverage of clinical trials costs differs by location and by study. In some programs, some of the patient’s expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” 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: 

  • Describe all of the patient's options so that the person understands how the new treatment differs from the standard treatment.

  • List risks of the new treatment, which may or may not be different from the risks of standard treatment.

  • 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. 

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together.

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.

PRE-ACT, Preparatory Education About Clinical Trials

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. It explains areas of scientific research currently going on for this type of cancer. Or, use the menu to choose another section to continue reading this guide.

Skin Cancer (Non-Melanoma) - Latest Research

Approved by the Cancer.Net Editorial Board, 01/2018

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. Use the menu to see other pages.

Doctors are working to learn more about non-melanoma skin cancer/keratinocyte carcinoma and Merkel cell cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with these diseases. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you. 

  • EGFR inhibitors for advanced or metastatic squamous cell carcinoma. A tumor protein known as the epidermal growth factor receptor (EGFR) causes many squamous cell carcinomas to grow out of control. Several clinical trials are investigating whether combining radiation therapy with drugs that inhibit EGFR can help treat advanced or metastatic disease.

  • Additional hedgehog pathway inhibitors for advanced basal cell carcinoma. Researchers are developing new hedgehog pathway inhibitors to treat 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 helpful in treating basal cell carcinomas that are difficult to cure.

  • Immunotherapy. Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Immunotherapies are currently approved by the FDA for the treatment of other cancers, including melanoma and head and neck squamous cell carcinoma, but are being actively studied for certain non-melanoma skin cancers, including Merkel cell cancer. These medications are usually given through a vein, and their beneficial effects can last a long time. 

  • Merkel cell polyomavirus (MCV). As described in Risk Factors, MCV is present in most but not all Merkel cell cancer tumors. Researchers continue to investigate the link between this common virus and this uncommon type of tumor, including whether the presence or absence of the virus in a tumor could result in different treatment approaches.

  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current skin cancer treatments 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 Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. You may use the menu to choose a different section to read in this guide.

Skin Cancer (Non-Melanoma) - Coping with Treatment

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ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. This page includes several links outside of this guide to other sections of this website. Use the menu to see other pages.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people don’t experience the same side effects even when they are given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical and cosmetic side effects

Common physical side effects from each treatment option for non-melanoma skin cancer/keratinocyte carcinoma are described in the Treatment Options section. Because skin cancers often occur in areas of the skin that are exposed, the scars that result from treatment can affect a person’s self-esteem. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s extent, the length and dose of treatment, and your general health.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late 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.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as sadness, anxiety, or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in response.

Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. Learn more about managing financial considerations in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with skin cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers take care of: 

  • Providing support and encouragement

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues 

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask: 

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them? 

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Follow-up Care. It explains the importance of checkups after cancer treatment is finished. You may use the menu to choose a different section to read in this guide.

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

Approved by the Cancer.Net Editorial Board, 01/2018

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

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.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. An important part of your follow-up care will be regular screening for new non-melanoma skin cancers/keratinocyte carcinomas, which should include whole-body skin examinations by a health care professional. This is because many people treated for 1 skin cancer develop other skin cancers later.

Learn more about the importance of follow-up care.

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 ask specific questions about your health. Some people may have blood tests or imaging tests done 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.

The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scan-xiety.” Learn more about how to cope with this type of stress.

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. 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, reconstructive services may be needed. 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 at home 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. Talk with your health care team, including a social worker, to help plan for this, if necessary.

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 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 discuss 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 when 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 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 and with 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. Participate in outdoor activities before 10:00 AM or after 4:00 PM. When you are outdoors, plan on wearing long sleeves, pants, broad-spectrum sunscreen, sunglasses with UV protection, and a wide-brimmed hat to 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 on your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. You may use the menu to choose a different section to read in this guide.

Skin Cancer (Non-Melanoma) - Questions to Ask the Health Care Team

Approved by the Cancer.Net Editorial Board, 01/2018

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. Use the menu to see other pages.

Talking often with your health care team 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 a digital 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 any other risks to performing the biopsy?

  • 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 available for 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?

  • Are there other ways to treat the cancer, in addition to the treatment you are suggesting?

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

  • Could this treatment cause changes to my appearance?

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

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

  • Who will be leading my overall treatment?

  • If I’m worried about managing the costs of cancer care, who can help me?

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

  • Whom should I call with questions or problems?

Questions to ask about having surgery

  • What type of surgery will I have?

  • How long will it take to remove the lesion? 

  • How will the surgical area resulting from the removal of the lesion be closed, repaired, or reconstructed?

  • Can you describe what my recovery from surgery will be like? Are there limitations to activities? If so, for how long?

  • Will there be ongoing pain after the cancer is removed? 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 radiation therapy and targeted therapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

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

  • How often should I have checkups 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 leading 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. It offers some more resources on this website beyond this guide that may be helpful to you. You may use the menu to choose a different section to read in this guide.

Skin Cancer (Non-Melanoma) - Additional Resources

Approved by the Cancer.Net Editorial Board, 01/2018

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. Use the menu to go back and see other pages.

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. You may use the menu to choose a different section to read in this guide.