The skin is divided into two main layers. Cancer can develop in the different types of cells that make up these layers.
There are three main types of skin cancer:
- basal cell carcinoma (BCC)
- squamous cell carcinoma (SCC)
- malignant melanoma.
We have separate information on malignant melanoma.
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Most skin cancers are caused by skin damage that happens from exposure to the sun. The damage can happen over a long period of time or from getting sunburnt.
People with a history of sunburn or overexposure to the sun in childhood also have a greater risk of developing both basal cell carcinoma and squamous cell carcinoma. Because people are living longer, they are exposed to more sun over their lifetime.
If you are worried about skin cancer, we have more information about risk factors.
People who have symptoms usually begin by seeing their GP. If your GP thinks cancer could be causing the symptoms, they will usually refer you to a specialist (called a dermatologist) at the local hospital. But sometimes, a specially trained GP may be able to remove the affected area themselves.
If the GP thinks you have an SCC, you will usually see the specialist within 2 weeks. For BCC, you will usually be seen within 18 weeks, because nearly all BCCs are slow-growing. Sometimes you will be seen sooner. Your GP can explain the referral process.
At the hospital
The dermatologist will do the following:
- Examine the affected area of skin. They may use an instrument called a dermascope, which looks like a magnifying glass with a light.
- Ask you questions about how long you have had it and if you have noticed any changes.
- Check the rest of your skin to see if there are any other unusual areas.
It is not always possible to tell the difference between skin cancers and benign (non-cancerous) conditions just by examining the skin. The doctors may advise you to have a sample of tissue taken (biopsy). This is a simple procedure which you can have in the outpatient department.
The dermatologist will remove all or part of the affected area and send it to the laboratory. A doctor who specialises in analysing cells (pathologist) will then look at it under a microscope.
Further tests after diagnosis
You probably will not need any further tests. This is because the cancer is usually removed completely during the biopsy and BCCs almost never spread.
The dermatologist may want to check the rest of your body. This is to make sure that you do not need any further treatment, as SCCs can occasionally spread. This is particularly important if you have had skin cancer before and it has come back.
They may also feel the lymph nodes close to the cancer to check if they are enlarged. Rarely, they may recommend an operation to take samples if they think the cancer may have spread there.
Very occasionally, you may have some scans, which might include the following:
A PET-CT scan is a combination of a CT scan, which takes a series of x-rays to build up a three-dimensional picture, and a positron emission tomography (PET) scan. A PET scan uses low-dose radiation to measure the activity of cells in different parts of the body.
Waiting for test results can be a difficult time. We have more information that may help.
A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).
Your doctor will explain the different treatments and their side effects. They will also talk to you about the things you should consider when making treatment decisions.
Most people with BCCs or SCCs are cured with treatment. There are different types of treatments. The one you are offered will depend on:
- the size of the skin cancer
- where it is on your body
- the biopsy results
- whether you have had skin cancer before
- your general health and any preferences you have.
The types of treatment include:
Photodynamic therapy (PDT)
Radiotherapy can be a very effective treatment for BCCs and SCCs and may be used instead of surgery. Or you may have it after surgery if there is a risk that some cancer cells may still be present. Sometimes it is used for cancers that have grown into the deeper layers of the skin.
If there is evidence that a SCC has spread, you may need to have some lymph nodes removed. Only a very small number of people who have SCCs need this operation.
Rarely, if the cancer has spread deeper or further from the original site, you may have chemotherapy.
You may also be offered treatment as part of a clinical trial.
Follow up after treatment for skin cancer
Many people who have surgery for BCCs and very early-stage SCCs will not need long-term follow-up. But you may have regular check-ups with your doctor for a time. This is to make sure treatment has been successful, and to make sure the cancer has not come back.
Once you have had a skin cancer, you are more at risk of developing another one somewhere else. You also have a higher risk of developing a recurrence of the skin cancer in the area where you had it before. There are things you should do to help prevent further skin cancers.
You should check your skin regularly for any new symptoms or changes. You could use a mirror to check areas like your back, or you can ask a relative or friend to help. If you have any problems, or notice any new symptoms in between check-ups, tell your doctor straightaway.
Doctors try to minimise the effects of skin cancer treatments on appearance. If treatment has changed the way you look, you may feel differently about yourself and your body image.
Although the effects will often improve with time, it may make some people feel more self-conscious about how they look.
There are practical things that can help you to feel better about your appearance.
Below is a sample of the sources used in our skin cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
Motley et al. British Association of Dermatologists. Management of the patient with primary cutaneous squamous cell carcinoma. 2009.
National Institute for Health and Care Excellence (NICE). NG12: Suspected cancer: recognition and referral. 2015 (updated 2017).
National Institute for Health and Care Excellence (NICE). NG134: Sunlight Exposure: Benefits and Risks. 2016.
National Institute for Health and Care Excellence (NICE). PH32: Skin Cancer Prevention. 2011 (updated 2016).
Scottish Intercollegiate Guidelines Network (SIGN) 140. Management of primary cutaneous squamous cell carcinoma. 2014.
Telfar N et al. Guidelines for the management of basal cell carcinoma. British Journal of Haematology. 2008.
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Professor James Larkin, Consultant Medical Oncologist.
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