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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The first sign you notice may be a change in how an area of skin looks. This may be on any area of skin but usually affects an area of skin that gets a lot of exposure to the sun.
There are different symptoms of skin cancer. If you have any of these or notice any changes in your skin, it is important to have them checked by your GP.
Most skin cancers are caused by skin damage that happens from exposure to the sun. The damage can happen from sun exposure over a long period of time or from a history of 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 lifetimes.
If you are worried about skin cancer, we have more information about risk factors.
You usually begin by seeing your GP. If your GP thinks your symptoms could be linked to cancer they refer you to a specialist skin doctor (a dermatologist) at your local hospital. Sometimes, a specially trained GP may be able to remove the affected area of skin first.
Your GP decides how quickly you need to be seen based on your symptoms and national guidelines.
If they think you have an SCC, they refer you to see the dermatologist within 2 weeks. If the GP thinks you have a BCC, you will usually see the dermatologist within 18 weeks. This is because nearly all BCCs are slow-growing and unlikely to change during this time. Sometimes, you will be seen sooner. Your GP can explain the referral process to you.
At the hospital
The dermatologist will do the following:
- Examine the affected area of skin. They may use an instrument called a dermatoscope, which looks like a magnifying glass with a light.
- Ask how long you have had it and if you have noticed any other changes.
- Check the rest of your skin for 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. Your doctor may advise that you have a sample of tissue taken (biopsy). This is a simple procedure that you can have in an outpatient department.
You have a local anaesthetic to numb the area first. Then they remove all or part of the affected area and send it to the laboratory. A doctor who specialises in analysing cells (pathologist) will look at it under a microscope.
Different types of biopsy are used. Your doctor or nurse will tell you what to expect. If you need stitches these will be removed after a few days.
The doctor removes a small piece of the abnormal area, using a surgical knife.
They remove all the abnormal area and a small margin of healthy tissue around it.
The doctor uses a small round cutting instrument to remove a sample of skin.
They use an instrument to shave off the top layer of the affected area of skin. The wound forms a scab and heals so you do not need stitches.
If the biopsy shows you have a skin cancer, your doctor usually checks over the rest of your skin for other possible areas of skin cancer.
Further tests after diagnosis
Occasionally, some people may need further tests.
If you had treatment for skin cancer before, your doctor may want to check whether it has come back.
For basal cell carcinoma (BCC)
You will not usually need any further tests, as long as the cancer has been completely removed. This is because BCCs almost never spread.
For squamous cell carcinoma (SCC)
Your doctor may feel the lymph nodes close to the cancer to check whether any are enlarged.
If they think the cancer may have spread, which is rare, they may recommend surgery to take samples of the nearby lymph nodes.
You may have some scans if your doctor thinks the cancer has started to spread. These can include:
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.
These scans are not usually needed when you are first diagnosed. Your doctor will explain more about these tests to you.
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).
If you think you want a second opinion, talk to your specialist doctor or GP first about anything you do not understand. If you feel it would be helpful, you can ask your specialist or GP to refer you to another specialist for a second opinion.
Most people with BCCs or SCCs are cured with treatment. The types of treatment include:
Photodynamic therapy (PDT)
Radiotherapy may be used instead of surgery for BCCs and SCCs. This might be when surgery is not possible, or it would damage surrounding tissue or change your appearance. Sometimes it may be given after surgery if there is a risk that there are any cancer cells still there.
Less common treatments
Occasionally skin cancer may have spread deeper into the skin or very rarely to another part of the body. If this happens other treatments can be used.
We have more information about treatment for skin cancer.
Follow up after treatment for skin cancer
After surgery for BCCs and very early-stage SCCs you may not need long-term follow-up care. But your doctor may want you to have regular check-ups for a time. This is to make sure your treatment has been successful and the cancer has not come back.
Once you have had a skin cancer you have a higher risk of:
- developing it again in the same area (a recurrence)
- getting another skin cancer somewhere else on your skin.
You should check your skin regularly for any new symptoms or changes that could be cancer. You could use a mirror if there are areas like your back you cannot see easily or ask a relative or friend to help.
If you have problems or notice any new symptoms in between check-ups, tell your doctor straightaway.
After treatment for skin cancer it is very important to protect your skin from the sun. This can help prevent further skin cancers. Being exposed to a small amount of sunshine without getting red or burning, helps our bodies make vitamin D. If you are not exposed to the sun often, you can ask your dermatologist or GP to check your vitamin D levels and for advice on getting enough vitamin D.
Doctors try to minimise the effects of skin cancer treatments on your appearance. Many people have only minor scarring after treatment but for others it may be more obvious.
If treatment has changed your appearance you may feel differently about your body image. Although this often improves with time, you may feel self-conscious about how you look. Camouflage make-up to cover a scar, may help you to feel better about how the area affected looks. The British Association of Skin Camouflage provides advice about camouflage make-up.
Even though your skin cancer is likely to be cured, you may feel anxious or upset for a while after you have been diagnosed.
Everyone has their own way of dealing with a diagnosis and the different emotions they may experience. Macmillan is here to support you. If you would like to talk, you can:
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
National Institute for Health and Care Excellence (NICE) NICE pathways: Skin Cancer Treatment overview. (updated 2020)
Institute for Health and Care Excellence (NICE). Sunlight exposure: risks and benefits. NICE guideline [NG34] Published:2016.
British Journal of Dermatology. British Association of Dermatologists guidelines for the management of people with cutaneous squamous cell carcinoma. 2020.
National Institute for Health and Care Excellence (NICE) Cemiplimab for treating metastatic or locally advanced cutaneous squamous cell carcinoma [TA592] Published: 07 August 2019.
BMJ Best Practice. Overview of Skin Cancer. (updated 2019)
British Association of Dermatologists. Service Guidance and Standards for Mohs Micrographic Surgery (MMS). 2020.
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, Dr Samra Turajlic, Consultant Medical Oncologist.
Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.
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