• Patients with non-melanoma skin cancers are treated by members of the BC Cancer Agency’s Skin Tumour Group.
• For healthcare professional information on treating this cancer, please see our Cancer Management Guidelines.
• Cancers of the skin are also known as cutaneous cancers or dermatological cancers.
• Non-melanoma refers to common skin cancers that are distinct from the more serious type of skin cancer called malignant melanoma.
• Non-melanoma skin cancer is the most common cancer diagnosed in Canada.
• The main types of non-melanoma skin cancer are basal cell carcinoma and squamous cell carcinoma.
• Other cancers that affect the skin include skin lymphoma, and Kaposi’s sarcoma.
• Skin keeps moisture inside the body and repairs and renews itself as millions of dead skin cells are lost each day. The skin is also the outermost limit of the immune system.
• The skin consists of two layers: outer epidermis and supporting dermis. The dermis is made up of connective tissue, blood vessels, and nerves. Together the epidermis and the dermis contain hair follicles, sweat glands, sebaceous glands and nerve endings.
• The epidermis also contains melanocytes, the cells which produce melanin, the pigment responsible for skin colour.
• New skin cells are produced in the bottom layer of the epidermis called the basal layer, just above the dermis.
• Skin cancers arise in the epidermis, usually on sun-exposed skin.
• Non-melanoma skin cancers are curable with early diagnosis.

What causes it and who gets it?
Listed below are some of the known risk factors for this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors.

• The main cause of skin cancer is ultraviolet (UV) radiation from the sun. Tanning and sunburn cause injury and long-term damage to the skin.
• “Sun spots” or actinic (solar) keratoses are rough, scaling spots that develop in areas of most exposed to the sun.. They are at high risk of becoming skin cancers.
• Basal cell carcinomas (BCC) occur most frequently in areas of the skin that occasionally receive severe sun damage. These include the face, scalp in balding individuals, the back of the hands, arms and legs.
• Squamous cell carcinomas (SCC) may develop slowly from actinic keratoses or these cancers may appear and grow rapidly with a risk of spreading invasively.
• People particularly at risk are children and outdoor workers.
• People who are taking medications that suppress the immune system or who have had an organ transplantation are at higher risk to develop skin cancer.
• Statistics
• Non-melanoma skin cancer is the most common cancer diagnosed in Canada. The chance of developing skin cancer in British Columbia is about 1 in 7.
• Statistics on squamous and basal cell carcinomas of the skin are not routinely collected by provincial cancer registries. Estimates for Canada are based on information from a few provinces including B.C.
• In 2011, Canada estimated 74,100 cases, and B.C 13,000. 

Can I help to prevent it?

• Protect your skin from the sun and other sources of ultraviolet (UV) light.
• Avoid sunburn, particularly in children.
• Avoid tanning salons and sunlamps.
• Limit time in the sun, especially between 11am and 3 pm.
• Seek shade.
• Cover up by wearing long sleeves and pants and a hat with a wide brim.
• Use sunscreen, specifically one labeled broad-spectrum, SPF 30. 
• Be aware that some drugs increase your reaction to ultraviolet radiation. Check with your doctor or pharmacist if you are taking prescription drugs.

Sun Safety

• The BC Cancer Agency’s Prevention Programs offer specific advice on preventing skin cancers for people of all ages.
• For detailed prevention tips and ideas for children, teens, adults, outdoor workers, sunbathers, outdoor sportspeople, users of tanning beds, see these websites:
• Sun Safety  
• SunTips 
• Hi5Living
• Pre-School Sun Awareness 
• Sun Safety brochures  

Sunscreens 

• Sunscreens are not intended to increase your exposure time but to increase your protection during unavoidable sun exposure.
• Everyone, even if not in a high risk category, should avoid repeated extensive exposure to sun, wear protective clothing and use sunscreens with at least SPF 30.
•  A list of sunscreens currently recognized by the Canadian Dermatology Association is available.
• Sunscreen ingredients are effective for at least two years (check expiration date on package).
• There is no evidence that the active ingredients in sunscreens cause cancer in humans.
• For a complete physical block, opaque sunblocks such as zinc oxide or titanium dioxide should be used if extreme sun exposure is likely (e.g., skiers, mountain climbers).
• Protect the lips with lip sunscreen or zinc oxide.
• Do not apply oils to the skin. They usually increase the likelihood of a sunburn.

Sun Tanning Beds

• The use of sun tanning beds and sunlamps is strongly discouraged because they give off UV radiation that cause skin damage.
• Beginning in fall 2012, B.C. will ban commercial tanning bed use by young people under the age of 18 to reduce the chances of developing skin cancer later in life.
• The suntan provided by sunbeds/tanning booths is only minimally protective against a sunburn. If you do go to a tanning salon, continue to use a good sunscreen even after acquiring the artificial tan. A tan does not completely protect you from harmful UV radiation.  

Screening for this cancer

• Any skin changes such as a sore that does not heal. 

Diagnosis
This is a list of some or all of the tests used to diagnose this type of cancer.

• T describes the site and size of the main tumour (primary)
• N describes involvement of lymph nodes
• M relates to whether the cancer has spread (presence or absence of distant metastases)

Types

• The main types of non-melanoma skin cancer are:
• Basal cell carcinoma (BCC)
• Squamous cell carcinoma (SCC)

Stages

• T1  Carcinoma in situ.
• T2  Tumour of 2 cm or less, completely superficial.
• T3  Tumour of 2-5 cm, or with minimal infiltration.
• T4  Tumour extends to other structures, like cartilage, muscle or bone.

Treatment
Cancer therapies can be highly individualized – your treatment may differ from what is described below.

         Surgery

• The decision on which surgical technique to use to remove a skin cancer depends on its size and location.
• Techniques include curettage, electrofulguration (electrosurgery), Mohs micrographic sugery, and skin grafting.
• Mohs micrographic surgery may be the choice of treatment for cancers that recur.  The tumour is removed in slices, which are examined under the microscope. More slices are removed until no more cancer cells are seen and the tumour has been completely removed.

Radiotherapy

• Radiation therapy may be used if surgery would cause significant cosmetic deformity or if surgery is not possible in an older patient.

Basal cell carcinoma (BCC) 

• Surgical excision.
• Radiation therapy may be used to treat lesions on the face.
• Chemotherapy called Interferon may be used in case where surgery and radiation therapy are not possible.
• Topical imiquimod cream (Aldara®) may be used for low risk, superficial basal cell carcinomas on the trunk, neck, arms, hands, legs and feet. This drug is applied to the skin where the cancer is located.

Squamous cell carcinoma (SCC)

• Actinic keratoses are precancerous lesions that may eventually develop into invasive squamous cell carcinomas. Treatment may include:
• Topical 5-fluorouracil therapy, a chemotherapy applied to the skin.
• Liquid nitrogen freezing (cryotherapy).
• Light electrofulguration surgery
• Topical imiquimod cream (Aldara®)
• Invasive squamous cell carcinoma treatment may include:
• Surgery for complete removal.
• Radiation therapy if surgery is not possible or would cause significant cosmetic deformity.
• Chemotherapy called Interferon in cases where surgery and radiation therapy are not possible.

• Guidelines for follow-up after treatment has ended have been developed by the BC Cancer Agency and are listed on our website.
• You will be returned to the care of your family doctor or dermatologist for regular follow-up.
• Follow-up testing is based on your type of cancer and your individual circumstances.
• The BCCA Survivorship Research Centre focusses on the issues that cancer survivors can face

Coping with cancer

The Coping with Cancer section of our website is a joint project among different BC Cancer Agency departments and programs. This website section provides information and links that can help cancer patients with the physical, emotional, psychological and practical aspects of care. Each cancer experience is different, but in one way or another, many cancer patients share the same needs.

The effects of cancer and its treatment can present unique challenges: from practical concerns like money and housing, to emotional concerns like anxiety and grief. If you need support with the practical and emotional impacts of cancer, or in managing symptoms and side effects you can use the information in Coping with Cancer to connect to these resources.

Search our library catalogue

• The BC Cancer Agency Library has many resources about cancer, coping, talking to children, etc.  Please visit the Library in your Centre, call a librarian, or visit the Library online to see the many resources available.
• Automatically get a bibliography of books, videos and other items available through our library.

Recommended websites
The BC Cancer Agency has selected and evaluated these useful websites for your further information.

Sun and Skin Cancer Prevention
Skin cancer and Melanoma
Websites for cancer survivors, and how to stay healthy after treatment.

Videos
View videos on cancer-related topics that the BC Cancer Agency produces.

How can I help with research at BC Cancer Agency?
BC Cancer Agency patients are very helpful when it comes to the fight against cancer. Here are a few ways that you can help:

• The BCCA is deeply involved in cancer research.  We operate various Research Programs, the BC Cancer Research Centre and Canada's Michael Smith Genome Sciences Centre.
• Clinical Trials – join our treatment-based research. Ask your oncologist if you qualify for a clinical trial. What are the pros and cons of joining a clinical trial?
• Tumour Tissue Repository – support our research by donating some of your cancer tissue.
• BC Cancer Foundation – support our research with a donation of money.

This information is awaiting Tumour Group approval.