Skin, Non-Melanoma

This information should not be used for self-diagnosis or in place of a qualified physician's care.

Revised Jan 2016

The basics

Guidelines for treating this cancer have been developed by the Skin Tumour Group.
For health 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.
Non-melanoma skin cancers are curable with early diagnosis.
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 helps the body regulate heat. The skin also protects the body from pathogens.
The skin consists of three layers: outer epidermis, supporting dermis and the subcutis or fat layer.
The epidermis 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.
Basal cell carcinomas (BCC) occur most frequently in areas of the skin that occasionally receive severe sun damage. These include the face, ears, scalp, the back of the hands, arms and legs.
Actinic keratoses are rough, scaling spots that develop in areas of most exposed to the sun. They are considered pre-cancerous, as they may develop into squamous cell carcinomas.
Squamous cell carcinomas (SCC) may develop slowly or these cancers may appear and grow rapidly with a risk of spreading invasively.

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.

Skin cancers are more common in Caucasians but people of all races are vulnerable.
Regardless of skin colour, 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.
Everyone, regardless of skin colour can sunburn.
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.
BC
Canada

Can I help to prevent it?

Skin cancer is one of the most preventable types of cancer. The key is to protect your skin from the sun and other sources of ultraviolet (UV) light throughout your life.

Avoid sunburn, particularly in children.
The use of sun tanning beds and sunlamps is strongly discouraged because they give off UV radiation that causes skin damage. Commercial tanning bed use by people under the age of 18 is banned in British Columbia.
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.
Protect the lips with lip sunscreen or zinc oxide.
Be aware that some drugs increase your reaction to ultraviolet radiation. Check with your doctor or pharmacist if you are taking prescription drugs.

The BC Cancer Agency offers more information and resources on skin cancer prevention:

Visit our Prevention page on Sun Safety to learn more about sun protection for infants, children, teens, adults and outdoor workers.
Suntips.ca is a website to educate young people about the risks of UV exposure and to help them develop healthy lifelong behaviours that reduce their risk of skin cancer.

Screening for this cancer

No effective screening program exists for this cancer yet.

Check your skin and your children's regularly for any changes in moles, freckles or skin discolourations and bring them to your doctor's attention.

Signs and symptoms

Any skin changes such as a sore that does not heal.
A new skin spot or growth, or a change in an existing one.
See the Suntips.ca page on What to Look For.

Diagnosis & staging

Diagnosis

These are tests that may be used to diagnose this type of cancer.

Physical examination by a family physician or a dermatologist.
Physical examination of lymph nodes in the case of squamous cell carcinoma.
Skin biopsy (surgical removal of tissue sample) to determine if it's benign, pre-cancerous or malignant.

For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests section.

Types and stages

Types

The main types of non-melanoma skin cancer are:

Basal cell carcinoma (BCC)
Squamous cell carcinoma (SCC)

Stages
Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.

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

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 surgery, curettage, electrofulguration (electrosurgery), Mohs micrographic surgery.
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.
Removal of larger lesions may require skin grafting.

Radiotherapy

Radiation therapy may be used if surgery would cause significant cosmetic deformity or if surgery is not possible.

Treatment for Basal cell carcinoma (BCC)

Surgical removal is the best treatment.
Radiation therapy may be used to treat lesions on the face, or when cosmetic outcomes are a concern.
A chemotherapy drug called Interferon may be used in cases where surgery and radiation therapy are not possible.

Treatment for Actinic Keratosis

Actinic keratoses are precancerous lesions that may develop into invasive squamous cell carcinomas. Treatment may include:

Topical 5-fluorouracil therapy, a chemotherapy drug that is applied to the skin
Liquid nitrogen freezing (cryotherapy)
Light electrofulguration surgery

Treatment for Squamous cell carcinoma (SCC)

Invasive squamous cell carcinoma treatment may include:

Surgery for complete removal.
Radiation therapy if surgery is not possible or would cause significant cosmetic deformity.
A chemotherapy drug called Interferon may be used in cases where surgery and radiation therapy are not possible.

Regional lymph nodes should be assessed initially, and during follow-up visits, as these tumours may metastasize.

Follow-up after treatment

Guidelines for follow-up after treatment are covered on our website.
You will be returned to the care of your family doctor or dermatologist for regular follow-up. If you do not have a family physician, please discuss this with your BC Cancer oncologist or nurse.
Follow-up testing is based on your type of cancer and your individual circumstances.
Life after Cancer focuses on the issues that cancer survivors can face.

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