Non-melanoma skin cancer: basal cell and squamous cell carcinoma basics

Basal cell carcinoma often appears as a pearly or waxy bump with visible tiny blood vessels, or as a scar-like patch, or as a sore that bleeds, crusts and does not heal. It usually occurs on sun-exposed skin such as the face, ears, scalp and shoulders. Squamous cell carcinoma tends to appear as a scaly, crusted, firm lump or a sore that does not heal, often on the face, lips, ears, backs of hands and scalp. Both can be itchy or tender, or cause no symptoms.

• Fair skin that burns easily, red or blond hair and light eyes.

• A history of sunburn, outdoor work or sunbed use.

• Previous skin cancer or many actinic keratoses.

• A weakened immune system, for example after organ transplant.

• Older age, though younger people can be affected.

• Certain genetic conditions and previous radiotherapy.

A clinician examines the lesion, usually with a dermatoscope, and takes a biopsy to confirm the diagnosis and, for squamous cell carcinoma, assess features that guide treatment. Rapidly growing or suspicious lesions suggestive of squamous cell carcinoma are referred urgently under NICE guidance. Basal cell carcinoma is usually referred routinely unless it is aggressive or in a sensitive site.

Surgical excision with a safety margin and histological confirmation is the most common treatment. Mohs micrographic surgery, in which tissue is examined layer by layer during surgery, is used for high-risk sites such as the face. Other options include curettage and cautery, cryotherapy, topical medicines for superficial lesions, photodynamic therapy and radiotherapy. The choice depends on the type, size, site and your health and preferences.

Actinic keratoses are rough, scaly patches on sun-damaged skin that can develop into squamous cell carcinoma in a minority of cases. They are often treated with topical creams, cryotherapy or photodynamic therapy. People with many patches are at higher risk and need regular checks.

After treatment, you may be followed up for a time, and you are at risk of further skin cancers, so regular self-checks matter. Protect your skin with shade, clothing and sunscreen, avoid sunbeds and report new or changing lesions. People with weakened immunity may need specialist skin clinics.

After surgery, keep the wound clean and dry as instructed, avoid strenuous activity that stretches it and watch for signs of infection such as spreading redness, heat, pus or fever. Protect scars from sun for at least a year to reduce pigment change. Attend follow-up and examine your own skin, including the scar and surrounding area, for any new lump or sore. If you have had one non-melanoma cancer, your risk of another is higher, so sun protection and prompt review of changes become habits worth keeping.