How to spot non-melanoma skin cancers

24th June, 2022 • 12 min read

Worried about a patch of skin on your leg that’s turned red and scaly, or a lump on your nose that looks pink and waxy?

Skin cancer is on the rise, so it’s important to be aware of any changes to your skin. Every year, between 2 and 3 million cases of ‘non-melanoma’ skin cancer are diagnosed worldwide – making it one of the most common cancers.

Non-melanoma skin cancers grow slowly in the outer layer of your skin (epidermis). In most cases, they don’t spread to other parts of your body and are highly curable. But they can still cause damage to the surrounding skin and tissues. And surgery to remove them can be painful and cause scarring. So the sooner you get them diagnosed and treated, the better.

Your skin changes naturally all the time, and not every lump or patch of dry, scaly skin will be skin cancer. But it’s important to be aware of the changes to look for, so you’ll know if you need to see a doctor.

Types of non-melanoma skin cancer

There are 2 main types of non-melanoma skin cancer:

  • basal cell carcinoma (BCC) – this is the most common type of skin cancer. Around 75 to 80 out of every 100 skin cancers are BCCs. Sometimes known as ‘rodent ulcers’, they start in cells at the bottom of your skin’s outer layer (epidermis)
  • squamous cell carcinoma (SCC) – about 20 out of every 100 skin cancers are SCCs. They start in cells at the top of your epidermis

What do basal cell carcinomas (BCCs) look like?

BCCs can look really different from each other, even if you have more than 1. You’ll usually notice a BCC when a scab doesn’t heal, bleeds, or only partially heals, or you find a new lump on your skin.

They can start from a tiny spot that’s just 1mm to 3mm in diameter, but can then grow larger and damage your skin and nearby tissues. They’re much less likely to spread than SCCs (see below).

In 70 out of 100 cases, BCCs appear on your face or head, while 15 out of 100 cases are on the main part of your body (excluding your head, neck and limbs), known as the ‘trunk’.

There are 3 main types of BCC:

  • nodular BCCs – these are raised spots that are pink or flesh-coloured, with a pearly appearance. They often have a broken blood vessel in the middle, and have a raised outer edge with a crater in the centre. About 80 out of 100 BCCs are nodular, and usually appear on your face. They can develop into ulcers (which is why BCCs are sometimes called rodent ulcers)
  • superficial BCCs – these often appear on your trunk, and are slightly scaly, thin patches of skin, which have lightened to a pink colour. They make up about 15 out of 100 cases of BCCs
  • morpheaform/infiltrative BCCs – morpheaform BCCs are smooth, flesh-coloured or very light pink bumps (papules) or raised patches (plaques), while infiltrative BCCs can look like scars. They make up between 5 and 10 out of 100 cases of BCCs

What do squamous cell carcinomas (SCCs) look like?

Squamous cell carcinomas (SCCs) are thought of as ‘low-grade’ cancers, and most can be cured. But they can be aggressive in a small number of cases. And if left untreated, they can spread to other parts of your body through your lymph nodes (glands).

They can vary in size. A ‘stage 1’ cancer is classed as 2cm across or smaller; stage 2 is 2cm to 4cm; and stage 3 is larger than 4cm. Stage 4 can be any size, and has spread to 1 or more lymph nodes.

They also vary in how they look. They may:

  • grow on any part of your skin – but they’re more common on your head, ears, lips, neck or the backs of your hands
  • look scaly or crusty, raised and rough
  • feel tender or sore, and sometimes bleed
  • develop an ulcer underneath, which bleeds easily

Early signs to watch out for

It’s a good idea to be on the lookout for early signs of an SSC – particularly if you’re light-skinned, or have been sunburnt or had other skin cancers in the past. These include:

  • actinic keratosis (also known as actinic keratoses or solar keratosis) – these are common on parts of your body that are often exposed to the sun, such as your face, head and the backs of your hands. They’re patches or slightly raised bumps of red, scaly skin, or pinkish wart-like spots, which may itch, burn, bleed or crust over. They’re usually only 1cm to 2cm, but there’s a small risk of them becoming SCCs. If you only have 1, the risk is very low – about 1 to 2 in 100 – but increases to about 10 to 15 in 100 if you have more than 10. If an actinic keratosis turns into a lump, grows very fast, becomes sore to touch or opens up or bleeds, it could be an early sign of an SCC
  • Bowen’s disease – this is a very early, slow-growing form of SCC. It usually starts as a scaly red patch of skin, which sometimes itches. Read more about
    Bowen’s disease

Who is at higher risk of non-melanoma skin cancer?

Most non-melanoma skin cancers are caused by ultraviolet (UV) rays from the sun.

You’re more at risk if:

  • you’re white – BCCs are particularly common in white people, and uncommon in black people. According to Cancer Research UK, studies show that people with very pale or pale skin have a 70% higher risk of BCCs, compared with people with darker white or brown skin. In the US, the number of BCCs diagnosed in white people has been increasing by 10% each year, and the lifetime risk of getting one is about 30%
  • you get a lot of sun exposure – working outdoors and spending a lot of time in the sun increases your risk of non-melanoma skin cancers, as does a history of
    sunburn
    (including sunburn that happened when you were a child). Find useful information on other areas of sun safety with our
    complete Guide
  • you’re older – in the US, people aged 55 to 75 are 100 times more likely to be diagnosed with BCC than people under 20. In the UK, almost half of non-melanoma skin cancers are diagnosed in people aged 75 or older
  • you’re male – research suggests that BCC is about 30% more common in men than women. This is thought to be because men tend to be more likely to work outdoors
  • you’re a smoker – smokers have a higher risk of developing SCC (read about
    quitting smoking
    )
  • you use sunbeds – these give out the same UV rays as the sun, so using them can make skin cancer more likely. How much they increase your risk will depend on the strength of the UV rays they give out, the colour of your skin, and how often you use them
  • you’ve had a BCC or SCC before – if you’ve had skin cancer in the past, you’re at higher risk of getting it again
  • you’re taking photosensitising medication – certain medicines can have the side effect of making you more sensitive to the sun, increasing your risk of skin cancer
  • you have a weakened immune system – such as if you’ve had an organ transplant, or you have
    HIV

What is melanoma skin cancer?

Melanoma skin cancer is less common than non-melanoma skin cancers. According to the WHO, about 132,000 melanomas are diagnosed each year worldwide.

But this type of skin cancer is more likely to spread if it’s not treated early. It usually starts from changes to a mole or a new mole appearing, or other skin changes.

Read more about melanoma and how to spot it.

When to see a doctor

It’s a good idea to get into the habit of regularly checking your body for any skin changes, particularly if you’re in 1 of the higher-risk groups listed above. (Read our tips about how to examine your skin.) And you should see your doctor if you notice anything on your skin that you’re not sure about.

This is especially important if it’s:

  • changing colour
  • growing
  • bleeding
  • itching
  • changing in sensation
  • sore, or has redness around it
  • oozing
  • bigger than 7mm
  • scaly, crusty or rough
  • a scab that’s not healing as you would expect

Your doctor will usually ask some questions, and examine and feel your skin. You may also be referred to a skin specialist called a dermatologist. They can look at your skin with a hand-held light device called a dermatoscope, and take a skin

biopsy
to check if you have skin cancer.

If you’re concerned about your skin, but you’re not sure if you need to see a doctor, you can try our

Smart Symptom Checker
to help you get more information.

What’s the treatment?

Whether you have a BCC or SCC, the treatment options are similar. Which treatment you’ll need will depend on how advanced your skin cancer is, and where it is on your body.

Early-stage treatments

Possible treatments for early-stage non-melanoma skin cancers include:

  • anti-cancer creams – these are used to treat early-stage BCCs, actinic keratosis and Bowen’s disease. There are 2 main types: chemotherapy creams and immune-stimulating creams. They need to be applied for several weeks, and may cause soreness, itchiness, peeling or flaking
  • photodynamic therapy – this is also used for BCCs, Bowen’s disease and actinic keratosis. A special cream is applied to the affected area to make your skin sensitive to UV light, then a strong light is then shone on to it, which destroys the cancer. It can cause a burning sensation, but leaves less scarring than surgery (see below)
  • cryotherapy – this uses liquid nitrogen to freeze BCCs and SCCS. It makes the area scab over, then the scab (and the cancer) will fall off after about 4 weeks. It can leave a small white scar

Surgery

Many non-melanoma skin cancers will need to be removed with surgery, even if they’re only small or suspected cancers. This way, the skin that’s removed can be looked at under a microscope, to check what kind of cancer it is and if you need any further treatment.

Surgical treatments include:

  • curettage and electrocautery – this minor surgery can treat small BCCs and SCCs. The surgeon uses a blade to scrape off the cancer, before burning (cauterising) your skin to remove any remaining cancer cells and seal the wound. It sometimes needs to be repeated 2 or 3 times
  • surgical excision – this is when your surgeon removes the cancer and some of the surrounding healthy skin under
    local anaesthetic
    . If a large area needs to be removed, a skin graft may be done at the same time. This is when a patch of healthy skin is taken from somewhere else on your body, to cover the area that’s removed
  • mohs micrographic surgery (MMS) – this type of surgery aims to remove as little skin as possible, to reduce scarring. This is important in delicate areas, such as on an eyelid or ear. It has a high cure rate, because your surgeon can see exactly where the cancer stops during the surgery. The tumour is removed, along with surrounding skin, and checked under a microscope straight away, to make sure all the cancer has been removed. If it hasn’t, you’ll have more surgery, usually on the same day

Non-surgical treatments

If surgery isn’t suitable, you may need an alternative treatment, such as:

  • radiotherapy – this is sometimes used to treat BCCs and SCCs if surgery isn’t suitable, they affect a large area, or they’re difficult to operate on. It can also be used after surgery, to help stop the cancer coming back. It uses low, safe doses of radiation to kill cancer cells, and can cause soreness for a few weeks afterwards. (Read more about
    radiotherapy
    )
  • electrochemotherapy – this may be recommended if surgery or radiotherapy haven’t worked, or aren’t suitable for you. It involves giving
    chemotherapy
    into the tumour, or sometimes into a vein. Short pulses of electricity are then sent into the tumour, helping the chemotherapy medicine to damage it more effectively
  • immunotherapy – this can be used if the above treatments haven’t worked or aren’t suitable. It involves using medicines that work with your immune system to stop cancer growing. For advanced SCC and BCC, medicines called ‘checkpoint inhibitors’ are used, which help restore your body’s immune response to cancer cells
  • targeted therapy – this may be tried if other treatments aren’t suitable. It uses medicines aimed at certain features of a cancer, which work by blocking a specific protein or molecule

Your medical questions answered

I’ve had a small basal cell carcinoma removed. Can I still go on beach holidays?

“Once you’ve had skin cancer, you’re at higher risk of getting another one or having it come back. So it’s a good idea to make some lifestyle changes. Lots of people who live in a colder climate and take holidays in hotter countries think that a couple of weeks in the sun won’t do them any harm. But that’s not the case if you’re not careful or you get sunburnt. So if you do take a holiday in the sun, be sure to take steps to protect your skin. This includes wearing

sunscreen
, sunglasses and a hat, covering up with clothes in breathable fabrics, and sitting in the shade rather than direct sun – especially during the hottest parts of the day. Read more about
sun safety
.”

Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.