Nonmelanoma skin cancer refers to all the types of cancer that happen in the skin that are not melanoma.

Several types of skin cancer fall within the broader category of nonmelanoma skin cancer. Almost all nonmelanoma skin cancers are either basal cell carcinoma or squamous cell carcinoma. Other types of nonmelanoma skin cancer are rare.

Nonmelanoma skin cancer treatment depends on the type of cancer. Skin cancer treatment usually involves surgery to remove the cancer cells.

Symptoms

Symptoms of nonmelanoma skin cancer often develop on parts of the body that are exposed to the sun. Examples include the scalp, face, ears, neck, chest, arms and hands. But nonmelanoma skin cancer can happen on other parts of the body too. This includes the lips, fingers, fingernails and genital areas.

Nonmelanoma skin cancer symptoms appear as a change in the skin, including:

• A new growth on the skin.
• Changes to an existing skin spot, such as changes in shape or color.
• Itching, pain, crusting or bleeding of a skin spot.
• A sore that won't heal or one that keeps coming back.

When to see a doctor

Make an appointment with a healthcare professional if you see any changes on your skin that worry you.

Causes

Nonmelanoma skin cancer develops when changes happen in the DNA of skin cells. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA tells the cells to grow and multiply at a set rate. The DNA also tells the cells to die at a set time.

In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to grow and multiply quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells. In nonmelanoma skin cancer, the cells grow out of control and may form a new growth on the skin or cause changes in an existing spot on the skin.

Ultraviolet light, also called UV light, causes most of the DNA changes in skin cells. UV light can come from sunlight, tanning lamps and tanning beds. But sun exposure doesn't explain skin cancers that develop on skin that's not typically exposed to sunlight. Other factors can contribute to the risk and development of nonmelanoma skin cancer. The exact cause is not always clear.

Risk factors

Factors that may raise the risk of nonmelanoma skin cancer include:

• Being in the sun too much. A lot of time spent in the sun or using tanning beds raises the risk of nonmelanoma skin cancer. Getting severe sunburns also raises the risk.
• Having skin that sunburns easily. Anyone of any skin color can get nonmelanoma skin cancer. But it's more common in people who have low levels of melanin in their skin. Melanin is a substance that gives color to skin. It also helps protect the skin from damaging UV light. People with Black or brown skin have more melanin than people with white skin. The risk of nonmelanoma skin cancer is highest in people who have blond or red hair, have light-colored eyes, and freckle or sunburn easily.
• A personal or family history of skin cancer. People who have had skin cancer before have a higher risk of developing it again. Those with a family history of skin cancer also may have a higher risk of developing nonmelanoma skin cancer.
• Medicines to control the immune system. Medicines that work by suppressing the immune system raise the risk of nonmelanoma skin cancers significantly. Medicines that work in this way include those used after an organ transplant to prevent rejection.
• Radiation therapy. Radiation therapy to treat acne or other skin conditions may raise the risk of nonmelanoma skin cancer at the previous treatment sites on the skin.
• Increasing age. The risk of some types of nonmelanoma skin cancer goes up as people get older.
• Inherited syndromes that cause skin cancer. Some rare genetic diseases can raise the risk of nonmelanoma skin cancer.

Diagnosis

Tests and procedures used to diagnose nonmelanoma skin cancer skin include:

• Physical exam. A member of your healthcare team asks about your health history and looks at your skin for signs of nonmelanoma skin cancer.
• Removing a sample of tissue for testing, called a biopsy. A biopsy is a procedure to remove a sample of tissue for testing in a lab. A member of your healthcare team uses a tool to cut away, shave off, or punch out some or all of the area of skin that looks out of the ordinary. The sample is tested in a lab to see if it is cancer and, if so, what type it is.

If a biopsy shows nonmelanoma skin cancer, other tests also may be needed to check if cancer has spread beyond the skin.

Treatment

Treatment for nonmelanoma skin cancer depends on the size, type and location of the cancer. How deep the cancer has grown into the skin also makes a difference. Small nonmelanoma skin cancers on the surface of the skin may not require treatment beyond a skin biopsy that removes the entire growth.

If other treatment is needed, options may include:

• Surgery. Surgery often can remove nonmelanoma skin cancer. In some situations, an area of healthy tissue around the cancer also may need to be removed.
• Freezing. Some small, early-stage nonmelanoma skin cancers can be destroyed by freezing them with liquid nitrogen. This is called cryosurgery.
• Radiation therapy. Radiation therapy treats cancer with powerful energy beams. Radiation therapy may be an option when cancer can't be completely removed during surgery.
• Chemotherapy. Chemotherapy treats cancer with strong medicines. For cancers limited to the top layer of skin, creams or lotions containing anti-cancer medicine may be put on the skin. Chemotherapy that goes to the whole body can be used to treat skin cancers that have spread beyond the skin.
• Photodynamic therapy. Photodynamic therapy is a two-stage treatment that combines light energy with a medicine called a photosensitizer. The photosensitizer kills cancerous and precancerous cells when activated by light, usually from a laser.
• Immunotherapy. Immunotherapy uses the body's immune system to kill cancer cells.

Preparing for an appointment

If you have any skin changes that worry you, start by making an appointment with a healthcare professional. If your healthcare professional suspects that you may have nonmelanoma skin cancer, you may be referred to a specialist. Often this is a doctor who specializes in the diagnosis and treatment of skin conditions, called a dermatologist.

Because appointments can be brief, it's a good idea to be prepared. The following information can help you get ready for an appointment.

What you can do

• Write down any symptoms you have, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medicines, vitamins or supplements that you're taking.
• Consider taking along a family member or friend. Sometimes it can be hard to remember all the information you get during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare professional.

Questions for your doctor

Below are some basic questions to ask your healthcare professional about nonmelanoma skin cancer. If you think of other questions during your appointment, be sure to ask those questions too.

• Do I have nonmelanoma skin cancer? What kind?
• How is this type of skin cancer different from other types?
• Has my cancer spread?
• What treatment do you recommend?
• What are the possible side effects of treatment?
• Will I have a scar after treatment?
• Am I at risk of this condition coming back after treatment?
• Am I at risk of other types of skin cancer?
• How often will I need follow-up visits after I finish treatment?
• Are my family members at risk of skin cancer?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?

What to expect from your doctor

Be ready to answer some basic questions, such as:

• When did you first notice this skin change?
• Has it grown or changed much since you found it?
• Is the skin change painful? Does it cause other discomfort?
• Do you have any other skin growths or sores that worry you?
• Have you had skin cancer before?
• How much were you in the sun as a child?
• Have you ever used tanning beds?
• How much are you in the sun now?
• What do you do to stay safe in the sun?
• Have you ever taken medicines that suppress your immune system?
• Do you or did you smoke? How much?