Non-melanoma skin cancer — BCC and SCC
Non-melanoma skin cancer (NMSC) accounts for most skin cancers in the UK — basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
Not melanoma — see melanoma for pigmented mole cancer — different biology and urgency.
>150,000 NMSC/year — underreported — many treated in primary care dermatology.
Basal cell carcinoma
Commonest human cancer overall
Features:
- Pearly nodule, rolled edge
- Telangiectasia
- Central ulcer — “rodent ulcer”
- Bleeds, heals, bleeds again
Behaviour:
- Local invasion — nose, eyelid, ear — cosmetic and functional damage
- Metastasis exceedingly rare
Squamous cell carcinoma
Second commonest NMSC
Features:
- Hyperkeratotic nodule or plaque
- Tender, may ulcerate
- Actinic keratosis precursor — rough sun spots
Behaviour:
- Can metastasise — ~5% high-risk tumours
- Immunosuppressed — transplant patients — much higher risk
Risk factors
| Factor | Notes |
|---|---|
| UV exposure | Cumulative — outdoor work, holidays |
| Fair skin (Fitzpatrick I–II) | Burns easily |
| Sunbeds | No safe tan |
| Previous NMSC | 30–50% second tumour within 5 years |
| Immunosuppression | Transplant, lymphoma treatment |
| Radiotherapy field | Years later |
Diagnosis
Dermatoscopy — pattern recognition
Biopsy mandatory before destructive treatment if diagnosis uncertain
2-week wait — NICE suspected cancer pathway
Treatment
Low-risk BCC:
- Curettage + cautery
- Cryotherapy
- Topical imiquimod or 5-FU
Standard:
- Excision with 4–5 mm margins — histological clearance
High-risk facial BCC:
- Mohs surgery — microscopic margin control
- Plastic repair
SCC:
- Excision — wider margins
- Sentinel node if high risk features
After treatment
Sun protection lifelong
Self-skin exam monthly — partner check back
Immunosuppressed — annual dermatology review
Any non-healing sore on face or scalp over 4 weeks — GP — simple cure usually — delay allows local destruction.
Common questions about non-melanoma skin cancer
- What does basal cell carcinoma look like?
- Pearly or waxy nodule with rolled edge and visible telangiectasia (small blood vessels), sometimes central ulceration (rodent ulcer). May bleed easily and scab repeatedly. Usually on face, ears, or scalp — sun-exposed sites. Slow growing over months to years.
- What does squamous cell carcinoma look like?
- Firm pink or red lump, or scaly crusted patch — may be tender. Can grow faster than BCC. Higher risk sites — lower lip, ear, scar, leg in elderly. Bowen disease is SCC in situ — red scaly patch — treat before invasive SCC.
- How is non-melanoma skin cancer diagnosed?
- GP or dermatologist examination with dermatoscope. Skin biopsy — punch or excision — confirms histology. SCC and BCC distinguished microscopically. Imaging only if large, deep, or palpable nodes — rare for BCC.
- How is non-melanoma skin cancer treated?
- Surgical excision with clear margins — standard. Mohs micrographic surgery for high-risk facial BCC — preserves tissue. Cryotherapy, curettage and cautery, photodynamic therapy, or imiquimod cream for superficial or low-risk lesions. Radiotherapy if surgery unsuitable.
- How can I prevent skin cancer?
- Sun protection — shade 11am–3pm, SPF 30+ broad spectrum, reapply every 2 hours, hat and sleeves. Avoid sunbeds. Check skin monthly — new or changing lesions. Extra vigilance if fair skin, many moles, immunosuppression, or previous skin cancer.
Sources
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