Nonmelanoma Skin Cancer: Introduction

Getting a cancer diagnosis

It can be shocking to learn that you or someone you care for has cancer. Feeling upset or nervous when you get this kind of news is only natural. But remember: You are not alone on this journey. And even though a diagnosis can be scary, it’s the first step toward treatment.

What is nonmelanoma skin cancer?

Cancer starts when cells in the body change and grow out of control. Most cancers involve a lump or mass of these abnormal cells. This is also known as a tumor. If cancer cells go undetected for long enough, they might spread into nearby tissues or other parts of the body. This process is called metastasis.

Skin cancer develops in the cells of the skin and often appears as a new flat, scaly patch or raised shiny bump that grows over time. Depending on your skin tone, the lesion may appear pink, red, brown, or black. There are several types of skin cancer. The most common kinds of skin cancer are nonmelanoma skin cancers. The most common subtypes are:

  • Basal cell carcinoma

  • Squamous cell carcinoma

    There are other types of nonmelanoma skin cancer, but they are much less common. Some examples include:
  • Merkel cell carcinoma

  • Cutaneous (skin) lymphoma

  • Kaposi sarcoma

Understanding the skin

The skin is the largest organ of the body. It serves as a protective barrier and is one of our first lines of defense against infections. It also protects us from heat, sunlight, and injury. Skin helps regulate temperature and water loss. It also stores water and fat, and makes vitamin D. The skin has 3 layers:

  • The outer layer called the epidermis. The epidermis consists of 5 layers and 4 main cell types (keratinocytes, melanocytes, Merkel cells, and Langerhans cells).

  • The middle layer called the dermis. The dermis consists of 2 main layers. It contains the sweat glands, hair and hair follicles, muscles, nerves, and blood vessels.

  • The inner, deep layer called the hypodermis, or subcutaneous tissue. This is the deepest layer of skin. It contains fat tissue and also hair follicles, nerves, and blood vessels.

Most nonmelanoma skin cancers start in the epidermis. The most common cells in the epidermis are keratinocytes. Keratinocyte carcinomas include 2 subtypes: basal cell and squamous cell carcinomas.

Cross section of skin showing dermis, epidermis, and hypodermis.

What are the different types of nonmelanoma skin cancer?

Basal cell carcinoma

Basal cell carcinoma is by far the most common type of skin cancer. As the name implies, basal cell carcinoma starts in the lower part of the epidermis in your skin’s basal cells.

  • Where is it commonly found? Sun-exposed areas, like the face, head, neck, arms, and hands
  • What does it look like?
    • Small, pink, red raised, shiny, or pearly bump (may have other areas with colors of blue, brown, or black)
    • Crusty, itchy, red patches
    • Flat pale, white, or yellow spots
    • Open sores or ulcers that don't fully heal

Nearly all cases can be cured. It grows slowly and rarely spreads to other parts of your body. Treatment helps prevent this cancer from growing deeper into bone and tissues under the skin, which can cause serious damage. Sometimes, basal cell carcinoma comes back after treatment. And having basal cell carcinoma puts you at higher risk for new ones in other places as well as other types of skin cancer.

Squamous cell carcinoma

Squamous cell carcinoma is the second most common type of skin cancer. It starts in the flat squamous cells in the upper part of the epidermis.

  • Where is it commonly found?
    • Sun-exposed areas, like the face, ears, lips, head, neck, arms, and hands
    • Genital area
    • In scars
    • In long-lasting skin sores
  • What does it look like? Appearance varies, but it often shows up as a rough, scaly, wart-like, reddish patch on your skin.

Squamous cell carcinoma tends to grow quickly. But this cancer rarely spreads to other parts of the body. Most cases of squamous cell carcinoma are found early enough to be treated and cured.

Merkel cell carcinoma

Merkel cell carcinoma is a very rare type of cancer that most often starts in the skin. It starts deep within the upper layer of your skin. Merkel cells are very close to nerve endings and help your skin sense light touch.

  • Where is it commonly found? Sun-exposed areas, such as the head and neck (but it can start anywhere on the body)
  • What does it look like? Firm, shiny lumps that don’t hurt. These lumps may be red, pink, purple, or blue.

A Merkel cell cancer tumor tends to grow really fast. So the sooner it is found, the easier it is to treat before it can spread beyond your skin.

Cutaneous lymphoma

Cutaneous lymphomas are a large group of relatively rare and varied immune cell cancers that affect the skin without any evidence of other organ involvement at the time of diagnosis. T cell lymphomas are the most common type of cutaneous lymphomas.

These T cell cutaneous lymphomas often show with skin lesions of variable size and shape that persist or progress over time. They may be localized or form nodules or widespread plaques. They are often itchy and uncomfortable.

Kaposi sarcoma

In Kaposi sarcoma, cancer starts in the cells that line lymph or blood vessels. It can cause lesions on the skin. There are 4 main types of Kaposi sarcoma, but the cancer cells look almost the same in all of them.

  • Where are skin lesions commonly found?
    • Legs or feet
    • Face
    • Groin
  • What does it look like? Purple, brown, or red patches on the skin in mucous membranes (like the inside of the mouth), or in internal organs

Rely on your healthcare provider

It’s normal to feel uncertain about what comes next. Just remember that you are not alone. If you have questions about nonmelanoma skin cancer, reach out to your healthcare provider. They’re here to help you understand more about your diagnosis and walk with you every step of the way.

Risk Factors

Nonmelanoma Skin Cancer: Risk Factors

What is a risk factor?

It isn’t always clear why a person gets cancer. But experts know that certain risk factors can raise your odds. Learning about your personal risk factors for skin cancer can go a long way in protecting your future health. Here’s what you should know.

A risk factor is anything that increases the chance of developing a disease. But having a risk factor doesn’t mean you will definitely get the disease.

General risk factors for cancer might include things like smoking, diet, or family history.

Here are a few important things to remember:

  • Some people with one or more risk factors never get cancer. Other people can get cancer and have no risk factors. 

  • Many risk factors are out of our control, such as age and family history. But several factors are things we can change.

  • Risk factor research is ongoing. There’s still a lot to learn about what puts us at risk for cancer.

If you know you have a risk factor, think of it as an opportunity for improvement. You get to make changes now that can help protect your future health. For example, sun exposure is a risk factor for many types of skin cancer, but there are ways to protect yourself from the sun.

What can put you at risk for nonmelanoma skin cancer?

Common risk factors you can control include:

  • Sun exposure. The sun’s ultraviolet (UV) rays can damage your skin, which might lead to skin cancer. This risk is even greater for those who live closer to the equator or at higher altitudes. These are places where the sun’s rays are stronger. Choosing to limit time spent in the sun and to protect your skin can help lower your chances for skin cancer.

  • Tanning booths and sunlamps. These artificial sources of UV rays can also increase your risk, especially for anyone who used them before the age of 30. If you fall into this category, that’s OK. You can keep your risk as low as possible going forward.

  • Smoking. People who smoke are more likely to get skin cancer, especially on the lips. Quitting is not easy though. Ask your healthcare provider to help you get started.

Also, here's a list of risk factors you can't control, but still need to be aware of:

  • Certain colors of skin, hair, and eyes. People with naturally pale or freckled skin, red or blond hair, and green, blue, or gray eyes have a higher risk. But even people with darker skin can get skin cancer. Remember that these factors are not a guarantee of a diagnosis.

  • Personal history of skin cancer or precancer.  Unfortunately, if you’ve had skin cancer before, it means you have a bigger risk of getting it again in the future. The same is true if you’ve had skin precancer, such as actinic keratosis.

  • Older age. While skin cancer can occur at any age, the risk rises as people get older.

  • Being male. Men are more likely to get nonmelanoma skin cancers than women. It's thought that this mostly comes from men spending more time in the sun. This is something you can control.

  • Immune system complications. For some people, like those who needed an organ transplant, their immune system isn’t operating at full capacity. This raises the risk for skin cancer and potentially having a more serious case.

  • Exposure to arsenic or hydrocarbons. Being around large amounts of these chemicals increases your risk for skin cancer.

  • Past radiation treatment. If you have needed radiation therapy for another condition, the area that was treated has a higher risk of developing skin cancer.

  • Scars, burns, or inflamed skin. Skin cancers are more likely to show up where there is damaged skin.

  • Human papillomavirus (HPV) infection. Certain types of HPV can infect the skin in the genital area and increase your risk for skin cancer there.

  • Certain rare inherited conditions. People with a condition such as basal cell nevus syndrome (Gorlin syndrome) or xeroderma pigmentosum have a much higher risk for skin cancer, starting at an early age. 

  • Certain medicines. Some medicines can weaken your immune system or make your skin more likely to sunburn, increasing the risk for skin cancers. Examples include vandetanib, vemurafenib, and voriconazole. A type of medicine to treat melanoma, called BRAF inhibitors, can also increase the risk of getting new nonmelanoma skin cancers. Always ask your healthcare provider about the benefits and harms of a medicine before you take it.

What are your risk factors?

Talk with your healthcare provider about your personal risk factors for nonmelanoma skin cancer. They can help guide the conversation and offer ideas to reduce your risk as much as possible. Plus, they may recommend having skin exams by a healthcare provider more often or doing monthly skin exams for yourself at home.

But you don’t have to wait for your next appointment to start making changes. Things like wearing sunscreen and staying away from tanning beds are easy to do on your own.

Protect your skin now so you have a better chance of preventing future problems.


Nonmelanoma Skin Cancer: Symptoms

What are the symptoms of nonmelanoma skin cancer?

Nonmelanoma skin cancer may appear as a new growth. Or it may start as a change in the size or in the color of a growth you already have. These changes can happen slowly or quickly. Here are things to watch for.

Basal cell carcinoma 

This type of skin cancer often develops on skin exposed to the sun. This includes skin on the head, face, neck, arms, and hands. The cancer may be:

  • A small, raised bump that's pink, red, shiny, or pearly. There may be black, brown, or blue areas in it.

  • A pink raised growth with a lower center. It may have small blood vessels in it.

  • A firm, flat, spot that looks a lot like a scar. It may look waxy or have pale or yellow areas in it.

  • An open sore that bleeds easily and briefly. It might heal up and seem to go away, but then bleeds again in a few weeks.

  • Bleeding, oozing, or crusting sores that don't heal

  • A reddish growth with raised edges that might itch

Squamous cell carcinoma 

Like basal cell cancer, it often starts in skin exposed to the sun. This includes skin on the face, head, ear, lips, neck, and hands. But it can also start in other parts of the body, like in scars or the skin in the genital area. The cancer may be:

  • A rough or scaly bump that appears, then grows quickly

  • A wart-like growth that might bleed or crust over

  • Flat, rough, red patches on the skin that are irregularly shaped. They may or may not bleed and crust.

  • An open sore that doesn't heal or heals and then comes back

Merkel cell carcinoma

Merkel cell cancer tumors are most often found on sun-exposed areas of skin, such as the face, neck, and arms. But they can start anywhere on the body. They can look like:

  • A firm, shiny skin lump that doesn't hurt and grows very quickly
  • The lump may be red, pink, purple, or blue.

Cutaneous (skin) lymphoma

Skin lymphoma may be:

  • A scaly, flat patch of skin
  • Small, raised spots that look a lot like pimples
  • Thick lowered or raised areas of skin
  • Patches or bumps that are often red or purple and tend to itch
  • Bumps or lumps that can be felt under the skin

When to see your healthcare provider

Many of these symptoms may be caused by other health problems. But it's important to see a healthcare provider as soon as possible if you have any new, changing, or growing spots or lumps on your skin. Only a healthcare provider can tell if you have cancer.

Newly Diagnosed

Nonmelanoma Skin Cancer: Newly Diagnosed

Being told you have skin cancer can be scary, and you may have many questions. But you have people on your healthcare team to help.

Coping with fear

It’s normal to feel afraid. Learning about your cancer and about the treatment choices you have can make you feel less afraid. This also helps you work with your healthcare team and make the best choices for your treatment. You can also ask to speak with a counselor.

Working with your healthcare team

Most nonmelanoma skin cancer can be treated by a dermatologist. This is a healthcare provider who specializes in treating disease of the skin. If your cancer is more advanced, you may also have other types of healthcare providers on your team. These may include:

  • Surgical oncologist. This is a healthcare provider with special training in surgery to treat cancer.

  • Medical oncologist. This is a healthcare provider with special training to treat cancer with medicines such as chemotherapy and targeted therapy.

  • Radiation oncologist. This is a healthcare provider with special training to treat cancer with radiation therapy.

  • Dermatologist. This is a healthcare provider who specializes in skin disease treatment, including nonmelanoma cancers like squamous and basal cell skin cancers, and precancers.
  • Oncology nurse. This is a nurse with special training to take care of people with cancer.

You may also have physician assistants or nurse practitioners as a part of your healthcare team. Your team will answer any questions you may have. They’ll help you through each of the steps you’ll take before, during, and after treatment. Your team will let you know what tests you need and the results of those tests. They’ll guide you in making treatment decisions and help prepare you and your loved ones for what’s ahead.

Learning about treatment choices

To decide the best course of treatment for you, your healthcare team needs to know as much as they can about your cancer. This may mean getting some tests and working with more than one healthcare provider or other type of healthcare professional. And you may decide that you want to get a second opinion to help you choose a treatment.

Getting support

Coping with cancer can be stressful. You can talk with your healthcare team about seeing a counselor. They can refer you to someone who can help. You can also visit support groups to talk with other people coping with cancer. Ask your healthcare team about local and online support groups.


Nonmelanoma Skin Cancer: Stages

The stage of a cancer is how much and how far the cancer has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is. They can also see if the cancer has spread to nearby areas, and if it has spread to other parts of your body. The stage of a cancer is one of the most important things to know when deciding how to treat the cancer.

In most cases, nonmelanoma skin cancer is confined to the skin and is easily treated and cured.

What are the stages of nonmelanoma skin cancer?

The stage is based on the type of nonmelanoma skin cancer (basal or squamous cell), the size of the tumor, how deeply into your skin it has grown, and if the cancer has spread beyond the tumor to other parts of your body.

If you have basal cell carcinoma, stage is seldom needed because these cancers tend to be treated and cured before they have a chance to spread internally.

If you have squamous cell carcinoma, your healthcare provider may check the lymph nodes near the tumor to see if the cancer has spread to them.

Skin cancer staging is very complex. The TNM system from the American Joint Commission on Cancer is most often used to stage squamous (and sometimes basal) cell skin cancers of the head and neck (includes lip, face, scalp, and neck). Be sure to ask your healthcare provider to explain the stage of your cancer to you in a way you can understand.

The first step in staging is to find the value for each part of the TNM system. Here's what the letters stand for in the TNM system:

  • T tells how far the main tumor has spread into the skin.
  • N tells if the lymph nodes in the area of the original tumor have cancer in them.
  • M tells if the cancer has spread ( metastasized) to distant organs in the body.

Numbers or letters after T, N, and M provide more details about each of these factors.

Stage groupings are determined by combining the T, N, and M values from the TNM system. These groupings give an overall description of your cancer. A stage grouping is listed as 0 or as a Roman numeral with a value of I through IV (1 through 4). Stage 0 is the earliest stage. The higher the number, the more advanced the cancer is. Letters and numbers can be used after the Roman numeral to give more details.

Most nonmelanoma skin cancers are Stage 0 or Stage I and can be easily treated. Stage III and IV are fairly rare.

High-risk features for nonmelanoma skin cancer

High-risk features can make a skin cancer harder to treat. These features include:

  • The tumor is thicker than 2 millimeters.

  • The tumor has spread into the lower layer of your skin, such as the connective tissue or fat under the dermis, called the subcutis.

  • The tumor has grown and spread along nerve pathways.

  • Cancer cells are in the blood vessels or lymph vessels outside the main tumor.
  • The tumor began on an ear or lip.

  • The cancer cells look very abnormal under a microscope.

  • Being on immunosuppressive medicines (like those used to prevent organ transplant rejection)

Talking with your healthcare provider

When your cancer is staged, talk with your healthcare provider about what the stage means for you. Make sure to ask questions and talk about your concerns.

Treatment Choices

Nonmelanoma Skin Cancer: Treatment Choices

There are various treatment choices for skin cancer. Which one may work best for you? It depends on a number of things. These include what type of skin cancer you have, how large the skin cancer is, if it has been treated before, where it is, what stage it is, and its risk of recurrence. Other things that affect your treatment choices include your age, health, your preferences, and what side effects you’ll find acceptable. The main goal of treatment is to remove the cancer completely while keeping function and appearance as much as possible.

Learning about your treatment choices

You may have questions and concerns about your treatment choices. You may also want to know how you’ll feel and function during and after treatment, and if you’ll have to change your normal activities.

Your healthcare provider is the best person to answer your questions. They can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your healthcare provider may advise a specific treatment. Or they may offer more than one and ask you to decide which one you’d like to use.

You may have just one treatment or a combination of treatments.

In some cases, you may elect to have no treatment. This may be a reasonable choice in elderly or frail patients with no symptoms. Be sure to discuss the risks of this choice with your healthcare provider before declining treatment.

Types of treatment for nonmelanoma skin cancer


Surgery is a common treatment for nonmelanoma skin cancer. It' s used in most cases when the cancer is still at an early stage. Many skin cancers can be removed easily and need only very minor surgery. Others may need a more extensive surgery. The surgery choices include:

  • Simple excision. This is done to cut the cancer from the skin using a scalpel blade, along with some of the healthy tissue around it (edges of tissue are called the surgical margin).

  • Curettage and electrodesiccation. The surgeon scrapes the tumor from the skin using a sharp, spoon-shaped instrument called a curette. Then they use a needle-shaped electrode to stop bleeding and kill any cancer cells that may have been left behind in the edges of the wound.

  • Mohs surgery. This procedure removes the cancer and as little normal tissue as possible. It’s done in sensitive areas, such as the head, face, and hands. During this surgery, the surgeon removes a thin layer of skin including the cancer and then uses a microscope to make sure no cancer cells remain. If cancer cells are seen, another layer of skin is removed. This is repeated until all of the cancer has been removed.

  • Cryosurgery. This procedure uses extremely cold liquid, like liquid nitrogen or a tool called a cryroprobe, to freeze the tissue and kill cancer cells.

  • Laser therapy. The surgeon uses a narrow beam of intense light to burn away cancer cells.


Chemotherapy is done with medicines. With nonmelanoma skin cancer, chemotherapy is most often done by applying a topical strong medicine to the skin to kill cancer cells. Basal cell cancer rarely spreads, and IV or oral medicine is not often used for it. Squamous cell cancer can sometimes spread. If this happens, medicines may be given through an IV or by mouth. Chemotherapy may be given with radiation therapy or alone.

Targeted therapy

Targeted therapy is also done with medicine, but it works differently than chemotherapy. It also can have different side effects. The medicine targets specific parts of cancer cells. In rare cases of locally advanced basal cell cancer, or where surgery or radiation can’t be used, a basal cell cancer may be treated with a targeted medicine, such as oral medicines called vismodegib or sonidegib. Squamous cell skin cancer can be treated with targeted therapy, such as an EGFR (epidermal growth factor receptor) medicine to keep cancer cells from growing.

Radiation therapy

Radiation therapy uses high energy X-rays or other types of radiation sources. The goal of this treatment is to kill cancer cells. In some cases, this treatment is used instead of surgery. It can also be used to get rid of any cancer cells that may be left after surgery. Radiation treatment is noninvasive (it does not need cutting the skin) but usually needs many treatments and may not be as reliable as other treatment choices. Chemotherapy may be used with radiation for some squamous cell skin cancers.

Photodynamic therapy

The goal of this treatment is to kill cells at the cancer site by using a medicine to make the cells more sensitive to a special laser light. This limits damage to healthy tissue. This therapy is occasionally used for nonmelanoma skin cancer or precancers. For more information, ask your healthcare provider about this therapy.


This type of therapy is done with medicines. The medicines use chemicals that stimulate the immune system. .The medicine uses your body’s immune defense to attack the cancer cells. The treatments can be given as a topical cream that is applied on the tumor, such as imiquimod for superficial basal cell skin cancers. Medicines that target PD-1 receptors on cancer cells are a type of immune checkpoint inhibitor, and may be used for some squamous or basal cell skin cancers.

Clinical trials for new treatments

Researchers are always finding new ways to treat cancer. These new methods are tested in clinical trials. Talk with your healthcare provider to find out if there are any clinical trials you should consider.

Talking with your healthcare provider

At first, thinking about treatment choices may seem overwhelming. Talk with your healthcare providers, nurses, and loved ones. Make a list of questions. Consider the benefits and possible side effects of each choice. Discuss your concerns with your healthcare provider before making a decision.