Non-Melanoma Skin Cancers

The two most important conditions in this group are basal cell carcinoma and squamous cell carcinoma. The most important risk factor in the development of both tumours is exposure to the sun's ultraviolet (UV) rays over many years. In other words — unlike short, high-dose exposure that causes sunburn — they develop as a result of sun damage accumulated over years. They are more common in fair-skinned people, at an advanced age, in those who work outdoors, in those with heavy sun damage, and in individuals whose immune system is suppressed.

Non-melanoma skin cancers usually present as a non-healing sore, crusting, bleeding, a steadily growing lump, or a lesion that does not resolve over a long period. When diagnosed early, the great majority can be treated completely. It is therefore important that lesions on the skin that persist for a long time or change in appearance are assessed by a dermatologist.

Basal cell carcinoma is the most common skin cancer. It tends to grow slowly and has a better course than other skin cancers. Although spread to distant organs is extremely rare, if left untreated it can progress locally and cause significant damage to surrounding tissue. It appears most often in areas most exposed to the sun, such as the face, nose, around the eyes, ears, scalp and neck. Patients usually notice a small non-healing sore, a shiny or pearly lump that occasionally bleeds, a pink lesion with a depressed centre, or a sore that repeatedly crusts. Dermatological examination together with dermoscopic examination has an important place in diagnosis; the definitive diagnosis is made by histopathological examination. The main aim of treatment is complete removal of the tumour, most often by surgical excision.

Squamous cell carcinoma is the second most common tumour among non-melanoma skin cancers. It tends to grow faster than basal cell carcinoma and, in some patients, has the potential to spread to lymph nodes or other organs; early diagnosis and treatment are therefore very important. While long-term sun exposure is the most important risk factor, actinic keratoses, chronic wounds, burn scars, immune-suppressing conditions or medications, and some HPV infections can also increase the risk. It appears most often on the face, lip, ear, scalp, neck and the backs of the hands. Treatment is based on complete surgical removal of the tumour; radiotherapy may be used in some patients, and immunotherapy or other systemic treatments may be needed in advanced cases.

Besides basal cell and squamous cell carcinoma, there are other, rarer malignant tumours of the skin. Merkel cell carcinoma, dermatofibrosarcoma protuberans, sebaceous carcinoma, some tumours arising from the skin appendages, and primary cutaneous lymphomas are among them. Although rarer, it is important that these tumours are assessed by a dermatologist for early diagnosis and appropriate treatment.