Skin cancer

Non-melanoma skin cancers include:

• basal cell carcinoma (BCC)
• squamous cell carcinoma (SCC)

BCC is the most common type of skin cancer in the UK. It starts in skin cells called basal cells. SCC is the second most common type in the UK, and it develops from the squamous cell layers of the skin.

A few other cancers can also affect the skin. They are much less common than BCC and SCC, and they are treated differently. Macmillan Cancer Support has separate information about these types:

• sarcoma
• Kaposi's sarcoma
• cutaneous lymphoma

The biggest risk factor for skin cancer is exposure to ultraviolet light (UV light). This can come from sunlight, or from indoor tanning devices like sunbeds.

Macmillan Cancer Support also has more information on the causes and risk factors of skin cancer.

Staying safe in the sun matters for everyone. It matters even more if you have already had skin cancer, or treatment for another type of cancer.

Macmillan Cancer Support has more information about sun safety and cancer treatment.

If you have symptoms, see your doctor. They'll examine you and may take photos of the skin change. Sometimes a specially trained doctor can remove the affected area there and then.

If your doctor thinks your symptoms could be skin cancer, they can refer you to a specialist at a hospital. This is usually a doctor who specialises in treating skin diseases, called a dermatologist.

Your doctor follows national guidelines to decide how quickly you need to see the specialist.

If they think you might have a melanoma or a squamous cell carcinoma (SCC), they'll make an urgent referral. This means they're asking for a dermatologist appointment for you within 2 weeks or as soon as the clinic can arrange it.

If your doctor thinks you have a basal cell carcinoma (BCC), they'll make a routine referral. This is a request for a less urgent appointment, usually within 18 weeks. The reason is that nearly all BCCs grow slowly and are unlikely to change much during this time.

At the hospital, a dermatologist will examine the affected area of skin. They'll also ask how long you've had symptoms and whether you've noticed any changes. A simple examination can tell them a lot.

They may use an instrument called a dermatoscope to look more closely at the skin. It looks like a magnifying glass with a light.

You can't always tell whether skin changes are cancer just by looking at the skin. So your doctor may talk to you about having a biopsy. This is when a sample of tissue is taken and then tested to find out more.

A biopsy can usually be done in an outpatient clinic. The doctor will numb the area with a local anaesthetic. They'll remove all or part of the affected skin and send it to the laboratory for tests.

Different types of biopsies are used to diagnose skin cancer.

An incision biopsy is when a doctor removes a small piece of the abnormal area, using a surgical knife. They'll then close the small wound with stitches.

An excision biopsy is like an incision biopsy, but the whole abnormal area is removed. The doctor will also remove a small amount of healthy tissue around the abnormal area. This is called the margin.

If you have an abnormal mole that may be melanoma, you may have the whole mole removed with an excision biopsy.

A punch biopsy is when a doctor uses a small, round cutting instrument to remove a sample of skin. You might need stitches to close the area.

A shave biopsy is when a doctor uses an instrument to shave off the top layer of the affected area of skin. The wound forms a scab and heals without the need for stitches.

Waiting for test results can be a difficult time, and support from the people around you can help.

If your biopsy shows skin cancer, the doctor will usually go on to check the other areas of your skin too. The reason is to see whether there are any other places where skin cancer might be starting.

If you have a basal cell carcinoma (BCC), you probably won't need any further tests, as long as the cancer has been completely removed. That's because BCCs almost never spread.

If you have melanoma, you may have tests to check the lymph nodes nearby.

If you have a squamous cell carcinoma (SCC), your doctor may feel the lymph nodes close to the cancer to check whether any are enlarged. They do this because SCCs can occasionally spread.

Your doctor may also recommend an operation to take samples of the nearby lymph nodes. They'll only suggest this if they think the cancer may have spread there, which is rare.

Your doctor may ask for scans if they think the skin cancer has started to spread. These scans are not usually needed when you're first diagnosed. Your doctor will explain more about them.

An ultrasound scan uses soundwaves to build up a picture of an area of the body. The person doing the scan puts some gel on your skin and moves a small device, called an ultrasound probe, over it.

A CT scan uses x-rays to build up a detailed picture. The scanner looks like a large, thick ring. You lie still on a narrow bed, and it moves slowly backwards and forwards through the ring.

An MRI scan uses magnetism to build up a detailed picture. You need to lie still on a bed inside a long cylinder (tube) while the scan is done.

A PET scan uses a low dose of radiation to check the activity of cells in different parts of the body. You'll have an injection about 1 hour before the scan. The scanner looks like a large, thick ring, and you lie still on a narrow bed which moves slowly backwards and forwards through it.

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

The treatment you're offered will depend on the type of skin cancer you have. Macmillan Cancer Support has more advice on cancer treatment options.

Doctors often treat basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) with surgery, and for most people it's the first treatment and the only one they need. Sometimes other skin cancer treatments are used instead of surgery.

Surgery is the main treatment for melanoma. Depending on the stage of the melanoma, some people need more surgery or other treatments as well.

You may be offered some of these treatments as part of a clinical trial.

Most people who have surgery for BCCs and SCCs don't need long-term follow-up appointments at the hospital. Even so, your doctor may want to see you for regular check-ups for a time. The reason is to make sure the treatment has worked and the cancer hasn't come back.

You can also talk to your doctor or specialist nurse about any problems or worries you have.

If you've been treated for melanoma, the follow-up you need depends on the stage of the melanoma.

Once you've had treatment for skin cancer, protecting yourself from the sun matters even more.

Never use an indoor tanning device, such as a sunbed or sunlamp. If you want to look tanned, use fake tan. You should also check your skin regularly for any changes.

If you're not often outdoors or in the sun, ask your specialist doctor or your doctor to check your vitamin D levels. Vitamin D is important for supporting general health, and levels can become low in people who avoid the sun or spend most of their time indoors. If your levels are low, you may need to take vitamin D supplements.

There's no right or wrong way to feel when you're told you have skin cancer. Everyone reacts differently, and you may find you have a mixture of emotions.

Even when skin cancer is likely to be cured, you may feel anxious or upset for a while. Talking about how you feel can help.

You could talk with your family, friends, doctor or nurse. Sometimes it's easier to speak to someone who isn't directly involved in your situation.

If you're finding it hard to cope, your cancer doctor, specialist nurse or doctor may be able to refer you to a counsellor who can help.