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When people refer to 'non-melanoma skin cancer', they are generally talking about two types of tumours: basal cell carcinomas and squamous cell carcinomas. These are the most common forms of skin cancer and, although they may look and act differently, they are treated in a similar way. Both types may also be hereditary skin cancers, but such cancers are very rare.
Basal Cell Carcinoma
Basal cell carcinomas (BCC) make up three-quarters of all skin cancers that are seen in the West, making them the single most common form of cancer. Their incidence is increasing, almost certainly because of increased exposure to the sun1. Most BCCs that develop do so on areas of skin that are usually uncovered: the face, ears, neck, shoulders and scalp. They can, however, occur on other areas of the body. Generally, people with fair skin are more likely to develop BCC than those with darker skin.
BCC can have a number of different appearances. They may look like an open sore or a pink lump on the skin, or may simply appear as a red patch or a scar-like area on the skin. In some cases, BCC may look similar to psoriasis or eczema. Although they can grow to become quite large, BCCs rarely spread to other areas of the body. If not removed, however, they can cause damage to surrounding tissue. This is particularly important if the tumour occurs on the face close to the eyes, ears or nose. Fortunately, they can be treated with a high degree of success.
Squamous Cell Carcinoma
Squamous cell carcinomas (SCC) of the skin occur at similar sites to BCC, particularly the ears and lower lip, as sunlight is important in their development. SCCs were also common in scientists working with radioactive materials in the early 20th Century, until the link between radiation and cancer was discovered. SCC may also develop on areas of skin where there has been some sort of injury, such as a burn (including severe sunburn) or exposure to certain chemicals. People with a suppressed or damaged immune system may be at higher risk of SCC and, as with BCC, fair-skinned people also have a higher chance of developing these tumours.
SCC generally begin as a crusty wart-like growth or sore that bleeds and lasts for several weeks, although some have a similar appearance to BCC as described above. If not treated, SCC are more likely to spread to other parts of the body than BCC, particularly those SCC that occur on the lips or mouth, or where the skin is already damaged. Even those that do spread, however, generally go through a period of local growth first, and can be successfully treated at this stage.
Treatment of Non-melanoma Skin Cancer
When skin cancer has been confirmed by biopsy2, treatment can begin. The type of treatment chosen depends on several factors, including the tumour type, size and location. The patient's age and health are also taken into account. Treatment usually takes place in an outpatient clinic under local anaesthetic, and is almost always painless.
Electrosurgery and Cryosurgery
Small tumours can be treated by electrocautery and curettage, in which the cancer is scraped away with a sharp, ring-shaped instrument (the curette) while an electric needle destroys any tumour tissue that is left behind. Alternatively, cryosurgery, in which the tumour is frozen off with liquid nitrogen, may also be used if the tumour is very small.
Mohs surgery, named after the surgeon who invented it, involves carefully removing thin layers of the tumour and checking each layer under a microscope for signs of cancer. Layers keep being removed until the tumour is gone completely. This technique has the advantage that as little healthy tissue as possible is removed, and it has a very high success rate.
Larger tumours can be treated by excisional surgery, which involves the surgical removal of the entire tumour. If the tumour is particularly large, a general anaesthetic may be needed, and some plastic surgery may follow.
Tumours in locations where surgery is very difficult (such as near the eyes or nose) or in elderly patients, in whom surgery may be dangerous, can be treated by radiotherapy. The tumour is destroyed by X-rays, usually given in several doses over a number of weeks.
Other treatments that are used less frequently include laser surgery, which is similar to electrosurgery, and drugs such as fluorouracil, which may be useful in patients whose tumour recurs.
Most BCC and SCC Can Be Treated Successfully
Overall, 90-95% of BCCs and SCCs can be cured quickly and easily using the techniques above. If treatment is started when the tumour is small, even higher rates of success can be achieved.