Non-Melanoma Skin Cancer: Basal and Squamous Cell Cancer

The term non-melanoma skin cancer covers several tumours that develop in the upper layers of the skin. Doctors use the word non-melanoma because, unlike melanoma, these cancers do not start in the pigment-producing cells known as melanocytes. They are also called white or light skin cancer, because the growths usually look paler than the surrounding skin and rarely have the dark colour of a mole. Two forms account for the vast majority of cases: basal cell carcinoma, often shortened to BCC, and squamous cell carcinoma, or SCC. They arise from different cell types in the outer skin and behave differently. A basal cell carcinoma almost always stays where it is, while a squamous cell carcinoma can, in rare cases, spread to other parts of the body. What they have in common is that they are far more common than melanoma and, when caught early, are usually very treatable. Non-melanoma skin cancer is one of the most common cancers worldwide. Because it is rarely life-threatening, it tends to receive less attention than melanoma. That does not mean it should be ignored: left untreated, it can grow into the surrounding tissue and cause real damage.

Basal cell carcinoma is by far the most common type of non-melanoma skin cancer. It arises from the basal cells, the lowest layer of the outer skin. It typically appears where the skin has had a lot of sun over the decades: on the face, nose, ears, forehead or a bald scalp. In the beginning a basal cell carcinoma often looks harmless. It frequently shows up as a small, skin-coloured to reddish lump with a slightly shiny, pearly surface crossed by fine blood vessels. Some form a flat, scaly patch, others a small sore that keeps bleeding and simply will not heal. It is exactly this seemingly trivial sore, one that lingers for weeks, that is an important warning sign. What sets basal cell carcinoma apart is that it almost never spreads to other organs, so secondary tumours are genuinely rare. Instead it grows slowly but persistently into the depth and can, especially on the face, eventually damage cartilage and bone if left untreated for a long time. Caught early, it can usually be removed completely with a minor procedure.

The second most common form of white skin cancer is squamous cell carcinoma. It develops from the keratinocytes, the horn-forming cells of the outer skin. Like basal cell carcinoma, it prefers areas with heavy sun exposure: the face, ears, lower lip, backs of the hands or a bald scalp. A squamous cell carcinoma often appears as a rough, firmly attached crust or as a nodular, easily injured spot that may weep or scab over. It frequently feels hard and scaly. Unlike basal cell carcinoma, in advanced stages it can spread, mainly through the lymphatic system. The risk of this is low overall, but it rises with the size and depth of the tumour, another reason not to wait too long. In many cases squamous cell carcinoma is preceded by an early form: actinic keratosis. These are rough, scaly, often slightly reddish patches on sun-damaged skin that feel like fine sandpaper. They are considered a pre-cancer and can, but do not always, turn into squamous cell carcinoma. Because you cannot tell from the outside which ones will progress, they should be monitored by a doctor and treated if needed.

The most important trigger for non-melanoma skin cancer is ultraviolet radiation, from the sun as well as from sunbeds. Unlike melanoma, which is more closely linked to occasional severe sunburns, what matters most for white skin cancer is the total: the UV dose that builds up over a lifetime. That is why these tumours so often sit on the sun-exposed areas of the body, such as the nose, ears, forehead and backs of the hands. People with fair skin who burn easily and tan poorly are especially at risk. Age also plays a role, because UV damage adds up over decades, so most people affected are older. Those who work outdoors, for example in construction or farming, accumulate a great deal of UV exposure over the years. In certain occupations non-melanoma skin cancer is even recognised as an occupational disease. Further risk factors include a long-term weakened immune system, for instance after an organ transplant, a family history, previous skin cancers and the regular use of sunbeds. The World Health Organization classifies the UV radiation from tanning beds as carcinogenic. The good news is that the most important risk factor is within your control: consistent sun protection noticeably lowers the risk.

Non-melanoma skin cancer causes no pain at first and often looks unremarkable, which is exactly what makes it deceptive. It is worth checking your own skin regularly and paying attention to changes that do not clear up on their own. Be alert to a wound or sore that has not healed after several weeks; a rough, scaly or crusted patch that keeps coming back; a shiny, pearly lump with visible blood vessels; a spot that bleeds, weeps or itches easily; or a firm, horn-like thickening on sun-damaged skin. Unlike with melanoma, the well-known ABCDE rule only helps to a limited extent here, because non-melanoma skin cancer is usually not pigmented. What matters instead is how a lesion develops over time: anything that is new, changes, or persists for weeks should be assessed by a dermatologist. It is better to have it checked once too often than once too late.

A first suspicion is assessed by a dermatologist with the naked eye and with a dermatoscope, a lit magnifier that makes deeper layers of skin visible. Certainty ultimately comes from a tissue sample, known as a biopsy: a small piece of the suspicious area is removed and examined under the microscope. Only this result reliably shows whether, and which kind of, skin cancer is present. The most common treatment is surgical removal of the tumour with a safety margin. In many cases this is a minor outpatient procedure. Depending on the size, location and type of tumour, other options may be considered, such as radiotherapy, specific creams, freezing or photodynamic therapy, particularly for superficial basal cell carcinomas and actinic keratoses. Which method is suitable is always decided by the treating doctor in each individual case. The outlook for non-melanoma skin cancer is generally good, provided it is detected early. Basal cell carcinoma can be removed completely in the vast majority of cases, and the chances of cure for early squamous cell carcinoma are high as well. After treatment, regular checks are important, because anyone who has had non-melanoma skin cancer carries a higher risk of further tumours.

Prevention above all means keeping the UV dose low. Avoid the strong midday sun, wear a hat, sunglasses and covering clothing in summer, and apply a sunscreen with a sufficiently high protection factor to exposed skin. Avoid sunbeds entirely. These recommendations hold throughout life, because every sunburn you avoid counts. In the UK there is no national screening programme for skin cancer, so checking your own skin regularly is all the more valuable. Look at your skin in good light and use a mirror for areas that are hard to see. If you notice anything that will not heal or keeps changing, see your GP, who can refer you to a specialist if needed. A digital tool like DermCheck can give you a first orientation. You upload a photo of a suspicious area of skin and receive an AI-based assessment of whether a medical check appears advisable. We value honesty here: such an initial assessment can sharpen your sense of your own risk and lower the barrier to seeing a doctor. It does not replace a medical diagnosis.

This article is for general information and health education only. It does not replace medical advice, diagnosis or treatment. If you notice a change in your skin or are unsure, please see a dermatologist or your doctor. Only a personal examination can reliably tell whether a change is harmless or needs treatment.