Non-melanoma skin cancer

Also called Basal cell carcinoma, Squamous cell carcinoma, Rodent ulcer

By far the commonest cancer in the UK. Rarely fatal, and it disfigures faces when it is left.

What it is

Non-melanoma skin cancer is the commonest cancer in the UK by a wide margin, with well over 150,000 cases a year, and the true figure is higher because registration is incomplete.

There are two main types. Basal cell carcinoma is much the commoner: it grows slowly, almost never spreads, and is essentially always curable. Squamous cell carcinoma grows faster and can spread, though most does not.

Both are caused by cumulative sun exposure over decades, which is why they appear on the face, ears, scalp, neck and backs of hands.

The reason to act rather than watch is not usually mortality. It is that a basal cell carcinoma left on a nose or an eyelid for five years requires far more reconstruction than one removed at six months. People lose parts of noses and ears to a cancer that was curable with a small excision.

Signs you might notice

Basal cell carcinoma: a pearly or waxy bump, sometimes with visible small vessels, or a flat scaly patch. It may bleed, crust, heal and then break down again. That cycle of healing and breaking down is the classic story.

Squamous cell carcinoma: a firm, scaly or crusted lump, sometimes tender, growing over weeks to months.

Actinic keratoses: rough, scaly patches on sun-exposed skin. These are pre-cancerous and worth treating.

Any sore that has not healed in four weeks needs looking at.

How it can affect day-to-day life

The people at highest risk are outdoor workers, older people with decades of exposure, and anybody on long-term immunosuppression, including after an organ transplant, where the risk is many times higher and skin surveillance should be routine.

In care settings, skin cancers on the scalp, ears and face are frequently only noticed by whoever provides personal care.

Sunscreen matters lifelong, not only on holiday, and factor 30 or above on exposed skin every day is reasonable advice for anyone with a history.

Supporting someone well

Use the four-week rule: any sore that has not healed in four weeks should be seen.

Look at scalps, ears and the backs of hands, particularly in older people and anybody who worked outdoors. If you provide personal care, this is part of it.

Protect skin: shade, hats, long sleeves, and daily sunscreen on exposed areas.

Treat actinic keratoses rather than ignoring them.

For anybody immunosuppressed or transplanted, ask for regular dermatology surveillance; the risk is substantially higher.

Do not delay because it is not melanoma. The tissue lost while waiting is what causes the harm.

Where to get help

See a GP for any non-healing sore, and photographs help.

Most basal cell carcinomas are treated with a small excision, sometimes under local anaesthetic in a GP surgery.

British Association of Dermatologists publish patient leaflets on every treatment option.