Skin Cancer (Nonmelanoma)

Skin cancer is the most common type of cancer in the world. Every year, nearly 5.5 million Americans are diagnosed with skin cancer and doctors have reported that skin cancer rates are growing faster than breast, colon and lung cancer combined. There are two types of skin cancer. The first is melanoma, which is less common and affects the deeper layers of the skin. Melanoma is more aggressive and difficult to treat. The second type of skin cancer is nonmelanoma skin cancer. This is a broad category that includes all cancers that are not melanoma and that occur in the outer layers of the skin. It can be classified into several categories, depending on the cancer cells causing it and compared to melanoma is much less dangerous and easy to treat if diagnosed early. Nonmelanoma skin cancer is the most common type of skin cancer.


Overview & Facts About Skin Cancer (Nonmelanoma)

  • The incidence of nonmelanoma skin cancer is very high. In the United States, almost 3.5 million people are treated for nonmelanoma skin cancer every year
  • The rates of nonmelanoma skin cancer have increased worryingly in the past 30 years, affecting more people that all other cancer types
  • According to the American Cancer Society, one in five Americans develops nonmelanoma skin cancer, especially after the age of 65
  • Nearly all cases of nonmelanoma skin cancer are caused by excessive exposure to the sun
  • Nonmelanoma skin cancer is more common in women than in men until the age of 50, but after this age men are more at risk of developing it.
  • The treatment of nonmelanoma skin cancer costs the United States a lot


Types of Nonmelanoma Skin Cancer

There are several types of nonmelanoma skin cancer and they are classified depending on the type of skin cell causing the them. However, there are just two main types of nonmelanoma skin cancer, which account for most skin cancer cases:

  • Basal cell carcinoma (BCC) – accounts for about 75% of skin cancer cases and it occurs at the bottom of the epidermis. BCC is also called a rodent ulcer. BCC typically manifests as a small, painless pink lump that gradually becomes bigger and develops a crust.
  • Squamous cell carcinoma (SCC) – accounts for 20% of skin cancer cases and it occurs at the top of the epidermis. SCC manifests as firm lump with a cracked surface. Unlike in the case BCC, this lump is usually painful.


Apart from these two types, there are several other subdivisions of nonmelanoma skin cancer and together they account for just 5% of cases:

  • Bowen’s disease – the precancerous form of squamous cell carcinoma, can progress into SCC if left untreated
  • Actinic keratoses – a benign form of SCC characterized by patches of flaky skin caused by long term sun exposure.
  • Angiosarcoma – a rare type of nonmelanoma skin cancer that occurs in the lining of the blood vessels, especially around the head and neck areas
  • Cutaneous B-cell lymphoma – a rare type of nonmelanoma skin cancer that starts in the white blood cells, forms a lump and attacks the skin cells
  • Cutaneous T-cell lymphoma – a rare type of cancer that starts in the white blood cells, forms a rash and attacks the skin.
  • Dermatofibrosarcoma protuberans – begins in the middle layer of the skin
  • Merkel cell carcinoma – a rare type of cancer that develops in seniors, looking like a red or blue nodule that keeps growing.
  • Sebaceous carcinoma – a rare type of skin cancer that forms in an oil gland. It typically forms around the eyelids.


Symptoms of Nonmelanoma Skin Cancer

The symptoms of nonmelanoma skin cancer depend on the specific type of cancer that the patient is dealing with. Nonmelanoma signs and symptoms can be both painful and painless, but, as a general rule, the first obvious symptom is a change in the appearance of the skin. More often than not, this change does not appear overnight, it slowly progresses, which is why in some cases it may go unnoticed. To discover skin cancer as quickly as possible, people are advised to look at their skin closely every month and see their doctor if they notice one or more of the following:


Symptoms of basal cell carcinoma:

  • A pink growth that does not disappear after one month and that has a crusty border
  • A pink or white bump with an elevated top
  • A protuberant red patch that does not hurt
  • A sore that hurts and oozes but does not close after one month

The signs of basal cell carcinoma can be mistaken for a benign skin lesion such as wart or an allergy.

Symptoms of squamous cell carcinoma

  • An unexplained growth that looks like a wart
  • A red lesion with irregular borders
  • A sore that bleeds easily and does not get better in four weeks

In most cases, nonmelanoma skin cancer does not hurt, which is why many people discard it. It may appear as a lump, bump or discoloration or as a bruise. However, what sets cancer apart from an innocent lesion is that it appears without a clear reason and does not disappear in several weeks.

When this type of skin cancer occurs around the nerves, symptoms may also include numbing and tingling of the surrounding area.

Nonmelanoma skin cancer may appear on any area of the body, but it is more common on the areas that are exposed to sunlight, such as the arms, legs and face. In rare forms of nonmelanoma skin cancer, the tumor can also appear on the eyelids or neck.


Diagnosis of Nonmelanoma Skin Cancer

Because the symptoms of nonmelanoma skin cancer are very similar to the ones caused by other conditions, and because nonmelanoma skin cancer does not spread, the only certain diagnosis of nonmelanoma skin cancer can be given through a biopsy.

The biopsy is a relatively simple medical procedure during which the doctor removes all or part of the skin tissue and tests it under a microscope for signs of abnormal cell growth. The biopsy will tell if those cells are normal and the growth is caused by something or else or if they are indeed cancerous.

In addition to the biopsy, the patient will also be required several details that will aid the medical investigation, such as their medical history, family history, existing conditions and symptoms and results of previous blood tests.


Treatment & Care for Nonmelanoma Skin Cancer

The preferred and most successful treatment for nonmelanoma skin cancer is surgery. Because this form of cancer does not spread to the surrounding tissue, complete removal of the tumor and area surrounding it will suffice. Surgery is done under local anesthesia and has a short recovery time. The patient is asked to avoid intense physical exercise until the stitches are removed and afterwards they may apply a lotion on the scar to speed up tissue healing.

If the tumor is situated in an area where surgery is not possible or if the patient cannot undergo surgery, then the doctor may also recommend non-surgical nonmelanoma treatments such as:

  • Cryotherapy (freezing the tumor)
  • Anti-cancer creams
  • Radiotherapy
  • Photodynamic therapy

In many cases, the treatment for nonmelanoma skin cancer is done in the diagnosis stage, when the doctor removes tissue for the biopsy. If the healthcare provider has reason to believe that the growth is indeed a cancerous tumor, then they can preemptively remove all of it plus the surrounding skin and then send it to the biopsy. More often than not, nonmelanoma skin cancer tumors or growths that are similar to it also pose an aesthetic concern, so doctors remove them from the very beginning.


Causes & Risk Factors of Nonmelanoma Skin Cancer

The causes of nonmelanoma skin cancer are diverse, ranging from generic to environmental:

  • Prolonged sun exposure is the primary cause of nonmelanoma skin cancer and accounts for most cases of skin cancer, including melanoma. Contrary to common belief, not just sunburns (UVB) trigger the development of cancerous skin cells. UVA rays, responsible for aging, are just as harmful and, apart from the fact that they affect skin elasticity, they also increase the risk of nonmelanoma skin cancer. People who live at high altitudes and in tropical regions with plenty of sunlight are the most at risk, which is why dermatologists recommend the application of sun screen all year round, not just on the beach.
  • Tanning beds have also been proved to increase the risk of skin cancer, even when used occasionally. Dermatologists point out that artificial tanning is never safe and numerous studies have shown the direct link between the use of tanning beds and increased cancer risk. Countries such as Australia have already banned tanning beds in an effort to reduce the incidence of melanoma and nonmelanoma skin cancers, especially among the younger demographic, but most countries have yet to regulate the activity of tanning salons.


Nonmelanoma skin cancer risk factors include:

  • Being older than 65 – after this age, the risk of developing nonmelanoma skin cancer rises exponentially
  • Being male – the risk of developing a cancerous nonmelanoma tumor is higher in men than it is in women
  • Having a fair complexion – people with light skin and cold undertone, red or blonde hair and freckles are more at risk because their skin burns instead of tan when exposed to the sun
  • Suffering from a pre-cancerous skin condition such as Bowen’s disease or actinic keratoses. These conditions can develop into cancer if left untreated for long periods of time
  • Suffering from sunburns. People who have had many sunburns in the past are more at risk to develop skin cancer, even if those sunburns occurred in the past. Sun damage is cumulative, so once the skin becomes sensitive, patients should be careful to avoid additional risk factors.
  • History of skin cancer. Patients who were treated for another form of skin cancer can develop basal cell carcinoma in the following five years, because a tumor may appear in a different place. Radiation therapy also increases the risk, which is why cancer patients are advised to go to follow-up visits to their doctor every year to make sure the tumor has not come back.
  • Weakened immune system. Some medications and medical conditions can weaken the immune system and increase the risk of squamous cell carcinoma. This includes patients with HIV/AIDS, people who have had organ transplants, patients with autoimmune disorders and people who take immunosuppressant drugs.
  • HPV – being infected with the human papillomavirus increases the risk of Human papillomavirus.


Nonmelanoma Skin Cancer Prevention

Although nonmelanoma skin cancer is very common and widespread, it can be prevented. Nonmelanoma skin cancer prevention includes the following lifestyle changes:

  • Avoiding sun exposure between 11 a.m. and 6 p.m. If it cannot be avoided, the use of broad spectrum (UVA + UVB) is mandatory, even in the cold season. For best results, sunscreen should be reapplied on the face and body every two hours. If the patient has vitamin D deficiency in addition to an increased risk of developing nonmelanoma skin cancer, then they should talk to their doctor about alternative sources of vitamin D.
  • Avoiding natural and artificial tanning. If a darker skin tone is desired, then the only healthy way of obtaining it is by using colored self-tanning lotions.
  • Wearing protective clothing such as broad rimmed hats and protective sunglasses with UV filters.
  • Inspecting the skin regularly for abnormal lesions and growths. Any new bump or discoloration, painful or not, should be carefully monitored and, if it does not go away in a few weeks, it should be seen by a doctor for professional diagnosis. At home, individuals may take photos of uncommon spots and lumps and compare them after some time to see if they have changed in shape, color and texture. Areas that are harder to observe, such as the back or behind the ears, can be examined using a mirror. Senior citizens who cannot examine the skin themselves are at a higher risk of living with untreated nonmelanoma skin cancer for longer, which is why family members should help them examine their skin every month. For better results, an annual visit to the dermatologist can prevent nonmelanoma skin cancer even more or diagnose it from the very beginning.

Last updated on September 30th, 2020

Chris Riley

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