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Nonmelanoma Skin Cancer Diagnosis

Nonmelanoma cancers usually appear as changes in the skin. You or your doctor may find areas of concern during skin exams. 

Types of Nonmelanoma Cancer

Basal cell cancers often show up on parts of the body that are most exposed to sun — the head, neck, back, chest, shoulders, and especially the nose. There are several types of basal cell cancers. They each look different, though they all have the same treatment.  

Common signs of basal cell cancers are:

  • Bump, growth, mole, or wart that is unusual or is growing.  
  • Sore that doesn’t heal.
  • Sore, lump, or patch of skin that itches, bleeds, or develops a scab and that takes a few weeks to heal.
  • Bump that looks shiny and might have tiny blood vessels or be indented in the center.
  • Patch of skin or spot that looks like a scar and bleeds easily.

Some people might have pain or sensitivity in these areas, however that's not common.

Squamous cell cancer often occurs in several areas — face, head, neck, forearm, back of hand, leg, lower lip, and rim of the ear. They commonly appear where skin has been exposed to UV radiation (from the sun or tanning beds) or, less commonly, in scar tissue.  

Common signs of squamous cell cancer are:

  • Old scars that change color, begin to bleed, form ulcers (sores), drain, or become painful.
  • Sores, wart-like growths, or scaly red patches that crust, bleed, and don’t go away.
  • Thickened skin on lower lip, especially for those who use tobacco or are often exposed to sun and wind.

Some of these areas may grow quickly in size. They may or may not be painful.

Actinic keratosis (AK) is a skin condition that is not cancer but can turn into basal or squamous cell cancer. AKs usually shows up on skin that has been exposed to the sun or tanning beds such as the face, head, neck, back of hands, and lower lip. AK may appear as:

  • One or many rough patches of skin, commonly size of a small pea, though some may be larger.
  • Pink or brown rough patches surrounded by irritated skin.
  • Skin on the lower lip that cracks or peels that isn’t helped by using lip balm.
  • Sometimes a patch of skin will itch, burn, or sting, but these symptoms aren’t common.

If you think you might have signs of AK, have it looked at and treated early to lower the chances that it will turn into skin cancer. Treatments for AK include freezing or applying topical (cream) treatments to the skin.

If you have any problems or concerns with your skin, always check with your doctor.

Diagnostic Tests

You might find a suspicious-looking skin area and see your doctor. Or your primary care doctor or dermatologist (skin specialist) may see an area of concern during a routine exam. Even if the doctor thinks the area may look like cancer, a biopsy (tissue sample) is the only way to know for sure.

In a biopsy, your primary care doctor, dermatologist, physician assistant, or nurse practitioner will remove all or part of a skin growth. You will have a shot to numb your skin and then have a biopsy which will do one of the following:

  • Shave off the top layer of skin
  • Take a deeper sample of tissue using a punch, which looks like a tiny round cookie cutter
  • Remove a wedge (incisional) or the whole (excisonal) growth

Your provider will let you know what kind of biopsy you’ll be having.  

After your biopsy, your provider will send the sample to a pathologist or dermatopathologist (specialists in studying skin or other tissue) who will examine it for cancer cells. Your doctor will let you know the results of the biopsy, which usually take up to a week to be completed.

Stages of Nonmelanoma Cancer

If you receive a diagnosis of basal cell or squamous cell cancer, the doctor might want to find out the extent of the cancer.

Basal cell cancer is never staged. Squamous cell cancer (which has a small risk of spreading) may be staged for those who have a higher skin cancer risk, such as those with suppressed immune systems. AK is not cancer, so it is not staged.

Staging will let your doctor know:

  • The size and location of the growth, and how deep in the skin it is.
  • If cancer may have spread.  

Your doctors and care team at Kaiser Permanente medical offices can answer any questions you have during diagnosis.