Skin Cancer: Basal and Squamous Cell Overview

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Early Detection, Diagnosis, and Staging TOPICS

How are basal and squamous cell skin cancers found?

Basal and squamous skin cancers can often be found early, when they are likely to be easier to treat.

As part of a routine check-up, your doctor should look at your skin carefully. This is even more important for people who have a high risk of skin cancer, such as those with lowered immunity. Ask your doctor how often you should have your skin examined.

Skin self-exam

Many doctors advise that you also check your own skin once a month. Skin self-exams are best done in front of a full-length mirror. Use a hand-held mirror for places that are hard to see. You should know the pattern of moles, freckles, and other marks on your skin so that you’ll notice any changes.

Friends and family members can also help you with these exams, especially for those hard-to-see areas, such as your scalp and back. For more details about skin self-exams, see Skin Cancer: Prevention and Early Detection.

Be sure to show your doctor any area that concerns you and ask them to look at areas that may be hard for you to see. If you can’t see your doctor right away, you might want to take good close-up photos of the area so your doctor can see if the area is changing when you do get an appointment.

Signs and symptoms of basal and squamous cell skin cancer

Skin cancers often don’t cause symptoms until they become quite large. Then they can itch, bleed, or even hurt. But they can often be seen or felt long before they reach this point.

Basal cell cancers usually start on places exposed to the sun, especially the head and neck, but they can occur anywhere on the body. These cancers can appear as:

  • Flat, firm, pale or yellow areas that might look like a scar
  • Raised reddish patches that might be itchy
  • Small, pink or red, shiny, pearly bumps, which might have blue, brown, or black areas
  • Pink growths with raised edges and a lower area in their center, which might have abnormal blood vessels
  • Open sores (which may have oozing or crusted areas) that don’t heal, or that heal and then come back

Basal cell cancers often bleed easily after shaving or after a minor injury. Sometimes people go to the doctor because they have a sore or a cut from shaving that just won’t heal, which turns out to be a basal cell cancer. A simple rule of thumb is that most shaving cuts heal within a week or so.

Squamous cell cancers also tend to occur on areas of the body exposed to the sun, such as the face, ears, neck, lips, and backs of the hands. Less often, they form in the skin of the genital area. They can also start in scars or skin sores elsewhere.

These cancers can show up as:

  • Rough or scaly red patches, which might crust or bleed
  • Raised growths or lumps, sometimes with a lower area in the center
  • Open sores (which may have oozing or crusted areas) that don’t heal, or that heal and then come back
  • Wart-like growths

Both of these types of skin cancer can also develop as a flat area showing only slight changes from normal skin. To see some examples of basal and squamous cell cancers, visit our Skin Cancer Image Gallery.

Any spot on the skin that is new or changing in size, shape, or color should be seen by a doctor promptly.

If you or your doctor finds something that doesn’t look normal, your doctor will do exams and tests to find out if it is cancer or something else. If it is skin cancer, more tests may be done to find out if it has spread to other places.

Medical history and physical exam

Your doctor will ask you when the mark on your skin first appeared, whether it has changed in size or the way it looks, and if it has caused any symptoms (pain, itching, bleeding, etc.). You might also be asked about sunburns and the use of tanning beds and other exposures to causes of skin cancer. You will probably be asked if you or anyone in your family has had skin cancer.

During the exam, the doctor will note the size, shape, color, and texture of the area in question, and whether it is bleeding, oozing, or crusting. He or she may check the rest of your body for spots and moles that could be related to cancer. The doctor may also check nearby lymph nodes (bean-shaped collections of immune system cells) to feel if they are larger or firmer than usual. This could mean the cancer has spread to the nodes.

Your regular doctor might refer you to a doctor called a dermatologist. This doctor has special training in skin diseases and will look at the area more closely. He or she may use a special magnifying lens (a dermatoscope) to see spots on the skin. Pictures of the spot may be taken.

Skin biopsy

If the doctor thinks that an area might be skin cancer, a sample of skin will be taken and looked at under a microscope. This is called a skin biopsy. If the biopsy removes the whole tumor, it is often enough to cure the skin cancer without further treatment.

Skin biopsies are done using numbing medicine, which is put into the area with a very small needle.

Types of skin biopsies

There are different ways to do a biopsy. Any biopsy is likely to leave at least a small scar.

Shave biopsy: The top layers of the skin are shaved off with a surgical blade.

Punch biopsy: This method is used to remove a deeper sample of skin. A tool that looks like a tiny round cookie cutter is used to remove the tissue sample. The edges of the biopsy site are often stitched together.

Incisional and excisional biopsies: These types of biopsies are used if the doctor needs to look at deeper layers of the skin. A scalpel is used to cut through the full thickness of the skin. A wedge of skin is removed, and the edges are often sewn back together. An incisional biopsy removes only part of the tumor. If the whole tumor is removed, it is called an excisional biopsy.

All skin biopsy samples are sent to a lab, where they are looked at with a microscope by a doctor called a pathologist.

Lymph node biopsy

In rare cases when basal or squamous cell skin cancer spreads, it can go first to nearby lymph nodes, which are small, bean-sized collections of immune cells. If your doctor feels the lymph nodes are too large or too firm, a lymph node biopsy may be done to find out if the cancer has spread to the nodes.

There are 2 ways to do a lymph node biopsy.

  • In fine needle aspiration (FNA), a thin, hollow needle is used to remove very small pieces of tissue from a lymph node.
  • If the doctor suspects there is cancer in a lymph node that the FNA did not find, a surgical lymph node biopsy may be done. For this, the doctor removes the whole lymph node.

Last Medical Review: 05/06/2015
Last Revised: 05/11/2015