If You Have Basal or Squamous Cell Skin Cancer

What is skin cancer?

Cancer can start any place in the body. Skin cancer starts when cells in the skin grow out of control.

Skin cancer cells can sometimes spread to other parts of the body, but this is not common. When cancer cells do this, it’s called metastasis. To doctors, the cancer cells in the new place look just like the ones from the skin.

Cancer is always named based on the place where it starts. So if skin cancer spreads to another part of the body, it’s still called skin cancer.

Ask your doctor to use this picture to show you where your cancer is

The skin

The skin is the largest organ in the body. It helps keep the body warm, protects the rest of the body from the sun, covers organs inside the body, guards against germs, and helps make vitamin D. It’s made of a lot of different types of cells.

Different kinds of skin cancer

There are many types of skin cancer. Some are very rare. Your doctor can tell you more about the type you have.

The two most common kinds of skin cancers are:

• Basal cell cancer, which starts in the lowest layer of the skin
• Squamous cell cancer, which starts in the top layer of the skin

Another kind of skin cancer is called melanoma. These cancers start from the color-making cells of the skin (called melanocytes). You can read about melanoma in If You Have Melanoma Skin Cancer.

Questions to ask the doctor

• Why do you think I have cancer?
• Is there a chance I don’t have cancer?
• Would you please write down the kind of cancer you think I might have?
• What will happen next?

How does the doctor know I have skin cancer?

Basal and squamous skin cancer may look like:

• Flat, firm, pale or yellow areas that look a lot like a scar
• Raised reddish patches that might itch
• Rough or scaly red patches, which might crust or bleed
• Small, pink or red, shiny, pearly bumps, which might have blue, brown, or black areas
• Pink growths or lumps with raised edges and a lower center
• Open sores (which may have oozing or crusted areas) that don’t heal, or that heal and then come back
• Wart-like growths

Tests that may be done

The doctor will ask you questions about when the spot on your skin first showed up and if it has changed in size or the way it looks or feels. The rest of your skin will be checked. During the exam your doctor will check the size, shape, color and texture of any skin changes. If signs are pointing to skin cancer, more tests will be done.

Skin biopsy

In a biopsy, the doctor takes out a small piece of tissue to check it for cancer cells. A biopsy is the only way to tell for sure if you have skin cancer and what kind it is.

There are many types of skin biopsies. Ask your doctor what kind you will need. Each type has pros and cons. The choice of which type to use depends on your own case.

In rare cases basal and squamous cell skin cancer can spread to the nearby lymph nodes (bean-size sacs of immune system cells.) Ask your doctor if your lymph nodes will be tested.

Basal and squamous cell cancers don't often spread to other parts of the body. But if your doctor thinks your skin cancer might spread, you might need imaging tests, such as MRI or CT scans.

Questions to ask the doctor

• What tests will I need?
• Who will do these tests?
• Where will they be done?
• Who can explain them to me?
• How and when will I get the results?
• Who will explain the results to me?
• What do I need to do next?

How serious is my cancer?

If you have skin cancer, the doctor will want to find out how far it has spread. This is called staging.

Basal and squamous cell skin cancers don't spread as often as some other types of cancer, so the exact stage might not be too important. Still, your doctor might want to find out the stage of your cancer to help decide what type of treatment is best for you.

The stage describes the growth or spread of the cancer through the skin. It also tells if the cancer has spread to other parts of your body that are close by or farther away.

Your cancer can be stage 0, 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread beyond the skin. Be sure to ask the doctor about the cancer stage and what it means for you.

Other things can also help you and your doctor decide how to treat your cancer, such as:

• Where the cancer is on your body
• How fast the cancer has been growing
• If the cancer is causing symptoms, such as being painful or itchy
• If the cancer is in a place that was already treated with radiation
• If you have a weakened immune system

Questions to ask the doctor

• Do you know the stage of the cancer?
• If not, how and when will you find out the stage of the cancer?
• Would you explain to me what the stage means in my case?
• What will happen next?

What kind of treatment will I need?

There are many ways to treat skin cancer. The main types of treatment are:

• Surgery
• Radiation
• Other local treatments
• Targeted drugs
• Immunotherapy
• Chemotherapy

Most basal cell and squamous cell cancers can be cured with surgery or other types of treatments that affect only the spot on the skin.

The treatment plan that’s best for you will depend on:

• The stage and grade of the cancer
• The chance that a type of treatment will cure the cancer or help in some way
• Your age and overall health
• Your feelings about the treatment and the side effects that come with it

Surgery

Surgery is the main type of treatment for most skin cancers. There are different kinds of surgery. The type that’s best for you depends on the kind of skin cancer, how big it is, and where it is. Ask your doctor what kind of surgery you will have and what to expect.

Side effects of surgery

Any type of surgery can have risks and side effects. Be sure to ask the doctor what you can expect. If you have problems, let your doctors know. Doctors who treat skin cancer should be able to help you with any problems that come up.

Radiation treatments

Radiation uses high-energy rays (like x-rays) to kill cancer cells. The kind of radiation used to treat skin cancer only go into the skin. This limits damage to other parts of the body.

Radiation can also be used to treat skin cancer that has spread to other parts of the body.

Side effects of radiation treatments

If your doctor suggests radiation treatment, talk about what side effects might happen. Side effects depend on the type of radiation that’s used. The most common side effects of radiation are:

• Skin changes and hair loss where the radiation is given
• Feeling very tired (fatigue)

Most side effects get better after treatment ends. Some might last longer. Talk to your cancer care team about what you can expect.

Other local treatments (treatments that affect only the skin)

There are ways to treat skin cancer without cutting into the skin. Some of these use freezing, chemo or other drugs put right on the skin, light therapy (PDT), or lasers to kill cancer cells.

If you’re getting one of these treatments, talk to your doctor about how it works and what you can expect. Make sure you know what the treatment will be like and how your skin will feel and look after it.

Immunotherapy

Immunotherapy is treatment that boosts your own immune system to attack the cancer cells. It can be used to treat some advanced squamous cell skin cancers. It is given as a shot into a vein.

Side effects of immunotherapy

Immunotherapy can cause many different side effects. They are usually mild, but some can be serious. Most of these problems go away after treatment ends.

There are ways to treat most of the side effects from immunotherapy. If you have side effects, talk to your cancer care team so they can help.

Targeted drugs

Targeted therapy drugs may be used for certain types of skin cancer. These drugs find and attack cancer cells while doing little harm to normal cells. Each drug works in a different way, but they change the way cancer cells grow, divide, or repair themselves.

Side effects of targeted drugs

Targeted drugs can cause different side effects. Most of these problems go away after treatment ends.

There are ways to treat most of the side effects from targeted drugs. If you have side effects, talk to your cancer care team so they can help.

Chemo

Chemo is the short word for chemotherapy – the use of drugs to fight cancer. This treatment uses drugs that are put into a vein or taken as a pill. These drugs travel through the bloodstream to all parts of the body. Unlike chemo that’s put on the skin, chemo given this way can attack cancer cells that have spread to lymph nodes and other organs.

Side effects of chemo

Chemo can make you feel very tired, sick to your stomach, and cause your hair to fall out. But these problems go away after treatment ends.

There are ways to treat most chemo side effects. If you have side effects, be sure to talk to your cancer care team so they can help.

Clinical trials

Clinical trials are research studies that test new drugs or other treatments in people. They compare standard treatments with others that may be better. Clinical trials are one way to get the newest cancer treatment. They are the best way for doctors to find better ways to treat cancer. If your doctor can find one that’s studying the kind of cancer you have, it’s up to you whether to take part. And if you do sign up for a clinical trial, you can always stop at any time.

If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials. See Clinical Trials to learn more.

What about other treatments that I hear about?

When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.

Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything you’re thinking about using, whether it’s a vitamin, a diet, or anything else.

Questions to ask the doctor

• Would you please write down the exact kind of skin cancer I have?
• Has the cancer grown deep into the skin? Has it spread?
• Will I need any other tests before we can decide on treatment?
• Do I need to see any other doctors?
• What treatment do you think is best for me?
• What’s the goal of this treatment? Do you think it could cure the cancer?
• What will treatment be like? Where will it be done? How long will it take?
• Will I be OK if the cancer is just removed with no other treatment?
• What side effects could I have from these treatments?
• Will I have a scar? What will it look like?
• What are the chances that the skin cancer will come back? What would we do if that happens?
• What are my chances of having skin cancer again?
• Is there a clinical trial that might be right for me?
• What about special vitamins or diets that friends tell me about? How will I know if they are safe?
• How soon do I need to start treatment?
• What should I do to be ready for treatment?
• Is there anything I can do to help the treatment work better?
• Should I take special care to avoid sun exposure? How should I do that?
• Are my family members at risk for skin cancer? What should I tell them to do?
• What’s the next step?

What will happen after treatment?

You’ll be glad when treatment is over. Your doctor will want you to check your skin at least once a month. It will be very important to protect yourself from getting too much sun.

For years after treatment ends, you will see your skin cancer doctor. At first, your visits may be every few months. Then, the longer you’re cancer-free, the less often the visits are needed. Be sure to go to all of these follow-up visits. Your doctor will ask about symptoms and check you for signs of the cancer coming back or a new skin cancer. Other exams and tests may also be done.

Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your cancer care team to find out what you can do to feel better.

You can’t change the fact that you have cancer. What you can change is how you live the rest of your life – making healthy choices and feeling as good as you can.