Basal cell carcinoma (basal cell cancer) and squamous cell carcinoma (squamous cell cancer) are collectively referred to as non-melanoma skin cancer. This is to distinguish them from melanomas, which often look like dark moles.
Non-melanoma skin cancer is much more common than melanoma. But non-melanoma skin cancer can usually be fully removed, and it only rarely spreads to other parts of the body.
Non-melanoma cancer can take on very different forms so it can have a number of different symptoms too: The affected area of skin may become scaly, lumpy, or change color. This makes it difficult to tell the difference between non-melanoma skin cancer and other spots or blotches on your skin. Non-melanoma skin cancer mainly develops on the parts of the skin that are often exposed to sunlight, such as the scalp or around the neckline.
People sometimes notice non-melanoma skin cancer because an area of skin is itchy or starts to bleed. Non-melanoma skin cancer doesn't cause any other symptoms for a long time. But if it grows larger, penetrates deeper into the tissue or spreads inside the body, it causes other symptoms – mostly pain.
Causes and risk factors
Various factors can increase your risk of developing non-melanoma skin cancer. Overexposure to sunlight is the main risk factor, but people with certain skin types or medical conditions are more prone too.
Basal cell carcinoma and squamous cell carcinoma are among the most common types of cancer. According to rough estimates for Germany in 2014, about 85,400 men and 83,700 women developed basal cell carcinoma, and about 29,300 men and 20,100 women developed squamous cell carcinoma. So men are slightly more likely to get non-melanoma skin cancer.
The risk of getting non-melanoma skin cancer increases with age. The average age of people diagnosed with basal cell carcinoma is about 60, and for squamous cell carcinoma it's 70.
Basal cell carcinoma grows slowly and usually doesn't spread to other organs (metastasis). But it can enter deeper layers of tissue if it goes unnoticed for a long time, and is then more difficult to treat. About 1 out of 1,000 people who develop basal cell carcinoma die of it.
Squamous cell carcinoma is more aggressive. It also grows in the area where it develops, gradually destroying tissue near to it. If left untreated, there is a danger that the cancer might spread to other parts of the body. About 40 to 50 out of 1,000 people with squamous cell cancer die of it.
In Germany, a total of about 435 men and 351 women die of non-melanoma skin cancer each year.
Doctors can often tell whether you have non-melanoma skin cancer just by looking at your skin. To examine it more closely, they need an instrument called a dermatoscope. This is a very powerful magnifying glass with a light on it.
If doctors think you may have non-melanoma skin cancer, they will remove the abnormal area of skin and some surrounding tissue. Sometimes they will first check whether it really is non-melanoma skin cancer. This involves taking a tissue sample (biopsy) and examining it under a microscope. Further examinations like an ultrasound scan of neighboring lymph nodes are usually only needed if it is thought that the cancer may have spread.
Skin cancer screening is aimed at large numbers of people who have not yet been diagnosed with this disease. In Germany, skin cancer screening focuses on people aged 35 and over. Statutory health insurers then offer to cover the costs of this screening examination every two years. The idea is to detect pre-cancerous changes in the skin and discover tumors before they can invade nearby tissue or spread to other parts of the body (metastasis). The ultimate aim is to provide better treatment and increase the chances of a full recovery.
In skin cancer screening, a doctor takes a close look at your skin from head to toe with their naked eye. For the examination to be thorough, he or she should also look at skin folds and mucous membranes.
Aside from skin cancer screening, you can also look out for changes in your skin yourself and have a doctor examine any abnormal areas.
There is no surefire way to prevent non-melanoma skin cancer. It is generally sensible to avoid overexposure to ultraviolet (UV) light. This mainly means not spending too much time in the sun without protection and not using tanning beds.
Basal cell carcinoma and squamous cell carcinoma can often be fully removed in a minor operation, particularly when discovered at an early stage. If skin cancer can no longer be surgically removed, radiotherapy or medication are considered. If the tumor has invaded deeper layers of tissue, more major interventions are necessary.
Squamous cell carcinoma and the abnormal changes in the skin that can lead to it – known as actinic keratosis – have been acknowledged as occupational diseases since early 2015. People who spend a lot of time being exposed to UV light because they work outdoors are more likely to develop this type of non-melanoma cancer.
You can find information about using tanning beds on the website of the German Federal Office for Radiation Protection (Bundesamt für Strahlenschutz, or BfS).
When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.
Bundesamt für Strahlenschutz (BfS). Optische Strahlung: Hinweise für Solariennutzer. September 05, 2019.
Dellavalle R. Skin cancer, moles, and actinic keratosis. In: Williams H, Bigby M, Herxheimer A, Naldi L, Rzany B, Dellavalle R (Ed). Edvidence-based dermatology. London: BMJ Books; 2014. S. 223-319.
Deutsche Gesetzliche Unfallversicherung (DGUV), Sozialversicherung für Landwirtschaft, Forsten und Gartenbau (SVLFG). DGUV-Arbeitshilfe "Hautkrebs durch UV-Strahlung": Hautkrebs durch UV-Strahlungsexposition. Eine Hilfestellung für die UV-Träger. September 25, 2013.
Deutsche Krebsgesellschaft (DKG), Deutsche Dermatologische Gesellschaft (DDG). Aktinische Keratose und Plattenepithelkarzinom der Haut (S3-Leitlinie). AWMF-Registernr.: 032-022. June 2019.
Gemeinsamer Bundesausschuss (G-BA). Hautkrebsscreening. Zusammenfassende Dokumentation des Unterausschusses „Prävention“ des Gemeinsamen Bundesausschusses. March 31, 2008.
Robert Koch-Institut (RKI), Gesellschaft der epidemiologischen Krebsregister in Deutschland (GEKID). Krebs in Deutschland für 2013/2014. 2017.
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