Non-melanoma skin cancer

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 skin changes.

Basal cell carcinoma:

• On light skin, it usually looks like a shiny, slightly see-through lump at first. The surface may look similar to candle wax.
• On darker and very dark skin, the bumps are often dark or brown in color with a shiny, glossy appearance.
• It mainly develops on areas of skin that are regularly exposed to sunlight, such as the scalp, neck or cleavage.

Squamous cell carcinoma:

• This may look like a scaly, red or brownish-yellow patch of skin – or a scabby or crusted sore.
• In people with light skin, it often develops on areas of skin that are frequently exposed to sunlight – on the face, for example.
• In people with dark skin, it more commonly develops in areas that are usually covered by clothing, such as on the legs.

People sometimes notice non-melanoma skin cancer because an area of skin is itchy or starts to bleed. It doesn't cause any other symptoms for a long time. But if it grows larger, enters deeper layers of tissue or spreads inside the body, it causes other symptoms – mostly pain in the affected area.

Various factors can increase your risk of developing non-melanoma skin cancer. Too much sunlight is the main risk factor, but people with light-colored skin or certain medical conditions are more prone too.

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 and squamous cell carcinoma are among the most common types of cancer.

In Germany in 2018, about 224 out of 100,000 women and 257 out of 100,000 men developed one of these two types of skin cancer. So men are slightly more likely to get non-melanoma skin cancer. A total of about 200,000 people were diagnosed with non-melanoma skin cancer in Germany in 2018.

The following year, 631 men and 445 women died of non-melanoma skin cancer.

Basal cell carcinoma grows slowly and usually doesn't spread to other organs (metastasis). But if it goes unnoticed for a long time, the cancer can enter deeper layers of tissue, 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 than basal cell carcinoma. It also grows in the area where it develops, gradually destroying tissue around 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 carcinoma die of it.

Doctors can often tell whether you have non-melanoma skin cancer just by looking at your skin. To examine it more closely, they often use an instrument called a dermatoscope as well. 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 unusual 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 nearby lymph nodes) are usually only needed if it's thought that the cancer may have spread.

People sometimes wrongly assume that you can’t get skin cancer if you have darker skin. It is also harder to see skin cancer on dark skin. Because of these two things, the cancer may go undetected for a longer time. This makes it even more important to look out for changes in darker skin too.

Skin cancer screening is aimed at large numbers of people who haven't 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 cancer before it 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, the doctor closely inspects all of your skin, from head to toe. For the examination to be thorough, they should also look at skin folds and mucous membranes. Doctors who mainly examine people with light skin sometimes find it harder to recognize non-melanoma skin cancer on darker skin. This is because the cancer might look different and develop on other parts of the body in people with darker skin. Aside from skin cancer screening, it's also important to look out for changes in your skin yourself and have a doctor examine any unusual 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 cancer has entered deeper layers of tissue, more major interventions are needed.

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. Information about health care in Germany can help you to navigate the German health care system and find a suitable doctor. You can use this list of questions to prepare for your appointment.