Understanding non-melanoma skin cancer

It can be tricky working out what types of skin cancer there is, the stages, and when skin cancer is serious and when it’s not. There are two main groupings of skin cancer: melanoma and non-melanoma. Melanoma is much more dangerous than non-melanoma cancers, but both can be a problem if undetected and untreated. 

Here we talk only about non-melanoma skin cancers, as they are distinctly different to melanomas. 

Different types of skin cancer

Non-melanoma skin cancers (keratinocyte cancers) are the most common form of cancers in Australia and are generally not life-threatening. The two main types of skin cancer are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

Basal cell carcinoma

BCC accounts for about 70 per cent of non-melanoma skin cancers and starts in the lower layer of the epidermis. The epidermis is the top, outer layer of our skin. BCC can occur anywhere on the body but is most likely found on areas that get intermittent sun (head, face, shoulders, neck, back). 

Signs of BCC skin cancer

BCC usually present no symptoms, grow slowly, do not spread, a pearly lump or a scaly, dry area that looks shiny and pale or bright pink. 

Squamous cell carcinoma

SCC accounts for the other 30 per cent of non-melanoma skin cancers and start in the upper layer of the epidermis and appear on areas of the most sun exposure (hands, forearms, lower legs, head, neck). SCC develops quickly (across weeks, months). 

Signs of SCC skin cancer

SCC tends to appear as a thickened red, scaly spot that grows quickly and looks like a sore that won’t heal. SCC may be tender to the touch. 

“Other” lesions

There is another group worthy of mention, called keratinocyte dysplasias. These non-invasive lesions include solar keratosis, Bowenoid keratosis and squamous cell carcinoma in-situ (Bowen’s disease). While not non-melanoma cancers, these lesions can develop into cancers and might require treatment. It pays to have regular skin checks and keep an eye on these types of growths. 

The stages of skin cancer

Most types of cancer have a set of stages that determine progress if it has spread and typical outcomes or requirements in terms of treatment. However, with non-melanoma skin cancers, basal cell carcinomas are not typically staged, with only some squamous cell carcinoma requiring staging. 

A doctor usually only needs the biopsy to stage skin cancer, and in SCC, your doctor will check the lymph nodes near the cancer for swelling as well. If your doctor detects swelling in nearby lymph nodes, it might mean the cancer has spread. 

We can successfully treat most early-stage skin cancers. If your BCC or SCC require staging, your doctor will advise you. 

Is there a cure for skin cancer?

We almost always surgically remove skin cancers, which typically provides a complete and successful treatment. However, if the cancer is advanced and has invaded surrounding tissue, your doctor may remove more tissue to ensure the complete removal of cancerous cells. 

Surgery is the most common treatment for skin cancer, with a local anaesthetic used to ensure your comfort. Other treatments for skin cancers include ointments, radiation therapy, cryotherapy (freezing), curettage (scraping) or cauterisation (burning). 

Understanding skin types and skin cancers

Some skin types are more likely than others to develop skin cancers. We use the Fitzpatrick skin type model to determine skin types. The Fitzpatrick skin type classification system looks at how skin reacts to exposure to sunlight. 

The skin type depends on the amount of melanin (pigment), determined by a constitutional colour. The colours are white, brown or black, and UV radiation or tanning effect on that colour skin. 

Pale or white skin doesn’t tan very well and is slow to tan while burning easily. Paler skins require more protection against the sun’s damaging rays. Darker skin tans more easily while burning less easily. Darker skin tones are prone to post-inflammatory pigmentation after injury, potentially resulting in brown marks. 

Your Fitzpatrick skin phototype is determined at birth and is a constitutional characteristic – you can’t change your Fitzpatrick skin type, and it won’t change across your lifetime. Your dermatologist at ENRICH Clinic in Melbourne can determine your skin type, though you’ll surely recognise yourself in these types.

Fitzpatrick skin types

Fitzpatrick skin type 1

• Ivory skin before sun exposure
• Light blue, grey or green eyes
• Naturally blonde or red hair
• In the sun, skin always burns, always peels
• Freckles appear
• Doesn’t tan

Fitzpatrick skin type 2

• Skin is fair before sun exposure
• Blue, grey or green eyes
• Naturally blonde hair
• In the sun, skin burns and peels often
• Freckles often appear
• Not a good tanner

Fitzpatrick skin type 3

• Before the sun, skin is a darker shade of pale with a gold tone
• Hazel or brown eyes
• Naturally dark blonde or light brown hair
• In the sun, the skin may freckle
• Occasionally burns
• Tans

Fitzpatrick skin type 4

• Olive or light brown skin
• Dark brown eyes
• Naturally dark brown hair
• In the sun, does not often burn
• Does not usually develop freckles
• Often tans

Fitzpatrick skin type 5

• Brown or dark brown skin
• Dark brown eyes
• Naturally dark brown or black hair
• Rarely freckles
• Hardly ever burns in the sun
• Always tans

Fitzpatrick skin type 6

• Dark brown to black skin
• Brownish black eyes
• Naturally black hair
• Never freckles in the sun
• Never burns
• Always develops a dark tan

To have a personalised assessment of your skin and your skin cancer risks, make an appointment with ENRICH Clinic in Melbourne.

We’re skin cancer specialists. 

ENRICH Clinic