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What are basal and squamous cell skin cancers?

Basal cell skin cancer and squamous cell skin cancer are the two most common types of skin cancer.

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.

Your skin is made up of several different layers and many different types of cells. Skin cancer starts when some of these cells begin to grow out of control.

Ask your doctor to use this picture to show you what layer of skin your cancer started in. The type of skin cancer you have depends on which layer and type of cells the cancer started from.

• Basal cell cancer starts in a lower layer of the skin
• Squamous cell cancer starts in the top layer of the skin

Your doctor can tell you more about the type of skin cancer you have.

For some types of skin cancer, the cancer cells can spread to other parts of the body, but this doesn’t happen often for basal cell and squamous cell cancers. When cancer cells do spread, it’s called metastasis.

Other types of skin cancer

Another type of skin cancer is melanoma. This cancer starts from the pigment-making cells of the skin (called melanocytes). Melanoma is less common than basal and squamous cell cancers, but it’s more dangerous because it’s more likely to spread to other parts of the body. You can read about melanoma in If You Have Melanoma Skin Cancer.

There are also many other types of skin cancer, but these are even less common. Ask your doctor if you have questions about the exact type of skin cancer you have.

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?

Skin cancers are usually found because of a change on the skin. Basal and squamous cell cancers 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 removes the abnormal area of skin 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.

Other tests

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 an MRI or CT scan.

Questions to ask the doctor

• Will I need any other tests?
• If so, who will do these tests? Where will they be done?
• 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?

For most types of cancer, the doctor will want to find out how far it has spread. This is called staging.

But basal and squamous cell skin cancers don't spread as often as most 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.

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 new or if it’s come back
• If the cancer is in a place that was already treated with radiation
• If you have a weakened immune system

Your doctor might look at these things (and others) to help decide which risk group your skin cancer falls into. This can help show how likely it is that your skin cancer will come back. This might affect your treatment options.

Questions to ask the doctor

• Do we need to know the stage of my cancer?
• Do we need to know the risk group of my cancer?
• What do these mean for me?
• 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. Most basal and squamous cell skin cancers can be removed quickly and easily with a simple surgery done in the doctor’s office using medicine to numb the skin (local anesthetic). There are different types of surgery to remove skin cancer. The type that’s best for you depends on the type of skin cancer you have, 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. Skin cancer surgery can also often leave a scar where the cancer was removed. 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 kinds 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, ask about what side effects might happen. 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, but 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 the 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.

Medicine to treat skin cancers that have spread

For basal and squamous cell cancers that have spread beyond the skin, treatment might include medicines such as chemotherapy, immunotherapy, or targeted therapy. These drugs travel through the bloodstream to all parts of the body so they can attack cancer cells that have spread to the lymph nodes or other parts of the body.

• Immunotherapy is treatment that boosts your own immune system to attack the cancer cells.
• Targeted therapy drugs find and attack certain parts of cancer cells.
• Chemotherap (chemo) affects fast growing cells throughout the body, including cancer cells.

Depending on the type of drug you need, it might be given as a pill, as a shot (injection), or as an infusion into a vein (an IV).

Different drugs can have different side effects. For example, some chemo drugs can make you feel very tired, sick to your stomach, and cause your hair to fall out. Ask your cancer care team what to expect, and be sure to tell them about any side effects you have. There are ways to prevent or treat many side effects.

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 that are not 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

• 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?

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?
• 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?
• 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?

After treatment is over, it will be important to check your skin for any new signs of cancer. It will also be very important to protect yourself from getting too much sun.

At first, follow-up visits to have your skin checked 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.