Non-Melanoma Skin Cancer: An Overview From Diagnosis to Treatment

Non-melanoma skin cancer is a common and highly treatable type of cancer that originates in the top layer of the skin. Unlike melanoma, it rarely spreads to other parts of the body. The two most common types are basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). A rare and more aggressive form is Merkel cell carcinoma (MCC).

• BCC is the most frequent type and typically grows slowly. It often appears as a pearly or waxy bump on sun-exposed areas like the head and neck.
• SCC is the second most common type and can present as a firm, red nodule or a flat, scaly lesion. It also frequently occurs on sun-exposed skin.
• MCC is a rare but aggressive neuroendocrine cancer of the skin, often appearing as a firm, shiny, flesh-colored to reddish-purple nodule. It grows quickly and can spread to other parts of the body.

“We can talk about the bad but also the good, (which is) that it is a potentially curable cancer if caught early,” Dr. Manisha Thakuria, director of the Merkel cell carcinoma clinic at the Dana-Farber Cancer Institute and assistant professor of dermatology at Harvard Medical School, told CURE in an interview. “And we cure lots of patients with Merkel cell carcinoma who are living great lives. But it can be a really nasty cancer … when it's caught late, when there are certain tumor characteristics that make it worse and certain host or patient characteristics that maybe make you more vulnerable.”

Prolonged exposure to ultraviolet (UV) radiation from the sun or tanning beds is the primary risk factor for developing non-melanoma skin cancer.

How is Skin Cancer Diagnosed?

The diagnostic process usually begins with a thorough skin examination by a dermatologist. If a suspicious lesion is found, a biopsy is performed. A small sample of the skin is removed and sent to a lab for microscopic analysis to confirm the presence and type of cancer. This procedure is usually quick and performed in the doctor's office.

For MCC, additional tests like lymph node biopsies or imaging scans (such as CT or PET scans) may be necessary to determine if the cancer has spread.

How is Skin Cancer Treated?

The treatment for non-melanoma skin cancer depends on several factors, including the type of cancer, its size, location and the patient's overall health. Most treatments are highly effective and are performed on an outpatient basis.

• Surgical Excision: The most common treatment, this involves surgically cutting out the cancerous tissue and a small margin of healthy skin around it. This is often curative for most cases.
• Mohs Surgery: A specialized procedure for tumors in cosmetically sensitive areas like the face, this technique involves removing the cancer layer by layer and examining each layer under a microscope until only cancer-free tissue remains. This maximizes the removal of cancer while preserving healthy tissue.
• Radiation Therapy: High-energy beams are used to destroy cancer cells. This is a good option for patients who are not candidates for surgery or for difficult-to-treat tumors.
• Topical Treatments: Certain creams or gels containing chemotherapy drugs or immunomodulating agents can be applied directly to the skin for superficial, low-risk cancers like BCC and SCC.
• Photodynamic Therapy (PDT): A light-sensitizing drug is applied to the skin, followed by a special light that activates the drug to kill cancer cells. This is used for some superficial cancers.
• Immunotherapy: For advanced or widespread MCC, treatments that help the body's immune system recognize and destroy cancer cells are often used.

What are the Side Effects of Skin Cancer Treatment?

The side effects of treatment are generally localized and temporary.

• Surgical Excision/Mohs Surgery: Patients may experience pain, swelling, and bruising at the surgical site. There may also be a scar, which often fades over time.
• Radiation Therapy: Side effects can include redness, swelling and a feeling of sunburn in the treated area. The skin may also become dry and itchy.
• Topical Treatments: These can cause skin irritation, redness, itching and a rash in the treated area.
• Photodynamic Therapy: Patients may have a temporary burning or stinging sensation during treatment, followed by redness, swelling, and scabbing. Treated areas will be highly sensitive to light for a period of time.
• Immunotherapy: Side effects can vary but may include fatigue, rash and flu-like symptoms.

Next Steps After Being Diagnosed With Skin Cancer

A non-melanoma skin cancer diagnosis can be unsettling, but it is highly curable with the right treatment. This overview is intended to provide a basic understanding of your diagnosis and treatment options. The most crucial next step is to have a detailed and open conversation with your oncologist. They will help you understand your specific diagnosis, the best course of action, and what to expect during your treatment journey. Regular follow-up appointments and continued sun protection are essential for long-term health.

References

1. “Jimmy Buffett Had Merkel Cell Carcinoma, a Cancer That 'Strikes Fear in the Hearts of Many,'” CURE; https://www.curetoday.com/view/jimmy-buffett-had-merkel-cell-carcinoma-a-cancer-that-strikes-fear-in-the-hearts-of-many-

This guide is designed to be a starting point. Your personal experience will be unique. By using this information as a foundation for your discussions, you can partner with your oncologist to make the best decisions for your health.

Editor's note: This article is for informational purposes only and is not a substitute for professional medical advice. Please contact your healthcare team with any questions or concerns.

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