The doctor says I have skin cancer. What happens next?

Two out of three Australians will develop skin cancer in their lifetime, almost all basal cell carcinoma (BCC), squamous cell carcinoma (SCC) or melanoma.

If the spot removed looked more like a sore or lump than a mole, your doctor is likely talking about basal cell or squamous cell carcinoma, also called keratinocyte cancer or non-melanoma skin cancer. (See our article on melanomas, which look more like moles, here).

Read more: The doctor says my mole is melanoma. What happens next?

Around 80% of all cancers treated in Australia are skin cancers, most of which are BCC or SCC. But because CBC and SCC are not reportable diseases, there is no official tracking system for them.

It’s hard to know how many are diagnosed each year, but according to Medicare data, there are over 900,000 treatments for BCC and SCC each year – some of these will be separate treatments for the same cancer.

Although they are less likely to be fatal than melanoma (about 560 deaths per year in Australia), their numbers cost more than 700 million Australian dollars per year to diagnose and treat.

When diagnosed early, BCCs and SCCs are usually simple to treat. But don’t be complacent. Without treatment, they will grow wider and deeper, up to 20 cm in diameter. They will invade and destroy surrounding tissues, even bones.


What is the treatement ?

The therapeutic pathway for SCCs and BCCs is much less clear than for melanomas. There are few firm guidelines and many treatment options, but here are the most common tactics.

Excision is the first-line treatment because it is most likely to be curative and prevent recurrence, and the tumor can be sent to a pathologist for microscopic examination.

The pathology report will indicate if there are any signs of an unusually aggressive variant of the tumor, and if all of the tumor and a safe margin of surrounding healthy skin have been removed. If not, your doctor will remove some more to make sure all of the tumor is gone. The size of the safety margin depends on the size, type and location of the tumor and can range from 2 mm to 1 cm.

A cancerous sore
A basal cell carcinoma.

Many BCCs and SCCs require only simple excision to heal. However, those on delicate parts of the face with many nerves and small muscles, or close to bones and cartilage, are difficult to cut safely. If they have grown into underlying fat, muscle, or bone, surgery may not be appropriate.

The right treatment in this case depends on the size and location of the tumor, whether it has well-defined or soft edges, whether it looks like a scar or is gelatinous. The patient’s informed preference is also important. Your doctor may freeze the tumor, cut it with a sharp spoon, and cauterize the wound, or prescribe a cream that promotes a strong immune reaction or reacts with light to damage cancer cells.

Your doctor may also refer you to a specialist for radiation therapy, which involves a very targeted dose of radiation, usually X-rays, to kill the tumor by damaging its DNA, and is performed by a specialist radiation oncologist.

Read more: Health check: do I need a health check for skin cancer?

Can it spread?

If the pathology report shows that the cancer has invaded a nearby nerve, or if you have painful, tingling, or crawling symptoms indicating that a nerve is compromised, excision or more aggressive radiation therapy might be suggested. In the case of SCC, you may also be offered an MRI to see how far it has spread.

In this case, you will be referred to a radiation oncologist to discuss the usefulness of radiation therapy. Radiation therapy may also be considered if a BCC has invaded the underlying bone, or if there is evidence of BCC cells in nearby lymph nodes.

It is extremely rare for BCC to spread outside the site of origin: only about 0.1% spread to the rest of the body. However, if it is very thick, has come back several times, or has other aggressive characteristics, your doctor may also refer you to a specialist to examine your lymph nodes.

Red, scaly patch on the skin
Squamous cell carcinoma on the skin.

SCCs are somewhat more likely to spread, but due to the lack of mandatory reporting, it is difficult to determine the true rate. Some studies report that about 4% of SCC has spread to the lymph nodes, but these are often drawn from higher risk cases, so the true rate is likely lower.

Your doctor may refer you for a lymph node exam if your SCC was more than 2 cm wide or had spread into the fatty tissue just under the skin. SCCs on the head and neck, those with ill-defined edges, tender and inflamed lesions, and lesions at the edge of the lips may also require more attention.

Read more: Why does Australia have so many skin cancers? (Hint: it’s not because of a hole in the ozone layer)

What follow-up is needed?

Your GP or dermatologist will want to see you for regular comprehensive skin checks after your initial treatment. In fact, 44% of people with basal cell carcinoma and 18% with squamous cell carcinoma will have another.

The frequency of recommended check-ups depends on the original location, pathology report, and choice of treatment, but is generally once a year. You will also be taught what to look out for so you can report any suspicious skin patches to your doctor early.

People with severely weakened immune systems, such as organ transplant recipients, should take special care in getting regular checkups for skin cancers, as their immune system will not be doing its usual job of detecting and destruction of all kinds of cancers at an early stage. Regular checkups can reduce health problems and deaths from skin cancer among organ recipients by up to a third.

Read more: Common bumps and bumps on and under the skin: what are they?

In areas of skin that show significant UV damage and signs of early superficial skin cancers, your doctor may suggest a “field treatment” to remove damaged skin cells. The most common is a cream used for four weeks, but other options include laser treatment.

It’s never too late to reduce your risk of developing other keratinocyte cancers. Recent research has shown that adopting smart solar behavior – sliding, collapsing, snapping, seeking and sliding – even late in life, significantly slows the rate of new skin cancers and, in some cases, even seems to allow the body to heal certain precursor lesions. .