Non-melanoma Skin Cancers

Presentation

Suspected squamous cell carcinoma (SCC)

Rapidly growing nodule or ulcer

SCC ear

SCC forehead

SCC hand

Basal cell carcinoma (BCC)

Slow growing ulcer with pearly edge

BCC eye

BCC morpheic

BCC nose

BCC pigmented

BCC post ear

BCC superficial 

Management

Suspected squamous cell carcinoma (SCC)

Refer urgently to dermatology/Plastic surgery as per local pathways.

Suspected basal cell carcinoma (BCC)

Low risk BCC can be removed in primary care where an appropriate service is available.

Criteria for removal in Primary Care (BCC)

  • Diagnosis certain
  • Well defined margins
  • BCC should be excised with a 4 mm lateral margin and a deep margin of 2 - 3 mm and a cuff of fat
  • Warn patient about scarring
  • Send all specimens to pathology
Referral

Dermatology Referral Criteria

Criteria for referral-SCC

  • All suspected SCC
  • SCC excised in primary care should be discussed with local skin cancer MDT

Criteria for referral – BCC

  • Any BCC which cannot be managed in Primary Care
  • Diagnosis uncertain
  • Morphoeic or sclerosing BCC with indistinct margins
  • High risk sites e.g. naso-labial
  • Cosmetically difficult sites e.g. periorbital
  • High risk patients i.e. immunosuppressed
  • Patients with multiple tumours
Patient Information
  • NHS24 Tel: 08454 242424
Diagnostic Tips

Suspected squamous cell carcinoma (SCC)

  • Squamous cell carcinoma usually develop on sun-exposed, sun damaged skin
  • Men affected more than women especially on bald scalps
  • Suspect keratotic nodules with thickened base
  • Usually rapid growth compared with basal cell carcinoma
  • Metastases occur in 5% of squamous carcinoma

Suspect Basal cell carcinoma (BCC)

  • Usually slow growth often over several months or years
  • Non-healing lesion which may bleed or crust
  • Provide education on sun avoidance and photoprotection
  • The risk of developing another BCC is high (40% over 5 years)
High Risk Squamous Cell Carcinoma

More likely if: 

  • Long term immunosuppression
  • High risk sites, e.g. lips, ears and in scars
  • Rapidly growing tumour