Free cancer support
Non-melanoma skin cancers (such as squamous cell carcinoma and basal cell carcinoma)
Non-melanoma skin cancer (NMSC) primarily comprises basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), representing the most common cutaneous malignancies worldwide. These tumors arise from epidermal keratinocytes or follicular basal cells. Although NMSC generally exhibits lower metastatic potential and better prognosis than melanoma, it can cause significant local tissue invasion and destruction; SCC carries a small but clinically relevant risk of regional and distant metastasis.
Major risk factors include:
- Ultraviolet radiation exposure: Chronic or cumulative exposure to natural sunlight or artificial UV sources (e.g., tanning beds) is the predominant etiologic factor, particularly in fair-skinned individuals (Fitzpatrick phototypes I–III) via DNA damage and p53 mutation accumulation.
- Age and sex: Predominantly affects middle-aged to elderly males due to greater lifetime occupational/recreational sun exposure and cumulative UV damage.
- Chronic skin injury or inflammation: Prior radiation therapy, burn scars (Marjolin’s ulcer), chronic ulcers, osteomyelitis sinuses, or persistent inflammatory dermatoses (e.g., discoid lupus erythematosus, lichen sclerosus) promote carcinogenesis through repeated cycles of injury and repair.
- Immunosuppression: Organ transplant recipients on long-term immunosuppressive therapy, patients with HIV/AIDS, or hematologic malignancies have markedly increased incidence and more aggressive clinical behavior.
- Genetic and hereditary factors: Family history of NMSC, inherited syndromes (e.g., xeroderma pigmentosum, basal cell nevus/Gorlin syndrome, Muir–Torre syndrome, epidermodysplasia verruciformis), or germline polymorphisms in DNA repair and detoxification pathways confer heightened susceptibility.
Early detection through routine total-body skin examination, patient self-monitoring of high-risk areas, and prompt biopsy of suspicious lesions, combined with rigorous photoprotection, wound care, and multidisciplinary nursing management, is essential for minimizing progression, preserving skin integrity, preventing functional/cosmetic morbidity, and maintaining long-term quality of life.
Non-melanoma skin cancer (NMSC) typically progresses slowly with relatively nonspecific early signs. Clinical manifestations vary by subtype as the disease advances:
Basal Cell Carcinoma (BCC)
- Small, translucent or pearly papule/nodule on sun-exposed skin, often with telangiectases on the surface.
- Rolled, waxy, or “pearly” raised borders; central ulceration, crusting, or bleeding (“rodent ulcer”) is common in advanced lesions.
- Slow-growing with predominant local invasion (rarely metastasizes, <0.1%); may cause significant tissue destruction if neglected.
Squamous Cell Carcinoma (SCC)
- Erythematous, scaly, or hyperkeratotic plaque/papule; may evolve into indurated nodule or ulcer with heaped-up edges.
- Frequent ulceration, bleeding, crusting, or serous exudation; tenderness or pain on palpation is common.
- Predilection for chronically sun-exposed sites (face, ears, scalp, lips, dorsum of hands); higher potential for local invasion and regional/distant metastasis (2–5% overall, higher in high-risk subtypes such as perineural invasion, poor differentiation, or immunocompromised patients).
Common Features of Both BCC and SCC
- Persistent non-healing ulcer, erosion, or crusted lesion (>4 weeks).
- Proliferative nodule, plaque, or tumor with irregular growth.
- Localized erythema, induration, inflammation, or pain.
- Cosmetic disfigurement and associated psychological distress (anxiety, depression, social withdrawal).
Early detection through routine skin examination, dermoscopy, and low threshold for biopsy of suspicious persistent lesions significantly reduces required surgical margins, minimizes functional impairment, and optimizes cosmetic/functional outcomes.
Diagnosis of non-melanoma skin cancer (NMSC)—primarily basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC)—employs a multimodal approach focused on early detection, accurate histopathological classification, risk stratification, and development of individualized nursing care plans:
- Clinical and dermoscopic examination
- Physician-performed total-body skin examination with the unaided eye and handheld dermatoscope (non-polarized or polarized) to identify suspicious lesions based on clinical morphology (e.g., pearly nodule with telangiectasia in BCC; erythematous scaly plaque or ulcer in cSCC) and dermoscopic criteria (arborizing vessels, leaf-like structures, blue-gray ovoid nests in BCC; glomerular/coiled vessels, keratin masses, white circles in cSCC).
- Histopathological examination
- Skin biopsy (shave, punch, or excisional) remains the gold standard for definitive diagnosis.
- Differentiates BCC (nodular, superficial, infiltrative/morpheaform, basosquamous) from cSCC; determines histologic subtype, grade of differentiation (well/moderate/poor/undifferentiated in cSCC), depth of invasion, perineural/lymphovascular invasion, and surgical margin status—critical for risk stratification (low- vs. high-risk per NCCN/AAD guidelines).
- Imaging studies
- Indicated for clinically suspected deep invasion, perineural spread, orbital/bone involvement, or regional nodal disease: – High-frequency ultrasound for tumor thickness and subclinical extension. – Contrast-enhanced CT or MRI for assessment of deep soft tissue, bone, or orbital involvement and regional lymph nodes in high-risk cSCC.
- PET-CT is rarely required but may be used in metastatic cSCC for staging.
- Molecular and biomarker testing
- Recommended in high-risk, recurrent, or metastatic cSCC (and selected aggressive BCC): – Tumor mutational profiling (e.g., TP53, NOTCH, CDKN2A mutations) and PD-L1 expression (CPS) via immunohistochemistry or next-generation sequencing. – In immunosuppressed patients or rare syndromes (e.g., xeroderma pigmentosum), germline testing may be considered.
- Results guide eligibility for immune checkpoint inhibitors (cemiplimab, pembrolizumab in locally advanced/metastatic cSCC), hedgehog pathway inhibitors (vismodegib, sonidegib in advanced BCC), and personalized long-term surveillance and nursing strategies.
Care and support strategies for non-melanoma skin cancer can be divided into traditional methods and personalized supportive strategies, aiming to eliminate lesions, delay recurrence, and maintain skin integrity and quality of life:
Surgery
• Local or wide excision is the preferred approach, with the extent of resection determined by lesion size and location.
• Postoperative management – including wound care, skin moisturization, nutritional support, and psychological counseling – helps promote recovery and minimize scarring.
Radiation Care
• Applicable for patients in whom complete surgical excision is difficult, with deeply invasive lesions, or at high risk of recurrence.
• Integration of skin care and nutritional management can reduce side effects and maintain skin function.
Targeted and Immune Support
• For selected cases of locally advanced or recurrent lesions, targeted therapies or immune-enhancing strategies may be considered.
• Combined with nutritional support and functional rehabilitation interventions, these approaches can improve immune resilience and quality of life.
Nutritional and Supportive Therapies
• Intravenous administration of high-dose vitamin C, glutathione, amino acids, and trace elements may enhance energy levels, support immune function, and promote skin repair.
• Dietary recommendations include foods rich in antioxidants and protein – supporting skin health and wound healing.
Personalized Monitoring and Care
• Regular dermatologic and imaging assessments to monitor lesions and recurrence risk.
• Development of individualized care plans – adjusting nutrition, lifestyle, and psychological support.
• Specialized care programs for patients with high recurrence risk or compromised immunity help maintain long-term quality of life.
