Non-Melanoma Skin Cancer: Getting a Diagnosis
This overview explains our diagnostic process to help you understand what to expect as you go through the early steps of your care.
We start your care by establishing or confirming a diagnosis. Because skin cancer can range from early-stage and curable to advanced and widespread, an accurate diagnosis is critical for your treatment plan. It helps us recommend the most effective treatment options for you, in the right sequence.
WHAT TO KNOW ABOUT NON-MELANOMA
1Getting Started In Your Care
2Getting Your Diagnosis
Consultation & Testing: What to Expect
3Planning Your Treatment
4Undergoing Treatment & Follow-Up
Select your type of treatment below.
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For everyone who comes to us, we start your care by establishing or confirming a diagnosis.
First Visit
Consultation
Test Results
Complex Cases
We collect your previous test reports and other medical records. We may need your help to do so, in case you need to sign a release form with your doctor.
a. Our goal is to review them before we meet with you so that we understand your unique case. Knowing the details of any previous diagnoses and treatments helps us provide the best possible care for you.
b. When you schedule your first appointment, our patient coordinators will contact your primary care physician and any other doctors to gather your medical records. We may need your help to do so, in case you need to sign a release form with your doctor. If we cannot obtain them in time, we may need to reschedule your appointment. You can speak with your patient coordinator or your doctor for more details.
c. Some types of medical records that you should keep include:
- Pathology reports from any biopsies or surgeries (for most skin non-non-melanomas, this is the most common outside record that is needed, along with the outside biopsy slides, which are reviewed by our dermatopathologists to confirm your diagnosis.
- Imaging test results, either on paper or stored on a DVD (although imaging and laboratory tests are not needed for most skin non-non-melanomas)
- Operative reports from any surgeries related to your non-non-melanoma
- List of medications, doses, and how long you took them
- Discharge summary if you had a hospital stay
- Contact information for health care providers who treated you for cancer
a. Our team meets with you for a thorough diagnostic evaluation. We gather more information during your first appointment but may still need additional tests to confirm or rule out a diagnosis.
b. If needed, you may undergo further imaging tests, blood work, or a biopsy.
a. After this testing, it typically takes a few days to 2 weeks to review the results and confirm your diagnosis. Getting your test results can take time because your care team is working hard to determine an accurate diagnosis for you.
b. Many health care professionals collaborate in the process and provide expert analysis, including your oncologist (cancer doctor), radiologist, and pathologist. Years of experience studying lung cancer every day means your pathologist can accurately identify critical details, such as whether the cancer:
i. Is invades into the skin or just involves the top layer of the skin (epidermis), including a measurement of the tumor thickness
ii. Shows ulceration, where tumor cells push through the epidermis
iii. Is aggressive or slow growing, which can be determined by looking at the type and number of growing and dividing cells, called mitotic figures
iv. Contains particular types of molecules that indicate the cancer subtype
c. Your care team will also determine the stage of your cancer. Staging describes the size of the cancer and whether (and how far) it has spread. Staging is the most important step in planning your treatment.
Stanford non-melanoma experts from several specialties meet as a team in tumor boards that occur as part of structed parallel visits among your cutaneous, surgical, and medical oncologists. Based on the diagnosis, we determine our recommendations for the best sequence of treatment for each patient.
Your doctor or a team of doctors (including cutaneous, surgical, and medical oncologists) will meet with you to discuss the recommended treatment plan. Together, you and your doctors decide on the treatment options that are right for you.
We collect your previous test reports and other medical records. We may need your help to do so, in case you need to sign a release form with your doctor.
a. Our goal is to review them before we meet with you so that we understand your unique case. Knowing the details of any previous diagnoses and treatments helps us provide the best possible care for you.
b. When you schedule your first appointment, our patient coordinators will contact your primary care physician and any other doctors to gather your medical records. We may need your help to do so, in case you need to sign a release form with your doctor. If we cannot obtain them in time, we may need to reschedule your appointment. You can speak with your patient coordinator or your doctor for more details.
c. Some types of medical records that you should keep include:
- Pathology reports from any biopsies or surgeries (for most skin non-non-melanomas, this is the most common outside record that is needed, along with the outside biopsy slides, which are reviewed by our dermatopathologists to confirm your diagnosis.
- Imaging test results, either on paper or stored on a DVD (although imaging and laboratory tests are not needed for most skin non-non-melanomas)
- Operative reports from any surgeries related to your non-non-melanoma
- List of medications, doses, and how long you took them
- Discharge summary if you had a hospital stay
- Contact information for health care providers who treated you for cancer
close First Visit
a. Our team meets with you for a thorough diagnostic evaluation. We gather more information during your first appointment but may still need additional tests to confirm or rule out a diagnosis.
b. If needed, you may undergo further imaging tests, blood work, or a biopsy.
close Consultation
a. After this testing, it typically takes a few days to 2 weeks to review the results and confirm your diagnosis. Getting your test results can take time because your care team is working hard to determine an accurate diagnosis for you.
b. Many health care professionals collaborate in the process and provide expert analysis, including your oncologist (cancer doctor), radiologist, and pathologist. Years of experience studying lung cancer every day means your pathologist can accurately identify critical details, such as whether the cancer:
i. Is invades into the skin or just involves the top layer of the skin (epidermis), including a measurement of the tumor thickness
ii. Shows ulceration, where tumor cells push through the epidermis
iii. Is aggressive or slow growing, which can be determined by looking at the type and number of growing and dividing cells, called mitotic figures
iv. Contains particular types of molecules that indicate the cancer subtype
c. Your care team will also determine the stage of your cancer. Staging describes the size of the cancer and whether (and how far) it has spread. Staging is the most important step in planning your treatment.
close Test Results
Stanford non-melanoma experts from several specialties meet as a team in tumor boards that occur as part of structed parallel visits among your cutaneous, surgical, and medical oncologists. Based on the diagnosis, we determine our recommendations for the best sequence of treatment for each patient.
Your doctor or a team of doctors (including cutaneous, surgical, and medical oncologists) will meet with you to discuss the recommended treatment plan. Together, you and your doctors decide on the treatment options that are right for you.
close Complex Cases
At Stanford, we tailor the diagnostic phase of Non-melanoma care to each patient. If you need further testing to complete your diagnosis, your doctor and care team will work with you to determine which tests you need. Tests may include:
- Biopsy (Pathology)
In a biopsy, doctors try to remove most or all of the non-melanoma on the skin so a dermatopathologist can fully examine it under a microscope. - Lab Tests (Blood Draws)
Blood tests are not usually done for skin or lymph node non-melanoma, unless you are on specific (adjuvant therapy) for regional lymph node involvement. More advanced non-melanoma (involving others sites of the body) generally requires specific lab testing, especially if you are on systemic immunotherapy or targeted drdugs. In this setting blood tests can provide a variety of information, helping to plan your course of non-melanoma treatment.
- Imaging Tests (Radiology)
To obtain the most precise understanding of your non-melanoma, your doctor may schedule you for different types of imaging tests that show if the non-melanoma has spread. If you have been screened elsewhere and received abnormal results, we may perform additional imaging, if needed
What is nonmelanoma skin cancer?
Nonmelanoma skin cancers comprise most skin cancer cases. When caught early, they are usually curable. The most common types of nonmelanoma skin cancer are basal cell carcinoma and squamous cell carcinoma.
Skin cancer tumors form in the skin, the body’s largest organ. The skin contains three layers:
- Epidermis: The outermost layer contains squamous cells, basal cells, and melanocytes.
- Dermis: The middle layer contains numerous structures, such as blood vessels, nerves, hair follicles, and sweat glands.
- Subcutaneous (fat): This is the deepest layer of skin.
How does nonmelanoma skin cancer develop?
Cancer starts when cells become abnormal (mutate) and grow out of control. Nonmelanoma skin cancer forms in the basal or squamous cells of the skin’s outer layer.
Nonmelanoma skin cancer typically appears as unusual spots or sores on areas of the skin exposed to the sun. However, nonmelanoma can also develop in unexposed areas, including the palms of the hands, soles of the feet, fingernails, or toenails.
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Other than an unusual-looking spot on your skin, you may or may not experience symptoms with nonmelanoma skin cancer. Symptoms may include:
- Bleeding at the spot or sore
- A scab or crust that doesn’t heal after bleeding
- A mole that is growing faster than others
Some skin cancers grow faster than others and may spread into nearby tissues or other parts of the body (metastasize). It’s important to see a doctor if you see any unusual spot on your skin, even if you have no other symptoms.
Risk factors increase your chance of developing skin cancer and other conditions. Having one or more risk factors does not mean you will develop cancer, and some people with no risk factors develop the disease.
Nonmelanoma skin cancer risk factors include:
- Excessive exposure to the sun, including a history of sunburns and living in a sunny climate
- Fair skin and light-colored eyes and hair
- Family history of skin cancer
- Personal history of skin cancer or precancerous lesions (areas of abnormal cells)
- Radiation exposure
- Weakened immune system
The most common forms of nonmelanoma skin cancer are:
- Basal cell carcinoma: This type comprises the majority of skin cancer cases. It starts in the top layer of skin (basal cell layer), grows very slowly, and rarely spreads.
- Squamous cell carcinoma: This is the second most common type of skin cancer. It occurs most often in fair-skinned and elderly people.
Melanoma is a different type of skin cancer. It starts in the melanocytes, the cells that give skin its color. Melanoma is much less common than basal cell and squamous cell carcinomas.
Your doctor will examine you and review your test results to determine if you have early-stage cancer or if your cancer is considered advanced.
The best way to prevent skin cancer is to limit your exposure to the sun, specifically:
- Use sunscreen. Make sure to follow instructions about how much to apply and how often to re-apply it.
- Wear a hat.
- Wear clothes that cover your skin, including your arms and legs. Light-colored clothes can keep you cooler.
- Wear sunglasses to protect your eyes.
If you have had skin cancer, you have a greater chance of getting it again. Therefore, it’s important to reduce your sun exposure and see your dermatologist annually for a skin exam.
We begin your care by establishing or confirming your diagnosis. Your doctor reviews your prior health records and completes a physical exam, including a thorough examination of your skin. Your doctor may recommend specific tests, including:
During this procedure, your doctor (usually a dermatologist) removes a tissue sample from your skin for evaluation.
We perform imaging tests of your skin if your doctor suspects your cancer has spread. A radiologist interprets the images to identify cancer cells.
Also called blood tests or draws, we remove a small blood sample to analyze. We conduct blood tests only if your doctor thinks your cancer has spread.