Key Points for This Section

After nonmelanoma skin cancer has been diagnosed, tests are done to find out if cancer cells have spread within the skin or to other parts of the body. There are three ways that cancer spreads in the body. The following stages are used for nonmelanoma skin cancer: Stage 0 (Carcinoma in Situ) Stage I Stage II Stage III Stage IV Treatment choices are based on the type of nonmelanoma skin cancer or precancerous skin condition diagnosed: Basal cell carcinoma Squamous cell carcinoma Actinic keratosis

After nonmelanoma skin cancer has been diagnosed, tests are done to find out if cancer cells have spread within the skin or to other parts of the body.

The process used to find out if cancer has spread within the skin or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. A biopsy is often the only test needed to determine the stage of nonmelanoma skin cancer. Lymph nodes may be examined in cases of squamous cell carcinoma to see if cancer has spread to them.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

• Through tissue. Cancer invades the surrounding normal tissue.
• Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
• Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for nonmelanoma skin cancer:

Stage 0 (Carcinoma in Situ)

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Stage 0 nonmelanoma. Abnormal cells are shown in the epidermis (outer layer of the skin).

In stage 0, abnormal cells are found in the squamous cell or basal cell layer of the epidermis (topmost layer of the skin). These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

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Pea, peanut, walnut, and lime show tumor sizes.

Stage I

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Stage I nonmelanoma skin cancer. The tumor is no more than 2 centimeters.

In stage I, cancer has formed and the tumor is 2 centimeters or smaller.

Stage II

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Stage II nonmelanoma skin cancer. The tumor is more than 2 centimeters wide.

In stage II, the tumor is larger than 2 centimeters.

Stage III

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Stage III nonmelanoma skin cancer. The tumor has spread below the skin to nearby tissues and/or lymph nodes.

In stage III, cancer has spread below the skin to cartilage, muscle, or bone and/or to nearby lymph nodes, but not to other parts of the body.

Stage IV

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Stage IV nonmelanoma skin cancer. The tumor has spread to other places in the body, such as the brain or lung.

In stage IV, cancer has spread to other parts of the body.

Treatment choices are based on the type of nonmelanoma skin cancer or precancerous skin condition diagnosed:

Basal cell carcinoma

Basal cell carcinoma is the most common type of skin cancer. It usually occurs on areas of the skin that have been in the sun, most often the nose. Often this cancer appears as a small raised bump that has a smooth, pearly appearance. Another type looks like a scar and is flat and firm to the touch. Basal cell carcinoma may spread to tissues around the cancer, but it usually does not spread to other parts of the body.

Squamous cell carcinoma

Squamous cell carcinoma occurs on areas of the skin that have been in the sun, such as the ears, lower lip, and the back of the hands. Squamous cell carcinoma may also appear on areas of the skin that have been burned or exposed to chemicals or radiation. Often this cancer appears as a firm red bump. Sometimes the tumor may feel scaly or bleed or develop a crust. Squamous cell tumors may spread to nearby lymph nodes.

Actinic keratosis

Actinic keratosis is a skin condition that is not cancer, but sometimes changes into squamous cell carcinoma. It usually occurs in areas that have been exposed to the sun, such as the face, the back of the hands, and the lower lip. It appears as rough, red, pink, or brown, raised, scaly patches on the skin, or cracking or peeling of the lower lip that is not helped by lip balm or petroleum jelly.

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