Skin Cancer: Squamous and Basal Cell Carcinomas

Approximately 1 in 5 Americans will develop skin cancer during their lifetime; 97% of these cancers will be nonmelanoma skin cancers (NMSCs). Basal cell carcinoma (BCC) comprises approximately 80% of NMSCs and most of the remainder are cutaneous squamous cell carcinomas (SCCs). The predominant risk factor for NMSC is exposure to solar UV radiation. Skin type also plays a role, with a higher incidence of NMSCs among fairer-skinned individuals. Immunocompromise can increase the risk. Biopsy of suspicious lesions should be obtained to determine histologic subtype and guide treatment. Surgical techniques include excision, curettage and electrodessication, and Mohs micrographic surgery. Nonsurgical therapies such as topical therapy or photodynamic therapy may be used for BCC lesions if surgical techniques are not appropriate. Staging and sentinel lymph node biopsy are reserved for patients with large infiltrative lesions. The prognosis for patients with NMSC is extremely favorable. Because of the low risk of metastasis, significant morbidity or mortality is rare. The American Academy of Dermatology recommends skin examinations for all patients with NMSC at least annually. Primary interventions for prevention include counseling on reducing sun exposure, use of UV-protective clothing and sunscreen, and discouragement of tanning bed use.