Basal and squamous cell carcinomaYour guide to best cancer care

It can be overwhelming after being told that you have or may have basal cell carcinoma (BCC) or squamous cell carcinoma (SCC). A lot can happen quickly, and you might have lots of questions, like 'what happens next after a diagnosis?'

This support resource can help to guide you, your family, and friends through this experience.

Information and support

If you need additional information or would like support, you can visit the non-melanoma skin cancer information page or call Cancer Council on 13 11 20 to talk to an experienced healthcare professional.

If you need a translator, call TIS on 13 14 50 or visit the TIS National website.

Symptoms:

Your general practitioner (GP) will look at any lesions that are unusual, change or grow quickly. A lesion can be a spot, mole, scab, area of a different colour, lump, growth or anything different on your skin.

Initial tests you may have:

If your GP is concerned, they will refer you to a GP more experienced in skin cancer or to a specialist, or will do one of the following tests:

Referrals:

Most BCCs and SCCs are treated by GPs. If your GP refers you, you will be referred to a GP more experienced in skin cancer or to a specialist such as a dermatologist or surgeon. Specialists are doctors who are highly trained in a particular area of health care.

You can bring a family member or friend with you to your appointments.

Timeframes:

If a BCC or SCC is suspected and a biopsy is required, it should be done within four weeks of your first GP appointment or as soon as possible.

If needed, referral to a GP more experienced in skin cancer or specialist should happen as soon as possible (e.g. within four weeks for a suspected SCC or within eight weeks for a suspected BCC).

If you can’t get an appointment within this time, follow up with your GP.

Most biopsies sent to a pathology laboratory to confirm a melanoma diagnosis will happen in general practice. This process of working out if you have a medical problem is called making a diagnosis. You might have one test or a mix of tests:

For most BCC or SCC with a low risk (early stage) complete excision is adequate.

In more advanced cases (higher risk BCC or SCC), the specialist may discuss and recommend more tests, to get more information about the cancer such as if it has spread to other areas of the body. This is called staging, which helps to work out the best treatment for you.

You might have a complete excision alone, with a margin of normal skin, or it might be recommended that you have other tests.

Timeframes:

Results should be available within two weeks from when you have the tests.

For most people, excision is all that is needed with no need for more advanced treatments.

Your GP or specialist should talk to you about your risk for getting more skin cancers. They should discuss a plan so that together you can look out for any BCCs or SCCs and other skin cancers if they grow and discuss how to prevent future skin cancers.

For high-risk BCCs or SCCs, you may need specialised treatments. Your GP and/or specialist will talk to you about your treatment options.

You may be treated by a team of experts, and you may need more than one treatment type to get the best results. The team will work with you and your family or carer to plan your treatment.

You might have one treatment or a mix of treatments:

Surgery. The BCC or SCC and a small area around it is cut out and the area is stitched up. If the area can’t be stitched up a skin graft/flap will be applied. A skin graft/skin flap is where healthy skin is removed from another area of the body and moved to a different area.

Other treatments may be used in some suitable cases:

Curettage is when the lesion is scraped off using a spoon-shaped instrument.

Electrocautery is where the lesion is burnt off.

Cryotherapy is where liquid nitrogen is used to freeze the lesion off.

Creams are used to kill cancer cells. Some creams that might be used are imiquimod or fluorouracil.

Photodynamic therapy is where a medicine is put on the lesion and a light is then used to activate the medicine to kill cancer cells.

For more advanced cases these procedures and treatments may be considered:

Sentinel lymph node biopsy or regional lymph node removal are rarely required but should be done by a surgeon in a specialist treatment centre.

Sentinel lymph node biopsy. A small amount of radioactive material is injected into the area where the BCC or SCC was cut out. This will assist the surgeon in identifying the correct node for that area of skin. Under general anaesthetic (you will be put to sleep), the lymph node will be cut out and checked for cancer.

Regional lymph node removal. If the skin cancer has spread, so that the lymph nodes are enlarged, the lymph nodes in that region are cut out.

Radiation therapy uses x-rays to kill cancer cells and stop the cancer growing. It is not often required but it might be used if surgery is not a good option, or after surgery.

Drug therapy uses drugs to kill cancer cells and stop the cancer growing. Rarely BCC or SCC require drug therapy. If required, you will be referred to a specialist centre.

For more information, visit Cancer Treatment. Supportive care (treatment or services that support you through a cancer experience) are also available.

Supportive care (treatment or services that support you through a cancer experience) are also available.

For more information on clinical trials, visit the Australian Cancer Trials page.

Recovery

Cancer treatment can cause a range of physical and emotional changes.

Follow-up care plan

Your healthcare team will work with you to make a plan for you and your GP. This plan will explain:

• who your main contact person is after treatment
• how often you should have check-ups and what tests this will include
• understanding and dealing with side effects of treatment
• how to get help quickly if you think the cancer has returned or is worse
• how to prevent future skin cancers such as using a combination of five forms of sun protection during sun protection times

Many people worry that the cancer will return. Your specialist and healthcare team will talk with you about your needs and can refer you to other healthcare professionals and community support services.

Other information you may get:

• signs and symptoms to look out for if the cancer returns
• late effects of treatment and the specialists you may need to see
• how to make healthy lifestyle choices to give you the best chance of recovery and staying well

For more information, visit After Cancer Treatment.

For information about skin cancer prevention and early detection, visit SunSmart.

Sometimes cancer can come back after treatment. BCC and SCC can occasionally come back in the same place, or an SCC can appear somewhere different in your body, however this is uncommon.

If cancer returns, you may be referred to the specialist or the hospital where you were first treated, or to a different specialist.

Treatment will depend on how far the cancer has spread, how fast-growing it might be, and the symptoms you are experiencing.

Although not relevant for the majority of people with a BCC or SCC, you may want to consider the following:

Advance care planning

If the cancer cannot be cured, your GP or healthcare team may talk with you, your carer, and family about your future treatment and medical needs.

Advance care directive

Sometimes known as a living will, an advance care directive is a legally binding document that you prepare to let your family and medical team know about the treatment and care you might want or not want in case you become too unwell to make those decisions yourself.

For more information, visit Advance Care Planning Australia.

Palliative care

Your specialist may refer you to palliative care services, but this doesn’t always mean end-of-life care. Today, people can be referred to these services much earlier if they’re living with cancer or if their cancer returns. Palliative care can help you to live as well as you can, including managing pain and symptoms. This care may be at home, in a hospital or at another location you choose.

Speak to your GP or specialist or visit Palliative Care Australia.

Making treatment decisions

You may decide not to have treatment at all, or to only have some treatment to reduce pain and discomfort. You may want to discuss your decision with your healthcare team, GP, family and carer.

For more information, visit Advanced Cancer Treatment.

Decisions about cost

You may have to pay for some appointments, tests, medications, accommodation, travel or parking. Speak with your GP, specialist or private health insurer (if you have one) to understand what is covered and what your out-of-pocket costs may be.

If you have concerns about costs, talk to your healthcare team or a social worker about:

• being bulk-billed or being treated in the public system
• help with accommodation during treatment
• the possible financial impact of your treatment

You can call Cancer Council on 13 11 20 to speak to a healthcare professional about financial support. For more information about costs, visit Practical and financial assistance and What will I have to pay for treatment.