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At a glance
Document unusual patches of skin, record your screening and follow-up appointments and go to the dermatologist with a clear overview. Free of charge.
A new, growing, bleeding or non-healing patch of skin — especially on the face or on sun-exposed areas — needs to be assessed by a dermatologist and should not be self-treated or left to wait.
Non-melanoma skin cancer (also known as white or non-melanocytic skin cancer) is the umbrella term for the most common malignant tumours of the skin that do not arise from the pigment-producing cells. It mainly refers to two forms: basal cell carcinoma (basalioma for short) and squamous cell carcinoma (spinalioma or prickle cell carcinoma for short). Both originate in the uppermost cell layers of the skin — where the sun has caused the most damage over the years.
The name "white" skin cancer distinguishes it from black skin cancer (malignant melanoma), which arises from the pigment-producing cells (melanocytes) and is often dark in colour. The difference is more than a question of colour: non-melanoma skin cancer usually grows slowly, stays confined to one spot for a long time and rarely spreads to other organs. That is precisely why it is generally highly curable — provided it is detected and treated.
Non-melanoma skin cancer is by far the most common cancer in humans. Because it is so treatable, it is often listed separately in statistics — but the number of new cases is considerably higher than for all other types of cancer. Those mainly affected are older people and people who have had a lot of sun over their lifetime. As we now live longer and expose ourselves to more UV radiation over decades, case numbers are rising steadily.
Non-melanoma skin cancer is not a single, uniform condition. It is worth telling the three most important forms apart — they differ in appearance, growth and how dangerous they are.
| Form | Typical appearance | Behaviour |
|---|---|---|
| Actinic keratosis (precursor) | Rough, scaly, reddish patch that feels like sandpaper | Early form; can progress to a spinalioma |
| Basal cell carcinoma (basalioma) | Glassy, pearly nodule with fine blood vessels, sometimes sunken or crusted in the centre | Grows slowly, destroys tissue locally, almost never spreads |
| Squamous cell carcinoma (spinalioma) | Firmly attached, horny or crusted patch, often on a reddened base | Grows faster, can spread in rare cases |
The basal cell carcinoma is the most common form. It often appears as a small, shiny nodule with a pearly rim and fine, translucent blood vessels, frequently on the face — on the nose, forehead or ear. It can also appear as a flat, scar-like or repeatedly crusting patch. Basaliomas grow slowly but, left untreated, can reach into deeper layers and destroy tissue there. Spread to other organs (metastases) is extremely rare — which is why the basalioma is regarded as "semi-malignant", i.e. only locally malignant.
The squamous cell carcinoma is the second most common form. It preferentially arises on so-called sun terraces — the areas that get the most sun over the years: ears, lower lip, bald scalp, backs of the hands, forearms. Typical signs are a firmly attached, rough horny growth or a non-healing, crusted wound. Unlike the basalioma, the spinalioma can spread in advanced cases, which is why it is monitored a little more closely. Here too: detected early, highly curable.
The actinic keratosis is the early form (precursor) of squamous cell carcinoma. It feels like a rough, scaly patch — you can often feel it more easily than you can see it. Over time, a spinalioma can develop from an actinic keratosis. Because this cannot be reliably predicted in the individual case, actinic keratoses are treated before they turn into an invasive tumour. An area with many such patches is called "field cancerisation" — here the entire sun-damaged skin region is affected.
Non-melanoma skin cancer usually does not hurt and, at first, mostly does not itch — which makes it deceptive. It grows slowly and is often mistaken for a harmless graze, an age-related wart or a "wound that won't close". But it is exactly this failure to heal that is an important warning sign. Watch out for the following abnormalities, especially on sun-exposed areas:
This may be accompanied by mild itching or a patchy, scaly skin rash, particularly with extensive actinic keratoses. Such complaints are non-specific, however, and prove nothing — what matters is the precise assessment of the spot. As a simple rule of thumb: any patch of skin that appears new, changes, grows, bleeds or has not healed after four to six weeks should be looked at by a doctor. Better once too often than once too late.
By far the most important cause is UV radiation — from the sun as well as from tanning beds. What matters here is not the individual sunburn but the total dose over a whole lifetime: every hour in the sun adds up. That is why non-melanoma skin cancer preferentially occurs on the areas that are permanently unprotected, and accumulates with increasing age.¹
The point about medicines is worth a closer look: some active substances increase the skin's sensitivity to UV light (photosensitisation). This does not mean you should stop such a medicine on your own — the benefit generally outweighs the risk clearly. What makes sense instead is particularly consistent sun protection and, with long-term use, an awareness of skin changes. Which medicines make the skin sensitive to light and what to look out for is explained in the guide Medicines and sun. Always discuss changes to your medication with your practice.
Diagnosis begins with the naked eye and the dermatoscope — an illuminated magnifier (skin surface microscope) with which the dermatologist assesses the structure of a spot at high magnification. Many forms of non-melanoma skin cancer can already be classified fairly reliably with this. For final confirmation, a tissue sample (biopsy) is usually taken and examined under the microscope. Only this histological finding shows beyond doubt which form it is and whether the tumour has been completely removed.¹,²
A key tool of early detection is the statutory skin cancer screening. In Germany, people with statutory health insurance aged 35 and over are entitled to a standardised whole-body examination of the skin every two years. Anyone at increased risk — fair skin type, many years of sun, a weakened immune system or previously treated skin cancer — should have their skin checked regularly in addition. The earlier a suspicious spot is found, the simpler and gentler the treatment.
The most important and most successful treatment for non-melanoma skin cancer is complete surgical removal (excision). The tumour is cut out with a small safety margin and then examined histologically — so it can be checked whether everything really was removed. For most basaliomas and squamous cell carcinomas, that settles the matter: the cancer is cured. Which procedure is right in the individual case depends on the form, size, location and depth of the tumour.¹,²
Not every spot has to be operated on. Especially for superficial tumours, actinic keratoses and when surgery is unfavourable, gentle alternatives are available. They are used above all for early forms and for extensive, area-wide sun damage:
After treatment, follow-up is important: anyone who has once had non-melanoma skin cancer carries an increased risk of further tumours. Regular check-ups help find new spots early. If you are also taking photosensitising medicines, it may be worth a look at possible interactions — more on this in the guide Medicines and sun.
brite reminds you of screening and follow-up and documents unusual patches of skin without gaps — ready for your next conversation at the dermatologist.
Non-melanoma skin cancer develops over decades through UV radiation — and this is exactly where the best prevention lies. Consistent sun protection noticeably lowers the risk and at the same time slows the emergence of new precursors. This applies to healthy people just as much as to everyone who has already been treated.¹
| Measure | Why it helps | Practical tip |
|---|---|---|
| Avoid the midday sun | UV radiation is strongest between 11 a.m. and 3 p.m. | Seek shade, move activities to the morning or evening |
| Clothing & headwear | Textiles block UV more reliably than cream | A wide-brimmed hat protects the face, ears and neck |
| Sunscreen | Reduces the UV dose on exposed skin | High sun protection factor, apply generously, reapply |
| No tanning beds | Artificial UV additionally raises the skin cancer risk | Avoid them altogether |
| Watch your skin | Spots detected early are easier to cure | Check yourself regularly, attend screening |
When applying cream, remember the often forgotten spots: ears, neck, lips, bald scalp and backs of the hands — that is precisely where non-melanoma skin cancer occurs particularly often. Sun protection is not just a summer topic: UV radiation reaches the skin in spring, in the mountains and on cloudy days too. Anyone who works outdoors or takes photosensitising medicines should be especially attentive.
The follow-up after treatment follows a simple principle: attend check-up appointments and keep an eye on your own skin. Since an already treated non-melanoma skin cancer increases the risk of further tumours, regular dermatological check-ups are recommended — how often depends on the form and extent of the original tumour. A fixed routine of self-examination and medical check-ups is the most effective protection against nasty surprises.
Record in brite when your next screening or check-up is due and how unusual patches of skin develop — ideal for your next conversation with the doctor.
The most important contribution to your own skin health happens in everyday life — not at the practice. A few simple habits make the difference:
Non-melanoma skin cancer is not dealt with in weeks but accompanied over years — with screening, follow-up and consistent sun protection. Success depends on keeping appointments and noticing changes early. That is exactly what brite supports.
