How Is Nonmelanoma Skin Cancer Diagnosed? Physical Exam, Skin Biopsy, and Imaging Tests

Nonmelanoma skin cancers can sometimes look like other skin conditions. This can make skin cancers such as basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) harder to spot without an exam or testing.

Your healthcare provider may use several tests to confirm a nonmelanoma skin cancer diagnosis. Once you have a diagnosis, you can begin treatment.

Physical Exam

The first step in diagnosing skin cancer is usually a physical exam. A dermatologist, primary care doctor, or another clinician may do this exam.

Your dermatologist will check the spot you’re worried about. They may also check other parts of your body for signs of skin cancer.

They’ll also ask questions about any abnormal areas of skin, called lesions. They may ask:

• How long ago did you notice this lesion?
• Does the lesion bleed, itch, or hurt if you touch it?
• Have you noticed any changes to the lesion’s color, shape, or size?
• Has anyone in your family ever had skin cancer?
• What other health conditions do you currently have, or have you had in the past?

Your doctor may also ask about your history of sun exposure and sunburns, or if you’ve used tanning beds in the past. Because these are risk factors for skin cancer, your answers may help your doctor know what to look for during the skin exam.

In addition to performing a skin exam, your doctor may also feel your nearby lymph nodes. When skin cancer spreads to a lymph node, it can cause swelling.

If your doctor feels a swollen lymph node during the exam, they may order more tests.

What Raises Suspicion During a Skin Exam?

During your skin exam, your dermatologist will look for any areas of concern. Here are some symptoms that might raise suspicion during a skin check:

• A wart-like growth with a flat center and raised edges
• A pearly or shiny bump
• A rough, flat, firm, or scaly skin patch
• An open sore that either fails to heal or returns after healing
• An itchy, sore, or changing spot of any color
• A patch of skin with visible blood vessels

Your doctor will ask you about your symptom history. Make sure to mention any new bump or sore that doesn’t heal. Let them know about any changes to skin bumps or lesions.

If the doctor sees any spots that need a closer look, they may use a dermoscope to check them. A dermoscope is a special tool that has a magnifying glass and a light on it. It lets your doctor take a closer, more detailed look at your skin.

Skin Biopsy

If your doctor sees an area of skin that looks concerning, they may take a biopsy of that area. This involves removing a small sample of skin and sending it to a pathologist, who can look at it under a microscope.

A pathologist who is specially trained in identifying skin diseases in tissue samples is called a dermatopathologist.

Depending on the size and location of your skin lesion, the doctor will decide which type of biopsy to perform. The types include:

• Shave biopsy — The doctor uses a razor to shave off the very top layer of skin. It’s the most common type of skin biopsy.
• Punch biopsy — The doctor uses a tool with a circular blade to remove a skin sample that includes all skin layers.
• Excisional biopsy — The doctor uses a scalpel (a small knife) to remove the whole tumor from the skin.

Most biopsies can be done in your doctor’s office. The doctor usually uses a numbing medication first, so you won’t feel pain during the procedure.

What Pathology Results Show

Your dermatology team will contact you when they get the biopsy results back. These results will show whether your skin sample was cancerous or not cancerous.

If your skin sample is cancerous, the pathology results will help determine which type of cancer you have, as well as the cancer’s stage, if applicable. Some early nonmelanoma skin cancers may not need a stage. Your doctor may only need the biopsy and exam results.

The doctor who performed your biopsy will share information about the type of skin cancer you’ve been diagnosed with. They’ll also answer your questions about your diagnosis.

Once you know whether you have BCC, SCC, or another type of skin cancer, the dermatologist will develop a treatment plan. Your treatment options will be personalized to your cancer type, whether the cancer has spread, and other factors.

Sometimes, doctors do a sentinel lymph node biopsy to check the lymph nodes where skin cancer would most likely spread first. If no cancer is found in these lymph nodes, it may mean the cancer is less likely to have spread.

When Imaging Tests Are Needed

Your provider might order imaging tests if they think your skin cancer has spread beyond the skin. These tests can show whether you have cancer in other areas, and if so, where it’s located.

Your provider may order one of the following tests:

• MRI — An MRI can detect cancer that’s spread from the skin to nearby nerves or other organs.
• CT — A CT scan may show cancer that’s spread to areas such as bones, organs, and soft tissues.
• Positron emission tomography (PET) scan — A PET scan can show whether cancer has spread to lymph nodes or other parts of the body. It may also help show whether treatment is working.

Not everyone with nonmelanoma skin cancer will need imaging tests. Talk to your care team about whether you’ll need a CT, MRI, or PET scan.

Skin Cancer Stages

Your healthcare team may use test results to give your cancer a stage. Skin cancer stages range from 0 to 4. What each stage means depends on the type of skin cancer and where it is on the body.

In general, the lower stages mean the skin cancer is smaller or only affects the top layers of skin. Higher stages mean the cancer has grown deeper, reached nearby lymph nodes, or spread to another part of the body.

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