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Textbook/Oncology and palliative care/Cutaneous squamous-cell and basal-cell carcinoma/Rapid
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Cutaneous squamous-cell and basal-cell carcinoma

Essential points for quick revision.

2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Orbital, neural or major-vessel invasion

Acute visual change, ophthalmoplegia, facial weakness or numbness, skull-base pain, major bleeding or rapidly spreading infection around an ulcerated skin cancer indicates destructive local or perineural disease.

Action: Use ABCDE and eye or neurological assessment, control haemorrhage and infection, obtain urgent contrast MRI or CT and involve dermatology, plastic or head-and-neck surgery, ophthalmology, radiology and oncology for biopsy, airway or vascular safety, resection, radiotherapy or systemic treatment.

Synopsis

Distinguish cutaneous squamous-cell carcinoma from basal-cell carcinoma, identify high-risk anatomy and pathology, obtain adequate tissue and select standard excision, Mohs surgery, field treatment, nodal care and advanced systemic therapy.

  • BCC typically appears as a pearly telangiectatic papule, rolled-edge ulcer or scar-like plaque and is locally destructive but almost never metastasises.
  • cSCC commonly appears as a tender indurated keratotic or ulcerated lesion that grows over weeks or months and can spread to regional nodes.
  • First-line assessment includes full-skin and regional-node examination with dermoscopy and measurement; photograph site and size before biopsy.

Key red flags

A rapidly enlarging tender keratotic nodule, indurated ulcer or non-healing lesion, especially on ear or lip, requires urgent SCC assessment.

Perineural disease

New pain, tingling, numbness, facial weakness or formication along a nerve is a high-risk neurological sign.

Investigation priorities

01
First-line dermoscopy and complete examinationFirst stepFirst line

Assess lesion pattern, margin, size, fixation and field damage and examine regional nodes and the remaining skin.

Management branches

Suspicious lesionBiopsy deep enough to classify risk

A non-healing, enlarging, ulcerated, keratotic, pearly or scar-like lesion is clinically suspicious.

  1. Assess growth, pain, immune suppression, previous cancer and neural symptoms and perform dermoscopic full-skin and nodal examination with measurement and photograph.
  2. Obtain full-thickness excision or incisional biopsy from the most representative deep area, avoiding destructive treatment before invasive risk is known.

Key medicines

Imiquimod for superficial BCCApply imiquimod 5% cream thinly to the lesion and a small surrounding margin five nights each week for 6 weeks, washing off after approximately 8 hours, within the licensed superficial-BCC criteria.
Cemiplimab for advanced cSCCGive cemiplimab 350 mg intravenously every 3 weeks within the licensed and current NICE-funded indication for metastatic or locally advanced cSCC not suitable for curative surgery or radiation.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom