Prognosis and survival for non-melanoma skin cancer

A prognosis is the doctor's best estimate of how cancer will affect you and how it will respond to treatment. Survival is the percentage of people with a disease who are alive at some point in time after their diagnosis. Prognosis and survival depend on many factors.

The doctor will look at certain aspects of the cancer as well as characteristics of the person (such as their overall health). These are called prognostic factors. The doctor will also look at predictive factors, which influence how a cancer will respond to a certain treatment and how likely it is that the cancer will come back after treatment.

Prognostic and predictive factors are often discussed together. They both play a part in deciding on a prognosis and a treatment plan just for you. Only a doctor familiar with your medical history, the type, size and grade of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis and chances of survival.

Doctors use many of the following prognostic factors to classify basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) into risk groups. The risk groups help the doctor estimate the risk that the cancer will come back (recur). Doctors also use the risk groups to help plan the best treatment.

Prognosis and survival for most non-melanoma skin cancers is excellent. The following are prognostic factors for non-melanoma skin cancer.

The location of the cancer is an important prognostic factor for non-melanoma skin cancer.

Non-melanoma skin cancer on the eyelids, skin around the eyes, cheeks, temples, nose, lips, ears, scalp, hands, fingers, feet, toes and genitals have a higher risk of recurring or spreading to another part of the body (called metastasis) than non-melanoma skin cancer in other places on the body.

SCC starting in a wound or scar is also considered high risk.

Non-melanoma skin cancer that is larger than 2 cm is more likely than smaller tumours to come back or to spread.

A tumour that has grown deep into the layers of the skin also has a high risk of coming back and a less favourable prognosis.

Non-melanoma skin cancer that comes back after treatment has a less favourable prognosis than non-melanoma skin cancer that is found for the first time.

Some subtypes of BCC and SCC tend to grow quickly.

The subtypes of BCC that have a less favourable prognosis include infiltrative, micronodular and morpheaform. The subtypes of BCC that have a better prognosis are nodular and superficial.

Desmoplastic SCC and adenosquamous carcinoma of the skin tend to come back after treatment and have a less favourable prognosis.

The grade is a description of how the cancer cells look and act compared to normal cells.

Low-grade non-melanoma skin cancers have a better prognosis than high-grade cancers.

Non-melanoma skin cancer with a border that is uneven has a higher risk of coming back than cancer with a border that is clear and smooth.

Non-melanoma skin cancer that has grown into or around nerves (called perineural invasion) has a less favourable prognosis.

Immunosuppression is a weakening of the body’s immune system that makes it less able to fight infections or diseases. For example, people who have had an organ transplant have a weakened immune system.

People with non-melanoma skin cancer and a weakened immune system have a poorer prognosis than people without a weakened immune system. Non-melanoma skin cancer is more likely to grow deeper into the skin and spread to nearby lymph nodes (regional lymph node metastases) in people with immunosuppression. The cancer is also more likely to have other high-risk features such as perineural invasion.

Non-melanoma skin cancer that has grown deeper into the skin or has spread to nearby tissues and structures has a less favourable prognosis.

Non-melanoma skin cancer that has spread to farther parts of the body (called distant metastases) has a very poor prognosis.