What is Non‑Melanoma Skin Cancer?

Non-melanoma is an umbrella term used for types of skin cancer that include BCCs and SCCs and start in the outer layer of skin. They are typically caused by ultraviolet light, whether it’s excessive sun exposure or using sun beds. Certain factors can increase the likelihood of developing non-melanoma skin cancer, including age, skin colour (technically referred to as Fitzpatrick type), and medical history.

At Elledge Surgical in Birmingham, Mr Ross Elledge focuses on the diagnosis, treatment and reconstruction of facial non‑melanoma skin cancer, working as part of the Local Skin Cancer Multidisciplinary Team (LSMDT) at Solihull Hospital.

BCC vs SCC: What’s the Difference?

Although both BCC and SCC fall under non-melanoma skin cancer, they behave differently and are managed slightly differently.

Basal Cell Carcinoma (BCC)

Also known as rodent ulcers, BCCs often appear as a pearly or translucent bump, sometimes with visible blood vessels, or as a scaly patch that doesn’t heal. It’s a slow-growing type of skin cancer and doesn’t typically spread to other parts of the body. BCC surgical treatment focuses on removing the lesion, which will be examined in the lab, and sometimes, reconstruction may be required to restore form and function in the area.

Squamous Cell Carcinoma (SCC)

This is a less common type of cancer, but it can grow faster and be more aggressive. SCCs often appear as scaly, crusted, or ulcerated lesions and may be tender to the touch. It’s important to note that SCC has a higher risk of spreading to lymph nodes and other areas of the body, so timely treatment is essential. Again, surgery is often required to remove the cancer, and follow-up treatment might include radiotherapy and chemotherapy.

Since they are so different, Mr Elledge will tailor your surgery and treatment plan to the exact type, size, site and risk profile of your lesion rather than taking a one‑size‑fits‑all approach.

How is Non‑Melanoma Skin Cancer Diagnosed?

An accurate diagnosis is incredibly important for skin cancer, and as a Fellowship-trained skin cancer surgeon, you can trust that you are in good hands with Mr Elledge. At your consultation, he will examine the lesion and surrounding skin, looking for specific characteristics that help distinguish benign lesions from BCC, SCC and other skin cancers.

In some cases, a biopsy will be recommended before creating a treatment plan to confirm the diagnosis and risk features under the microscope. This is particularly important where it might influence the choice between standard surgery, Mohs micrographic surgery or other options.

Treatment Options for BCC and SCC

Surgery is often the first recommendation for treating BCC and SCC; however, it’s not the only option. The right treatment choice depends on the cancer type, its size and position, its risk features, and your general health and priorities.

Standard Surgical Excision

For many non-melanoma skin cancers, especially on the face, standard surgical excision is a successful option to consider. The skin cancer is removed with a pre‑planned margin of healthy tissue, and the specimen is sent to a dermatopathologist to confirm that the margins are clear. Mr Elledge has performed over 2,500 skin cancer procedures to date, with a clear‑margin rate of over 98% for non‑melanoma skin cancers.

After the cancer is removed, reconstruction will take place using techniques such as direct closure, local skin flaps or skin grafts. As a dual‑trained oral and maxillofacial surgeon with additional Fellowships in skin cancer and reconstructive surgery, Mr Elledge’s goal is to achieve a result that looks and feels as natural as possible.

Mohs Micrographic Surgery

Mohs micrographic surgery (MMS) is a specialised technique often used for certain high‑risk non-melanoma skin cancers in difficult areas, such as the nose and eyelids. In MMS, the tumour is removed layer by layer, with each layer being examined under the microscope in “real time”. This has a positive impact on both cosmetic results and cure rates.

This careful approach allows the Mohs surgeon to remove as little healthy skin and tissue as possible while maximising the chance of complete clearance. The surgery will take place under local anaesthesia, and wherever possible, any reconstruction required will be carried out immediately afterwards.

Curettage, Cryotherapy and Topical Treatments

For selected low‑risk lesions in suitable areas, non‑surgical approaches may also be an appropriate option to consider. Some examples of treatments include:

• Curettage (with or without cautery): scraping away the lesion and burning the base.
• Cryotherapy: freezing the lesion, typically with liquid nitrogen, to destroy abnormal cells.
• Topical treatments: applying creams containing agents that destroy cancer cells.
• Electrochemotherapy: administering a chemotherapy drug intravenously alongside cycles of electric currents to the lesion, maximising local effect.

An accurate diagnosis is essential before considering any of these treatment plans, and you should make an informed decision alongside your medical team.

Reconstruction and Cosmetic Outcomes

Understandably, many patients are worried about how they will look after non-melanoma skin cancer surgery, especially for lesions on areas of the face, like the nose, eyelids, lips or ears. While any procedure that involves cutting the skin will leave a scar, there is a lot that can be done to minimise the visual impact.

With careful planning and reconstructive techniques such as flaps and grafts, scars can often be disguised along natural lines and creases, so they blend over time. Mr Elledge’s reconstructive practice is focused on restoring both appearance and function, and over the years, he has worked closely with colleagues in Plastic Surgery and Dermatology, honing his skills and learning tips and tricks to achieve the most natural-looking results.

Most surgery for non-melanoma skin cancer at Elledge Surgical is carried out under local anaesthesia, meaning you are awake, but the area is fully numbed, although general anaesthesia can be arranged if appropriate. Pain after surgery is usually controlled with painkillers, and follow-up appointments will be arranged to remove dressings.

Follow‑Up and Prognosis

The prognosis for most BCCs and SCCs is very good when they are diagnosed and treated effectively. After your treatment, you will usually have follow‑up appointments to:

• Review your wound and reconstructive site.
• Discuss your pathology report, including margin status.
• Check for any signs of new lesions.

As a member of the LSMDT, Mr Elledge ensures that any higher‑risk cases are discussed with colleagues from Dermatology, Oncology and Plastic Surgery so your follow‑up plan is comprehensive. You will also receive advice on sun protection, future self-examination, and when to get a professional review, as people who have had one non-melanoma skin cancer are at increased risk of developing others.

When Should You Get an Urgent Assessment?

You should arrange an urgent review if you notice:

• A new lesion that is growing, bleeding or not healing.
• A persistent scaly, crusted or ulcerated patch.
• A pearly or translucent bump, particularly on a sun‑exposed area of skin.
• Any previously treated area that changes in appearance.

If you have been diagnosed with BCC or SCC and are considering standard or Mohs micrographic surgery in Birmingham, a specialist consultation can help you understand your options. At Elledge Surgical, the aim is always the same: to choose the safest, most effective treatment that completely removes the cancer while preserving form and function as much as possible, with professional care at all times.

Book a consultation today if you’re concerned about non-melanoma skin cancer treatment.