Diagnosing skin cancer

Physical examination

If you notice any changes to your skin, your doctor will look carefully at your skin and examine any spots you think are unusual. The doctor will use a handheld magnifying instrument called a dermatoscope to examine the spots more closely. They will also usually do a total body skin check to look at all your other moles and spots.

Skin biopsy

If the doctor feels they can diagnose the skin cancer by examining the spot, you may not need any further tests before having treatment. However, it’s not always possible to tell the difference between a skin cancer and a non-cancerous skin spot just by looking at it. If there is any doubt, the doctor may need to take a tissue sample (biopsy) to confirm the diagnosis.

A biopsy is a quick and simple procedure that is usually done in the doctor’s room. You will be given a local anaesthetic to numb the area, then the doctor will either:

• completely cut out the spot and a small amount of healthy tissue around it to be tested (excision biopsy)
• take a small piece of tissue from the spot to be tested (shave or punch biopsy).

Stitches may be used to close a larger wound. After a biopsy, your doctor will give you instructions on how to look after the wound. The biopsy skin tissue is sent to a laboratory where a pathologist examines it under a microscope. Your doctor will get the results in 1–2 weeks.

If all the cancer and a margin of healthy tissue are removed during the biopsy, this may be the only treatment you need. If the doctor has taken a small piece from a larger spot, and it shows cancer, you will have the rest of the cancerous spot removed.

Staging

The stage of a cancer describes its size and whether it has spread. BCCs rarely need staging because they don’t often spread or have other high-risk features. A small number of SCCs may need staging – because of where it is, how big it is or because it has spread.

Usually a biopsy is the only information a doctor needs to stage skin cancer. The doctor may also feel the lymph nodes near the skin cancer to check for swelling. This may be a sign that the cancer has spread to the lymph nodes. Rarely, some people will have imaging scans to help with staging. For more information about this, talk to your doctor.

Prognosis

Prognosis means the expected outcome of a disease. Your treating doctor is the best person to talk to about your prognosis. Most BCCs and SCCs are successfully treated, especially when found early. If the skin cancer is large, deep, in a difficult place, has spread to nerves or lymph nodes, or if you have a weakened immune system, you may be treated by a multidisciplinary team (MDT). This group of health professionals can confirm the best treatment approach, including access to clinical trials. 

Being told you have cancer can cause a range of emotions. You can talk to your doctor, ask to see a counsellor or call Cancer Council 13 11 20.

Key points about diagnosing skin cancer

Which health professionals will I see?

You may see one or more of the following doctors: 

GP – Many GPs diagnose and treat people with BCC and SCC skin cancers. They may perform surgery, cryotherapy or prescribe topical treatments. Some GPs have extra training related to skin cancer. Before choosing a GP, you can ask what experience or qualifications they have with skin cancer. You may see a GP at a general practice, medical centre or skin cancer clinic. Skin cancer clinics are run by GPs with an interest in skin cancer. A GP may refer you to a dermatologist, surgeon, or radiation or medical oncologist for larger areas or cancers that are hard to remove. If there’s a waiting list and spot of concern, your GP can ask for an earlier appointment. 

Dermatologist – A doctor who diagnoses, treats and manages skin conditions and skin cancer. They perform surgery, cryotherapy and prescribe topical treatments. 

Radiation or medical oncologist – A radiation oncologist prescribes and oversees a course of radiation therapy, which may be used to treat some skin cancers. A medical oncologist prescribes cancer drug therapies, which may be used for a small number of (usually) advanced skin cancers. 

Surgeon – Some skin cancers are treated by surgeons: 

• Surgical oncologists specialise in treating cancer with surgery; they manage complex skin cancers, including those that have spread to the lymph nodes. 
• Reconstructive (plastic) surgeons are trained in surgical oncology and in complex reconstructive techniques for more difficult to treat areas (e.g. the nose, lips, eyelids and ears).