Most people have a rough idea as to what a melanoma looks like. Sort of a like a burnt raisin.

Every six minutes, an Australian dies from melanoma, despite endless awareness campaigns.

Despite the abundance of information available, we have nearly 17,000 melanoma deaths a year.

Less well known are the non-melanoma cancers that can also kill you – a high-risk version of cutaneous (skin) squamous cell carcinoma.

In a new paper, researchers from the University of the Sunshine Coast report that the number of non-melanoma skin cancer deaths has just about doubled over 20 years.

Namely, they rose from 400 a year in 2001 to almost 800 in 2021.

You might think, oh, that’s not so bad. But here’s the difficulty, the true extent of these potentially dangerous carcinomas is unknown, because – unlike melanomas – they’re not recorded on Australian cancer registries.

Because there are so many of them being treated by GPs, specialists and in hospitals. And possibly even more going untreated, especially on older people.

A further complication

One of the important take-aways from the research is that high-risk cutaneous squamous cell carcinomas (HRcSCC) are somewhat poorly understood.

Squamous cell carcinomas can present into a variety of ways. Photos: Health Direct

At the least, there is no firm agreement on how to define them, identify them at an early stage, or treat them.

The authors write: “The definition of early HRcSCC and our ability to identify them is evolving. Many significant prognostic factors have been identified, but a universally accepted prognostic index does not exist.

“Guidelines for workup, treatment and follow-up leave many important decisions open to broad interpretation by the treating physician or multidisciplinary team.”

They note that some of the treatments used for metastatic cSCC “are not supported by robust evidence and the prognosis of metastatic cSCC is guarded”.

Hence, in this review, the researchers highlight the rapid rise in NMSC deaths. And they discuss “some of the deficiencies in our knowledge of how to define, diagnose, stage and manage HRcSCC”.

Bottom line: Got a weird lump or sore that won’t away. Get it checked out.

Complacency doesn’t help

Squamous cell carcinomas are commonly found on sun-exposed areas of the head and neck.

And they’re easily removed with a scalpel and some local anaesthetic. Plenty of GPs are qualified to do this procedure.

The problem, though, is a widespread belief that skin cancers not identified as melanoma aren’t a threat to life and limb.

What the researchers say

This was a PhD study led by Sunshine Coast Health pathologist Dr Andrew Dettrick. He was supported by his supervisors and a team of fellow specialists from Sunshine Coast University Hospital and Pathology Queensland.

Dettrick said the newly published figures revealed the danger of underestimating the urgency of treating non-melanoma skin cancers.

“Non-melanoma skin cancer is often trivialised because of its high prevalence, combined with easy treatment for the majority of tumours,” he said, in a prepared statement.

“However, there is a subgroup of squamous cell carcinoma that is associated with a high risk of metastasis and death.”

Dettrick said the study recommended fixing deficiencies in defining, diagnosing and managing treatment of the cancer before it could spread elsewhere in the body.

“While the prognosis is excellent for the majority of patients with this skin cancer, including cure rates between 91 and 95 per cent following localised removal, things quickly worsen once the cancer has advanced locally or spread to lymph nodes,” he said.

He said patients and their caregivers must understand “that cutaneous squamous cell carcinoma is a serious and potentially fatal cancer”.

Identifying it early, before it has metastasised, “is critical”.

How to identify an SCC

According to government site Health Direct: The first sign of an SCC is usually a thickened, red, scaly spot on your skin that doesn’t heal.

You are most likely to find an SCC on the back of your hands, forearms, legs, scalp, ears or lips.

If it’s on your lips, it can look like a small ulcer or patch of scaly skin that doesn’t go away.

Your SCC may also look like:

• A crusted sore
• A small ulcer or thickened scaly skin on the lips
• A patch of skin that’s sore
• A firm, red lump
• A sore or rough patch inside your mouth
• A red, raised sore around your anus or genitals.

An SCC will probably grow quickly over several weeks or months.