How to identify and treat skin cancer on the face?

Because it is exposed to the sun more than other parts of the body, the skin on your face is especially vulnerable to skin cancer.

The most common type of skin cancer on the face is called basal cell carcinoma (BCC). You can also get cancers like squamous cell carcinoma (SCC) and melanoma on the face, neck, or ears due to excessive ultraviolet (UV) light exposure and other factors.

Skin cancer on the face is sometimes confused for moles or solar lentigo (liver spots), which is why is important to get them checked out if a new spot appears or an old one changes. A skin spot can also be due to a common type of precancer known as actinic keratosis.

This article describes both the common and uncommon types of skin cancer that occur on the face, including what the lesions look like and who is most at risk.

Actinic Keratosis

Actinic keratosis (AK), also called solar keratosis, is a common precancerous skin condition. It's often found on the face—near the eyes, nose, ears, or lips. The precancerous designation means these lesions aren't officially cancerous but can turn into more advanced cancer if left untreated.

These lesions have an appearance similar to age spots, pimples, irritated skin, or badly chapped lips.

The spots can be rough, dry, scaly, or sandpapery. You can often feel them before seeing them.
They may appear red, white, tan, brown, gray, or pink.
They might itch, burn, sting, feel tender or painful.
They might bleed.
Some can be hard, taking a form that looks like an animal's horn.

Who's at Risk

AKs are common—approximately 40 million Americans will develop AKs each year.

Risk factors:

Having a history of excessive exposure to UV light through the sun or indoor tanning equipment
Being middle-aged or elderly
Having fair skin that burns easily and rarely tans, and light hair and eyes
Conditions that suppress the immune system, like an organ transplant, HIV, or taking immunosuppressive medications
Albinism, an inherited condition characterized by a lack of pigment in the hair, skin, and eyes
Xeroderma pigmentosum, an inherited disease that causes sensitivity to the sun
Rothmund-Thomson syndrome, a rare disease that impacts the skin
Bloom syndrome, a rare disease that increases sensitivity to the sun

Treatment

Because AKs can lead to more dangerous conditions if untreated, it's essential to have your dermatologist review any suspect spots so they can treat them as soon as possible. Treatments will remove the lesions, and the treatment method depends on lesion location and number of lesions.

Treatments can include various surgeries that remove the AK spots, including:

Cryosurgery: Destroys the lesion with extreme cold
Curettage: Scraping, with or without electrodesiccation, which uses heat and physical scraping to remove the spot
Mohs surgery: An approach that leaves as much healthy tissue as possible by excising skin and examining it under a microscope to look for cancer cells, and repeating until all cancer is removed

Healthcare providers can also destroy the lesions directly with laser treatments and photodynamic therapy, which uses a combination of light and medications to kill precancerous cells.

Healthcare providers might also prescribe medications to treat AKs, including creams for the skin like Adrucil (fluorouracil), Solaraze (diclofenac), and Aldara (imiquimod).

Actinic Cheilitis

Actinic cheilitis is a precancerous condition of the lip (similar to actinic keratosis). Some healthcare providers classify it as a very early-stage cancer of the lip. It presents as a red, dry, scaling, itchy Inflammation of the lips.

It feels like persistent chapped lips or lip tightness, and you might see atrophy (thinning) and blurring of the border between the lips and the skin. The lips become scaly and rough with erosions or fissures and a sandpaper-like texture. It is more common on the lower lip but can also happen on the upper lip.

Actinic cheilitis is also known as farmer's lip, sailor's lip, and solar cheilitis.

Who's at Risk

One of the most significant risk factors for AC is long-term sun exposure, specifically outdoor jobs like construction, farming, and sailing.

Other risk factors include:

Light-colored skin
Lips that stick out
Being male and older
Living in hot and dry climates, higher altitudes, or closer to the equator
A history of skin cancer
Conditions that increase photosensitivity

Treatment

Treatments for AC include surgery to remove the affected area, and potentially part of the lip. Destructive treatments include photodynamic therapy (light treatment), cryosurgery (freezing), laser ablation, dermabrasion, and electrodesiccation.

These approaches seem to work best at preventing recurrence. Your healthcare provider may also prescribe topical therapies like Adrucil, Aldara, and Solaraze gel, or lotion.

Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the most common type of skin cancer. It is diagnosed in approximately 4 million people per year in the U.S. and makes up about 80% of non-melanoma skin cancers. They're common on the head and neck but can happen anywhere. Most cases can be treated and cured.

BCCs have a wide variety of appearances:

Can be flesh-colored
Pearl-like bumps or pinkish patches of skin, sometimes called a "pearly papule" because they're occasionally shiny.
Discolored
Raised or relatively flat
Sometimes scaly.
May have a central depression or ulcer

Who's at Risk

While anyone can develop BCCs, risk factors include:

Fair skin, blue eyes, light hair (but can develop in darker skin)
Years of recurrent sun exposure or indoor tanning
Intermittent high-intensity UV exposure (sunburns), especially in childhood
Middle age or older
Living closer to the equator
Having already been diagnosed with a BCC

Treatment

Most BCCs are not very serious. But, if these cancers are not recognized and treated, they can lead to disfigurement, complications, and even death. BCCs very rarely become malignant (spread to other areas of the body), but there are rare, aggressive forms that can be fatal.

Treatment options include surgery, specifically curettage and electrodesiccation, Mohs surgery, cryosurgery, laser surgery. Your healthcare provider might also recommend destroying the tumor by using photodynamic therapy or radiation treatment.

Medications, including topical medications Aldara or Adrucil, can be used to treat BCCs. If cancer has spread, oral medications including Erivedge (vismodegib) and Odomzo (sonidegib) might be used.

Squamous Cell Carcinoma

Squamous cell carcinomas (SCCs) are the second most common skin cancer and make up the other 20% of non-melanoma skin cancers.

SCCs might look like a scab, a red firm bump, scaly patch, or a sore that heals and reopens. They can be raised, flat, or scaly. Areas of the face most commonly affected by SCC are the upper rim of the ear, face, neck, scalp, and lip.

Who's at Risk

The people who are most at risk for SCCs include those who:

Have fair skin, hair, and eyes, including albinism
Have had frequent, chronic sun exposure
Are male—men get SCCs in a 2-to-1 ratio to women
Are older
Live closer to the equator
Have a suppressed immune system
Use or have used tobacco
Have a history of skin cancer or precancerous skin conditions
Have sun-sensitizing conditions
Have a history of human papillomavirus (HPV)

Treatment

SCCs are more likely to spread to other parts of the body than BCCs, but most are easily treatable and not likely to be fatal.

Treatment options for SCCs include skin cancer surgeries and destructive therapies, like photodynamic therapy and radiation. If the SCC spreads, your healthcare provider might recommend chemotherapy.

Melanoma

Melanoma is the ninth most common cancer in the U.S. It typically appears on the trunk in men and legs in women, but it can also happen on the face. While it's one of the better-known types of skin cancer, it's not all that common. It makes up about 1% of skin cancers. In the US, there are about 106,000 cases per year and about 7,100 people die from it annually.

There are four main subtypes of melanoma, each with unique characteristics. Melanoma can develop from existing moles or as a new dark spot that wasn't there before. It can be either flat or raised and might bleed easily. The parts of the face most commonly affected are the head, neck, eyes, and mouth.

Who's at Risk

Excessive sun damage is the most significant risk factor for melanoma, but some specific traits can increase your risk of developing it.

Risk factors for melanoma include:

Fair skin, freckles, light hair, and eyes; a tendency to burn instead of tan (melanoma is 20 times more common in Whites)
Older age, especially in men
Personal or family history of melanoma
A large number of moles (more than 50), atypical nevus syndrome, or very large moles present at birth
Weakened immune system
Xeroderma pigmentosum

Treatment

Melanoma has a tendency to become malignant and spread to the rest of the body, and it can be deadly.

Your healthcare provider will likely remove the tumor with surgery. Depending on how large the melanoma is, they might give it a wide excision around it, potentially even an amputation. If it has spread, your healthcare provider will also take a biopsy to see if it has spread to the lymph nodes.

There are a lot of promising medication therapies that can help treat melanoma. Immunotherapies are medications that use the body's immune system to fight the tumor. Targeted therapies specifically attack the cancer cells based on their unique characteristics.

Sebaceous Gland Carcinoma

Sebaceous gland carcinoma (SGC) is a rare skin cancer that grows from the sebaceous gland cells that secrete oil and sebum to lubricate the hair follicles. SGCs can occur anywhere, but most occur on the upper and lower eyelids because they have the most sebaceous glands. They're often referred to as eyelid cancers.

Sebaceous glands of the eyelid are called meibomian glands, and sebaceous gland carcinomas on the eyelid are sometimes called meibomian gland carcinomas. These tumors are painless, round, and firmly implanted in the eyelid. You may need to pull on the eyelid to see it.

The tumors can be slow-growing and often look yellowish. It can look like the part of the eyelid where it meets the lashes has thickened. SGC can have a yellow or reddish crust or can look like a pimple on the eyelid. It might bleed and form a sore that doesn't heal or that reappears.

The tumor might be mistaken for a stye, chalazion, or pink eye, all of which are much more common than SGC.

Who's at Risk

The major risk factors for SGCs include:

More common between age 60 to 80, but can occur at any age
May be more common in Asians, though studies aren't in agreement.
Previous radiation treatments
Weakened immune system
Muir-Torre Syndrome, a rare medical condition that causes tumors in the sebaceous glands.

Treatment

SGCs are aggressive cancers that can spread. Treatments include surgery to remove the tumor (usually Mohs), reconstructive surgery, and if the cancer is advanced, lymph node or eye removal. Other destructive methods are being tested for SGCs, including cryotherapy and radiation, though they're not the first choice.

Merkel Cell Carcinoma

Merkel cell carcinomas (MCCs) are a rare cause of skin cancer of the head or neck. Only about 2,000 are diagnosed every year in the U.S.30 Tumors take the form of rapidly growing, painless, firm, shiny nodules that can be pink, red, or purple. They're sometimes mistaken for an insect bite, sore, cyst, stye, or pimple.

Who's at Risk

The significant risk factors for MCCs include:

Age: 80% of patients are over 70.
Fair skin: 90% of patients are White.
Male: Men are two times more likely than women to develop MCCs.
High levels of UV exposure
Immunosuppression
Infection with Merkel cell polyomavirus: Researchers discovered this common virus in 2008 and have linked it to the development of MCCs. How the virus is linked to cancer development is still being researched.

Treatment

MCC cancers are at risk of spreading locally in the skin and to nearby lymph nodes. They are more likely to be aggressive and spread than other skin cancers and are harder to treat when they've spread.

Treatments involve surgery and medication options Destruction of the tumor through radiation, either after or in place of surgery, may also be done.

Medications include chemotherapy, hormone-like drugs, and targeted therapies that directly attack the cancer cells. There are immunotherapy options like immune checkpoint inhibitors.

Researchers are also testing out autologous T cell therapy, in which the patient's white blood cells are removed from their blood and taught to recognize cancer, then reinjected to fight MCCs.

Other Cancers on the Face

A few other rare skin cancers that might happen on the face:

Lymphoma of the skin is an uncommon type of white blood cell cancer.
Kaposi's sarcoma is cancer caused by a herpes virus in immunosuppressed patients that causes skin lesions on the face. They look like painless purplish spots.
Skin adnexal tumors is a rare cancer type that starts in hair follicles or skin glands.
Sarcomas are tumors of the connective tissues—specifically the fat, nerves, bone, skin, and muscles —80% of which occur in the face, head, or neck.
Cutaneous leiomyosarcoma is an uncommon soft-tissue sarcoma that can happen on the face.

Prevention

Your face is the most sun-kissed part of your body. Avoiding the sun (and other sources of UV light) is the best way to reduce your risk for skin cancers on the face (or anywhere!)

It's best to avoid indoor tanning beds and extended sun sessions outside. However, your face is likely to end up uncovered at some point, so you have to take extra precautions when you are out in the sun.

Sunscreen and SPF

The simplest way to avoid dangerous UV rays while outside is to apply sunblock or sunscreen.

Sunscreens come in two types—chemical and physical. Chemical sunscreens absorb the sun's UV light, while physical sunblocks block the light from reaching your skin.

The protection level of sunscreens is rated by sun protection factor (SPF) against UVA and UVB rays. You need a broad spectrum SPF that blocks both types of ultraviolet rays to protect you from skin cancers. The higher the SPF, the greater the protection.

Applying SPF 15 every day can lower your SCC risk by 40%. It can reduce melanoma by 50%. It'll also prevent wrinkles, sagging, and sunspots. Make sure you also use lip balms with broad-spectrum SPF as well.

In addition to daily prevention with SPF, you'll want to take some extra caution when you're spending a long time out in the sun, especially if it's a hot day. Make sure to use sunscreen formulated for the face, and reapply regularly (not just once in the morning), especially if you're sweating.

Another approach? Opt for a lifeguard vibe and swipe on some thick zinc SPF.

Beyond Sunscreen

Sunscreen isn't the only way to lower your skin cancer risk.

Try these tips:

Wear medium-dark sunglasses. Look for glasses with large lenses in a wraparound style that curves in close to the face—the more coverage, the better. Any lens that has 99 to 100% UV blocking is acceptable. Lenses that are polarized, photochromic, or infrared-blocking don't protect from sun damage on their own.
Wear big-brimmed hats in fabrics with an ultraviolet protection factor (or UPF) rating.
Try a wearable UV sensor to tell you when you've gotten too much sun.
Adjust your schedule to be inside during the strongest sun hours, and if you can't be inside, make sure to seek shade.
Avoiding tobacco can also help decrease your risk for skin cancer on the face (and other, more deadly cancers, too).

A Word From Verywell

While doing your best to prevent sun damage, you should also keep an eye on your skin for changes. Have someone else look at your scalp or the back of your neck if it's hard to see back there.

Early detection saves lives. What to look for when examining your skin:

A - Asymmetry: Two halves don't match
B - Borders: Uneven edges
C - Color: Multiple browns, tan, black, red, blue, or pink
D - Diameter: Bigger than 6 millimeters (0.25 inch) across
E - Evolution: Changes in size, shape, or color

If you have reasons to think you are at risk for skin cancer, see your dermatologist regularly for check-ups.