Rough red spot
A flat red scaly spot is what early-stage squamous cell carcinoma often looks like.
Precancerous skin diseases
CONDITION / FACE
Squamous cell carcinoma and melanoma of the face.
Facial skin cancer is not only basal cell carcinoma. Squamous cell carcinoma and melanoma can spread to the lymph nodes, so they are removed with a reserve of healthy tissue, and the stage and further treatment are determined together with the oncologist.
CONCEPTUAL VISUALIZATION- What it is
- Two types of skin cancer: squamous cell carcinoma and melanoma.
- How common
- Squamous cell cancer — 20% of all malignant skin tumors; 35–45% of them are on the head and neck.
- What are dangerous?
- Can give metastases; melanoma accounts for 90% of skin cancer deaths.
- Who treats it
- The surgeon removes the tumor and restores the skin; staging, medication and radiation are managed by an oncologist.
01 / WHAT IS ITWhat is
What is
squamous cell carcinoma and melanoma.
Squamous cell skin cancer is one of the most common tumors in fair-skinned people. It grows more often on skin exposed to the sun - face, ears, head. It is the most common skin cancer that can metastasize: in a nationwide study in England, metastases appeared in 1.1% of women and 2.4% of men over three years.
Melanoma is the most dangerous skin tumor: it accounts for 90% of skin cancer deaths. Most often, it looks like a new mole or a mole that has changed. On the face of elderly people, there is a special kind of malignant lentigo: it grows slowly on sun-damaged skin, and its borders are often wider than the eye can see.
Both tumors are treated much more successfully if they are detected early. According to a review in JAMA, in 77% of patients, melanoma is found before it has spread beyond the skin.
Basal cell carcinoma, the most common skin cancer that rarely spreads, is described on a separate page.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow does it look
How does it look
facial skin cancer.
Any new formation or birthmark that changes should be on the alert. Here are the most common signs.
Solid promotion
A red, firm, scaly or ulcerated nodule that enlarges.
The birthmark changes
A new birthmark or an old birthmark that has changed in size, shape, or color may be melanoma.
Nevi (moles)Wrong shape and colors
Uneven edges, two different halves, multiple colors, size over 6mm.
Bleeding or itching
The formation swells, hurts, bleeds, itches or crusts over.
A slowly growing spot
In elderly people, malignant lentigo is possible on skin damaged by the sun.
03 / REASONSWho has
Who has
higher risk.
The main cause of both tumors is ultraviolet radiation. Other factors are different for squamous cell carcinoma and melanoma.
Sun and solarium
Ultraviolet radiation is the main cause of both squamous cell carcinoma and melanoma.
Skin type
Fair skin that burns easily and does not tan well.
Birthmarks
Many birthmarks, particularly atypical birthmarks, increase the risk of melanoma; as well as melanoma in the past or in the family.
Age and precancer
Squamous cell carcinoma is more common in older people, in men, and in those who have had actinic keratosis.
Depressed immunity
In particular, after organ transplantation. It increases both the risk of squamous cell cancer and the risk of its spread.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Suspicion of skin cancer is a reason to make an appointment with a doctor without delay, but it usually does not require emergency care: the earlier the tumor is detected, the easier it is to treat. 103 may be needed only because of wound complications after surgery.
103 immediately if:
- bleeding from the wound does not stop, even if it is pressed;
- the blood gushes, bright red, hard to stop.
To the doctor:
On the same day: to the surgeon who operated, if the wound after removal is swollen, red, hurts more and more, pus flows from it, or you feel bad and have a fever. Without delay, go to a dermatologist or oncologist for a dermatoscopy examination: the mole has changed in size, shape or color, hurts, itches, is inflamed, bleeding or crusted over; a new unusual spot appeared that does not go away for several weeks; the growth on the skin grows or does not heal for more than 4 weeks. If the doctor suspects melanoma or squamous cell cancer, the biopsy and the oncologist's consultation are performed urgently, without waiting for an appointment.
05 / DIAGNOSTICSHow to make a diagnosis
How to make a diagnosis
and determine the stage.
- Examination and dermatoscopy
The doctor examines the formation through a special magnifying glass. Suspected melanoma is always checked by dermatoscopy.
- Biopsy
The diagnosis is confirmed only under a microscope. When melanoma is suspected, the birthmark is usually excised completely; with malignant lentigo, several small samples may be taken.
- Depth and thickness
For squamous cell cancer, the most important is the depth of germination, for melanoma - the thickness of the tumor in millimeters. The supply of tissues and further examinations depend on this.
- stage
If necessary — ultrasound of lymph nodes, CT or PET-CT, MRI, tumor mutation analysis. The scope of examinations is determined by the oncologist by stage.
06 / TREATMENTHow we treat
How we treat
facial skin cancer.
The main treatment for both tumors is surgery, especially if they are detected early. It is important that the edges of the removed tissue are clean. Further steps — stage, lymph nodes, drugs — are planned with the oncologist, in complex cases at a consultation.
01
Squamous cell cancer
Surgery is the treatment of first choice.
- Stock of fabrics
- According to the British guideline, a low-risk tumor is removed with a margin of at least 4 mm, and a high-risk tumor is removed with a margin of at least 6 mm or more. The edges are examined under a microscope or the tumor is removed according to the Mohs method.
- Which increases the risk
- In a meta-analysis of 36 studies, metastases were more common in tumors that grew deeper than the subcutaneous tissue, thicker than 2 mm, more than 20 mm, those that spread along a nerve, and those located on the temple, ear, or lip.
- Plastic
- For high-risk tumors, the guideline advises closing the defect after definitive histology confirms clean margins; if the edges are not clean, the tumor is removed again.
- If it is not possible to operate
- Radiation therapy is being considered.
02
Melanoma
Surgery with a larger supply of tissues.
- Stock of fabrics
- According to the European guideline, melanoma is removed by retreating 1–2 cm, depending on the thickness. In a meta-analysis of 7 randomized trials (4579 patients), a wider margin (up to 5 cm) compared with a narrower one did not reduce the risk of recurrence or death, but was more likely to require complex plastic surgery.
- Malignant lentigo
- The first choice is a complete deletion; for large or indistinct spots, edge control methods are better. Cream or radiation — if surgery is not suitable. Methods that destroy tissue without analysis should be avoided.
- When to close the defect
- According to a review of studies, after the removal of melanoma of the head and neck, the edges are not clean in 6–20.9% of cases. Therefore, plastics are often postponed until the final histology; in some cases, a one-stage operation is possible.
03
What does an oncologist do?
Stage, lymph nodes, medication.
- Sentinel lymph node
- Biopsy of the first lymph node, where the lymph drains from the tumor, is offered for melanoma with a thickness of 1 mm or more or 0.8 mm with other signs of risk. It specifies the stage, but a clear advantage for survival has not yet been proven.
- Other lymph nodes
- If melanoma cells were found in the sentinel node, immediate removal of the remaining nodes in a study of 1,934 patients did not prolong life (86% and 86% at 3 years), and edema due to impaired lymphatic drainage was more common: 24.1% vs. 6.3%.
- Medicines after surgery
- With stage IIB-IV melanoma, after complete removal, immunotherapy or targeted drugs are possible; the decision is taken by the oncology council.
- Advanced squamous cell carcinoma
- If the tumor cannot be cured by surgery or radiation, immunotherapy is the first choice.
04
After treatment
- reviews
- After high-risk squamous cell carcinoma, UK guidelines advise screening every 3–6 months for two years, then every year thereafter. After melanoma, the examination schedule depends on the stage.
- New tumors
- After squamous cell carcinoma or basal cell carcinoma, the risk of a new tumor is high — about 40% within 5 years, so the skin should be examined at least once a year.
- Sun protection
- In a randomized trial, daily sunscreen reduced the risk of squamous cell carcinoma.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Squamous cell cancer and melanoma of the skin of the face are treated at the Institute of Surgery of Dr. Valikhnovskyi in the "New Face" direction. The clinic is responsible for tumor removal with edge control and repair of the defect. The stage, biopsy of the sentinel lymph node, medication and radiation are determined and conducted by the oncologist according to the instructions, in complex cases - by the consultation.
CLINIC SERVICE
A new face
Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes.
View service
What we do for this condition
- Edge-controlled deletion — the tumor is excised with a reserve of healthy tissue; edges are assessed by a pathologist.
- Plastic surgery immediately or after histology — with low-risk tumors, the defect can be closed in the same operation; in high-risk squamous cell carcinoma and often in melanoma—after definitive histology confirms clear margins.
- Local patches — nasolabial, cervical-facial and frontal flaps — the skin closest in color and texture.
- Perforating facial flaps — a flap of skin on a thin vessel closes the wound without gross tension and distortion of the lines of the mouth or eyes.
- Fabric expander — for large defects: a supply of own skin is gradually grown nearby.
- Microsurgical flaps — large and deep defects are replaced with tissues from other parts of the body.
- Lipofilling — own fat helps to align the contour after a major reconstruction.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlinePlease send a close-up photo of the mass and the face as a whole, as well as the biopsy result and the oncologist's report, if available.
- ConsultationSurvey, assessment of size and boundaries; if necessary, a biopsy and a referral to an oncologist to determine the stage.
- PlanStock of tissues, how the edges will be checked, what and when the defect will be closed — together with the oncologist's plan.
- SurgeryRemoval of the tumor and plastic defect — immediately or in the second stage after histology.
- Recovery and supervisionReviews before healing; then — regular skin examinations and examinations according to the oncologist's schedule.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
How does squamous cell carcinoma differ from basal cell carcinoma?
Basal cell carcinoma rarely spreads to other organs. Squamous cell carcinoma is the most common skin cancer that can metastasize, although it occurs infrequently: 1.1% of women and 2.4% of men in England over three years.
Is melanoma curable?
If it is detected early, the treatment is mostly successful: in stages IA–IB, 94–98% of patients do not die from melanoma after 10 years. Therefore, it is better to show mole changes to the doctor as early as possible.
Why is there such a large supply of tissues in melanoma?
To reduce the risk of the tumor returning. A reserve of 1–2 cm is chosen according to the thickness of the melanoma; wider, up to 5 cm, in studies did not give advantages, but more often required complex plastic surgery.
What is a sentinel lymph node biopsy?
This is the removal of the first lymph node, where the lymph drains from the tumor, to check whether melanoma cells have entered there. It is offered for melanoma from 0.8–1 mm. Whether you need it, decide with the oncologist.
Is it possible to remove a suspicious birthmark with a laser?
If melanoma is suspected, the tumor must be examined under a microscope. Methods that destroy tissue without analysis are recommended to be avoided.
Why is plastic surgery sometimes done as a second stage?
After removal of melanoma of the head and neck, the edges are not clean in 6–20.9% of cases. Therefore, the defect is often closed after the final histology - it is more reliable.
Will medication or radiation be required after surgery?
Depends on the stage. In the early stages, surgery is usually sufficient; with stage IIB–IV melanoma, immunotherapy is possible after removal. The oncologist makes the decision.
How often to be examined after treatment?
The schedule depends on the type of tumor and the risk: after high-risk squamous cell carcinoma, every 3-6 months for two years. Examination of the entire skin — at least once a year.
Sources
18 sources · European and national guidelines, meta-analyses, randomized trials and the NHSshowCollapse
- European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma: Part 2. Treatment — update 2026European Journal of Cancer, 2026doi:10.1016/j.ejca.2026.116764 ↗
- European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma. Part 1: Diagnostics and prevention — update 2026European Journal of Cancer, 2026doi:10.1016/j.ejca.2026.116763 ↗
- European consensus-based interdisciplinary guideline for melanoma. Part 1: Diagnostics — update 2024European Journal of Cancer, 2025doi:10.1016/j.ejca.2024.115152 ↗
- European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment — update 2024European Journal of Cancer, 2025doi:10.1016/j.ejca.2024.115153 ↗
- Guidelines of care for the management of primary cutaneous melanomaJournal of the American Academy of Dermatology, 2019doi:10.1016/j.jaad.2018.08.055 ↗
- Non-melanoma skin cancer: United Kingdom National Multidisciplinary GuidelinesThe Journal of Laryngology & Otology, 2016doi:10.1017/S0022215116000554 ↗
- Risk Factors for Cutaneous Squamous Cell Carcinoma Recurrence, Metastasis, and Disease-Specific Death: A Systematic Review and Meta-analysisJAMA Dermatology, 2016doi:10.1001/jamadermatol.2015.4994 ↗
- Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in EnglandJAMA Dermatology, 2019doi:10.1001/jamadermatol.2018.4219 ↗
- Keratinocyte Carcinoma: A ReviewJAMA, 2026doi:10.1001/jama.2025.18749 ↗
- Cutaneous Melanoma: A ReviewJAMA, 2025doi:10.1001/jama.2025.13074 ↗
- Completion Dissection or Observation for Sentinel-Node Metastasis in MelanomaThe New England Journal of Medicine, 2017doi:10.1056/NEJMoa1613210 ↗
- Surgical excision margins in primary cutaneous melanoma: A systematic review and meta-analysisEuropean Journal of Surgical Oncology, 2021doi:10.1016/j.ejso.2021.02.025 ↗
- International Dermoscopy Society consensus recommendations for the management of lentigo malignaJournal of the European Academy of Dermatology and Venereology, 2026doi:10.1111/jdv.70406 ↗
- Immediate versus delayed reconstruction of head and neck cutaneous melanomaThe Laryngoscope, 2018doi:10.1002/lary.27250 ↗
- Considerations for Timing of Defect Reconstruction in Cutaneous Melanoma of the Head and NeckFacial Plastic Surgery, 2019doi:10.1055/s-0039-1693469 ↗
- Symptoms of melanoma skin cancerNHS, 2026nhs.uk/conditions/melanoma-skin-cancer/symptoms ↗
- Symptoms of non-melanoma skin cancerNHS, 2026nhs.uk/conditions/non-melanoma-skin-cancer/symptoms ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
The figures on the page are from these sources.
The birthmark has changed
does the stain not heal?
Send a photo and the result of the biopsy, if available. The doctor will tell you how to remove the tumor, how to close the defect and what to discuss with the oncologist.