If you get skin cancer, what happens next depends almost entirely on the type and how early it’s caught. The good news: most skin cancers are highly treatable, and when found early, the five-year survival rate for melanoma alone tops 99%. But the experience varies widely, from a quick in-office procedure you recover from in days to months of immunotherapy for advanced disease. Here’s what the process actually looks like.
The Three Types and Why They Matter
Skin cancer isn’t one disease. The type you’re diagnosed with shapes everything that follows, from urgency to treatment to long-term outlook.
Basal cell carcinoma is the most common skin cancer worldwide. It grows slowly, rarely spreads to other parts of the body, and is almost always curable with local treatment. It typically appears as a pearly or waxy bump, often on sun-exposed areas like the face and neck.
Squamous cell carcinoma is the second most common. These lesions can look like red, scaly patches or wart-like growths. The vast majority are not aggressive, but a small proportion can spread to lymph nodes or distant organs if left untreated for a long time.
Melanoma is far less common but far more dangerous. Roughly 90,000 to 100,000 people in the U.S. receive a new invasive melanoma diagnosis each year, with a similar number diagnosed at the earliest, in situ stage. Melanoma’s danger comes from its ability to penetrate into deeper skin layers where blood and lymph channels can carry cancer cells to distant organs.
The Biopsy: Your First Step
If your doctor spots a suspicious spot, the next step is a biopsy, where a small sample of tissue is removed and examined under a microscope. This is the only way to confirm skin cancer and determine what type it is.
The most common approach is a shave biopsy, where a blade removes the surface layers of skin horizontally. For spots that need deeper evaluation, a punch biopsy uses a small circular blade pressed straight down through all skin layers. Both are done in a doctor’s office with local numbing and take just minutes. Sometimes the biopsy itself removes the entire lesion. If melanoma is suspected, the goal is usually to remove the full depth of the spot so a pathologist can measure exactly how thick it is, because thickness drives every decision that follows.
How Doctors Determine the Stage
Staging tells you how far the cancer has progressed. For melanoma, this is based on three factors: how thick the tumor is (measured in millimeters from the skin surface to its deepest point), whether the surface skin over the tumor is ulcerated (broken), and whether cancer cells have reached lymph nodes or other organs.
For thin melanomas under 0.8 millimeters without ulceration, the risk of spread is very low, and no further testing beyond the initial removal is typically needed. For melanomas thicker than 1.0 millimeters, doctors generally recommend a sentinel lymph node biopsy, a procedure where the first lymph node that drains the area around the cancer is removed and checked for cancer cells. This is a key decision point: a positive result means the cancer has begun to spread regionally, which changes both the treatment plan and the follow-up schedule. For melanomas between 0.8 and 1.0 millimeters, or thinner ones with ulceration, a sentinel node biopsy may be offered depending on your individual risk factors.
Stage IV, the most advanced, means cancer has reached distant organs like the lungs, liver, brain, or bone.
What Treatment Looks Like
For most skin cancers, treatment is surgical and straightforward.
Standard Excision
The surgeon cuts out the cancer along with a margin of healthy-looking skin around it. The removed tissue goes to a lab, where a pathologist checks whether the edges are cancer-free. If they are, you’re done. Recovery involves caring for a wound that heals over one to several weeks, depending on the size and location.
Mohs Surgery
For skin cancers in cosmetically sensitive areas like the face, or for high-risk tumors, Mohs surgery offers the highest precision. The surgeon removes one thin layer of tissue at a time, maps and marks it, then immediately freezes and examines 100% of the deep and side margins under a microscope. If cancer cells remain at any edge, another layer is taken from that specific spot. The process repeats until the margins are completely clear. Each round of removal and examination takes about an hour. Mohs has a cure rate of up to 99%, the lowest recurrence rate of any skin cancer treatment, largely because it checks every margin rather than the less than 1% sampled in standard excision.
Immunotherapy for Advanced Disease
When melanoma or squamous cell carcinoma has spread beyond what surgery can remove, treatment shifts to drugs that help your immune system fight the cancer. These work by blocking proteins that cancer cells use to hide from immune cells. With those proteins blocked, your T cells (the immune system’s attack cells) can recognize and kill tumor cells again.
For advanced melanoma, several of these drugs are FDA-approved, and they’ve dramatically improved outcomes over the past decade. For advanced squamous cell carcinoma that can’t be managed with surgery or radiation, similar immune-based drugs are now available. Traditional chemotherapy combinations are reserved for cases where immunotherapy isn’t effective or isn’t an option.
Repairing the Wound After Surgery
Small excisions often heal on their own or are closed with stitches. But when a large area of skin is removed, especially on the face or neck, reconstruction becomes part of the plan.
Skin flaps are the most common approach. The surgeon shifts tissue from right next to the wound, preserving similar color and texture for a better cosmetic match. Flaps carry their own blood supply, which makes them particularly useful in areas with poor circulation or damaged blood vessels. In some cases, a tissue expander is placed under the skin weeks before reconstruction to grow extra tissue for the repair.
Skin grafts take tissue from a different part of the body entirely, often the thigh or groin. The color and texture match won’t be as close, so grafts are more common in areas that are less visible. Both options add recovery time, but for many patients, the cosmetic result is far better than they expected going in.
Survival Rates by Stage
The numbers here are reassuring for the majority of people. Based on data from patients diagnosed between 2015 and 2021, the five-year relative survival rates for melanoma are:
- Localized (cancer confined to the skin): greater than 99%
- Regional (spread to nearby lymph nodes): 76%
- Distant (spread to far-off organs): 35%
- All stages combined: 95%
Basal cell and squamous cell carcinomas have even better outcomes. Basal cell carcinoma is almost never fatal. Squamous cell carcinoma very rarely becomes life-threatening when treated in its early stages. The critical variable across all types is timing: the earlier skin cancer is caught, the simpler the treatment and the better the outcome.
What Follow-Up Looks Like
After treatment, you’ll enter a monitoring schedule tailored to your risk level. For higher-stage melanomas (stage 2B and above), follow-up appointments are typically every three months for the first two to three years. At each visit, your doctor performs a full skin examination and checks for signs of recurrence or new cancers.
The schedule gradually stretches out if everything stays clear. People with additional risk factors, like a family history of melanoma or a large number of moles, may be seen more frequently than standard guidelines suggest. Having one skin cancer also increases your risk of developing another, so regular self-checks between appointments become a permanent part of life. You’re looking for any spot that changes in color, shape, size, or texture over a period of about three months, as change over time is the single most important warning sign.