STEP 3: Diagnosis, staging and treatment planning


All patients should have had a complete skin check recently.

Most diagnoses occur in the primary care setting before specialist referral.

Specialist management may include complete excision or re-excision with recommended margins, imaging including medical photography (in some circumstances), radiation therapy or reconstructive surgery.


Usually a biopsy is sufficient to diagnose keratinocyte cancer.

In cases of SCC, clinically suspected lymph node metastases should be confirmed by fine needle aspiration cytology if possible. Open surgical biopsy should be avoided.

Genetic testing

While most keratinocyte cancers develop through sun exposure, several genes and hereditary syndromes increase the risk of keratinocyte cancer development. See the optimal care pathway for keratinocyte cancer for more information.

Treatment planning

Selected patients with advanced stage primary keratinocyte cancer, lymph node metastases and keratinocyte cancer in unusual sites are best managed by a multidisciplinary team in a specialist facility.

Research and clinical trials

Consider enrolment where available and appropriate. Search for a trial.


The lead clinician’s (1) responsibilities include:

  • discussing a timeframe for diagnosis and treatment options with the patient and/or carer
  • explaining the role of the multidisciplinary team in treatment planning and ongoing care
  • encouraging discussion about the diagnosis, prognosis, advance care planning and palliative care while clarifying the patient’s wishes, needs, beliefs and expectations, and their ability to comprehend the communication
  • providing appropriate information and referral to support services as required
  • communicating with the patient’s GP about the diagnosis, treatment plan and recommendations from multidisciplinary meetings (MDMs).

1: Lead clinician – the clinician who is responsible for managing patient care.

The lead clinician may change over time depending on the stage of the care pathway and where care is being provided.



Biopsy should be considered before referral, where appropriate.