The phone call came on a Tuesday. My mother said "they think the one on my leg is a melanoma" in the same tone she uses to report that the boiler is playing up, which is how I knew she was frightened. I spent that evening on the internet doing exactly what you may be doing now, and I remember the particular helplessness of reading survival statistics without knowing which column she belonged in. Two weeks later a surgeon took a wider margin of skin from her calf, the sentinel lymph node came back clear, and she was told the word that nobody in oncology likes to say out loud: cured. That was four years ago. Her melanoma was 0.6 millimetres thick. If the locum GP had not asked about it, and it had been left for two more years, this would be a very different article.
So let me put the answer to the question first, because I know you are scrolling for it. Yes, skin cancer is curable, and in the great majority of cases it is cured by a single operation done under local anaesthetic. Basal cell and squamous cell carcinomas have cure rates above 95 percent. Melanoma caught before it is a millimetre deep has a five year survival above 98 percent. Even advanced melanoma, which was a near certain death sentence fifteen years ago, now has around half of patients alive at ten years on modern immunotherapy. What follows explains how each type is treated, what the stages mean, what the numbers really are, and what to expect if you or someone you love is facing this.
First, which skin cancer are we talking about?
"Skin cancer" covers three diseases with very different personalities. Knowing which one you have changes everything about what comes next.
| Type | Typical appearance | Chance of spreading | Overall cure rate |
|---|---|---|---|
| Basal cell carcinoma | Pearly bump, rolled edge, sore that will not heal, often on the face | Under 0.1 percent | Above 95 percent |
| Squamous cell carcinoma | Firm scaly lump, crusted, may be tender, on sun exposed skin | 2 to 5 percent, higher on lip, ear, in immunosuppressed people | Above 95 percent when caught early |
| Melanoma | New or changing mole, asymmetric, multiple colours, may be flat | Depends heavily on depth | Above 98 percent at stage I; around 50 percent at stage IV with modern drugs |
If you have not yet had a diagnosis and are worried about a spot, our prevention guide walks through the ABCDE check and when to see a doctor. The rest of this article assumes a biopsy has been done or is booked.
How skin cancer is diagnosed and staged
A dermatologist looks at the lesion with a dermatoscope, a magnifier with polarised light that reveals structures beneath the surface. Experienced dermoscopy improves melanoma detection accuracy by about 50 percent over the naked eye (Vestergaard et al., British Journal of Dermatology 2008). If it looks suspicious, the whole lesion is removed with a 2 millimetre margin and sent to a pathologist. This is the biopsy, and for many people it is also the cure.
For melanoma, the pathologist measures the most important number in the whole process: the Breslow thickness, how deep in millimetres the tumour reaches. It, together with whether the surface is ulcerated, whether nearby lymph nodes are involved and whether there is spread elsewhere, gives the stage (Gershenwald et al., CA: A Cancer Journal for Clinicians 2017, AJCC 8th edition).
| Melanoma stage | What it means | Five year survival (approx.) |
|---|---|---|
| Stage 0 (in situ) | Confined to the top layer of skin | 99 percent or better |
| Stage I | Up to 2 mm thick, no ulceration if over 1 mm, nodes clear | About 98 percent |
| Stage II | Thicker than 2 mm or ulcerated, nodes clear | About 80 percent (range 55 to 90 depending on substage) |
| Stage III | Spread to nearby lymph nodes or skin | About 60 percent (range 32 to 88) |
| Stage IV | Spread to distant organs | Around 15 percent before 2011; around 50 percent now with combination immunotherapy |
If your melanoma is thicker than 0.8 mm, or thinner but ulcerated, you will usually be offered a sentinel lymph node biopsy: a dye and tracer injected at the site find the first lymph node it drains to, which is removed and checked. It does not by itself improve survival, but it tells you the stage accurately and decides whether you are offered drug treatment afterwards (Morton et al., NEJM 2014, MSLT-I). If the sentinel node is positive, current practice is close monitoring with ultrasound rather than removing all the nodes, since the MSLT-II trial showed full dissection did not improve survival and caused lymphoedema in a quarter of patients (Faries et al., NEJM 2017).
Treatment for basal cell and squamous cell carcinoma
Surgical excision
The standard treatment. Under local anaesthetic, the cancer is cut out with a margin of 4 mm for basal cell and 4 to 6 mm for squamous cell, and the wound is stitched. Twenty to forty minutes, home the same afternoon. Five year recurrence is around 2 to 5 percent for basal cell (van Loo et al., European Journal of Cancer 2014). My mother has had nine of these. She describes the worst part as the anaesthetic sting and the second worst as the itching while it heals.
Mohs micrographic surgery
For cancers on the nose, eyelids, lips and ears, where every millimetre of healthy skin matters, or for recurrent or aggressive tumours, the surgeon removes a thin layer, examines it under the microscope while you wait, and takes more only where cancer cells remain. It gives the highest cure rate of any method, 99 percent for a first basal cell and 94 percent for recurrent ones, with the smallest scar (Rowe et al., Journal of Dermatologic Surgery and Oncology 1989). The day is long, sometimes four or five hours of waiting between stages, so take a book.
Non surgical options
- Curettage and cautery. Scraping and heat sealing for small, superficial basal cells on the trunk and limbs. Cure rates around 90 to 95 percent for well chosen lesions.
- Imiquimod cream (Aldara), applied five nights a week for six weeks to superficial basal cells. It works by provoking a local immune reaction; the site goes red and weepy, which is the point. Around 80 to 84 percent clearance at five years, lower than surgery but no scar (Williams et al., Journal of Investigative Dermatology 2017, SINS trial).
- Photodynamic therapy. A light sensitising cream followed by a bright red lamp. Good cosmetic results for superficial lesions, less durable than surgery.
- Radiotherapy. For people who cannot have surgery, for very large tumours, or after surgery when margins are involved or nerves are invaded. Cure rates around 90 percent for basal cell, but the treated skin ages badly over decades, so it is usually kept for the over 60s.
- Hedgehog pathway inhibitors (vismodegib, sonidegib) for the rare locally advanced or metastatic basal cell. Shrinks tumours in about half of patients; side effects of muscle cramps, hair loss and lost taste are wearing (Sekulic et al., NEJM 2012).
- Cemiplimab immunotherapy for advanced squamous cell carcinoma, with responses in about half of patients (Migden et al., NEJM 2018). Given before surgery, it made the tumour disappear entirely in 51 percent of patients with locally advanced disease (Gross et al., NEJM 2022).
Treatment for melanoma by stage
Stage 0 to II: surgery, and usually nothing else
After the biopsy confirms melanoma, a second operation, the wide local excision, removes a further margin of normal looking skin around the scar: 5 mm for in situ, 1 cm for tumours up to 1 mm thick, 1 to 2 cm for 1 to 2 mm, and 2 cm for anything thicker (NICE guideline NG14). This is what removed the last of my mother's melanoma. For most stage I patients, that is the end of treatment and the beginning of follow up.
For stage IIB and IIC, the thick or ulcerated tumours with clear nodes, a year of adjuvant pembrolizumab or nivolumab is now offered in many countries, since it cut recurrence by about 35 to 40 percent in the KEYNOTE-716 and CheckMate 76K trials (Luke et al., Lancet 2022). Whether to take it is a genuine decision: roughly one in five people gets a permanent thyroid or other hormone problem from these drugs, and many stage II patients would have been cured by surgery alone.
Stage III: surgery plus a year of drug treatment
Once the lymph nodes are involved, surgery alone leaves a high chance of the disease returning. Twelve months of adjuvant immunotherapy (pembrolizumab or nivolumab) roughly halves the risk of recurrence (Eggermont et al., NEJM 2018, KEYNOTE-054). If the tumour carries a BRAF mutation, which about half of melanomas do, a year of the tablets dabrafenib plus trametinib is an alternative and gave 52 percent relapse free survival at five years versus 36 percent with placebo (Dummer et al., NEJM 2020).
The newest shift is neoadjuvant treatment: giving immunotherapy before the node surgery rather than after. The NADINA trial gave two doses of nivolumab plus ipilimumab before surgery and found 83.7 percent of patients free of disease at 12 months versus 57.2 percent with standard post surgery treatment (Blank et al., NEJM 2024). If you are stage III and your team has not mentioned this, ask.
Stage IV: the immunotherapy revolution
Until 2011, a diagnosis of metastatic melanoma carried a median survival of six to nine months and the only drug, dacarbazine, helped about one person in ten for a few months. Then came ipilimumab, then the PD-1 drugs nivolumab and pembrolizumab, then the combination. In CheckMate 067, patients with untreated stage IV melanoma were randomised to nivolumab plus ipilimumab, nivolumab alone or ipilimumab alone. At ten years, median survival in the combination group was 71.9 months and 43 percent of patients were alive; among those alive, most had been off all treatment for years (Wolchok et al., NEJM 2025). Some of those people are, for practical purposes, cured of a cancer that had spread to their liver and lungs.
The price is a different kind of side effect. Immunotherapy does not cause hair loss or nausea in the chemotherapy sense. It causes the immune system to attack normal tissue: colitis, hepatitis, thyroid failure, pituitary failure, rashes, and rarely heart or lung inflammation. Serious immune side effects occur in around 55 percent on the combination and around 20 percent on a PD-1 drug alone. Most are treatable with steroids if caught early, which is why every patient on these drugs is told to report diarrhoea, breathlessness or unusual tiredness the same day.
Other stage IV options:
- BRAF and MEK inhibitors (dabrafenib plus trametinib, encorafenib plus binimetinib) for BRAF mutant tumours. They work fast, shrinking tumours in about 70 percent of patients within weeks, but resistance usually develops within a year or two. The DREAMseq trial showed that starting with immunotherapy and switching to targeted drugs if needed gave better two year survival (72 percent) than the reverse order (52 percent) (Atkins et al., Journal of Clinical Oncology 2023).
- Nivolumab plus relatlimab, a newer combination that blocks LAG-3, with fewer serious side effects than the ipilimumab combination (Tawbi et al., NEJM 2022).
- Lifileucel, the first cell therapy for a solid tumour, approved in the US in 2024. The patient's own tumour infiltrating lymphocytes are grown in the lab and returned in one infusion. Responses in about a third of patients whose immunotherapy has failed (Sarnaik et al., Journal of Clinical Oncology 2021).
- Stereotactic radiotherapy or surgery for a single brain or other metastasis, often alongside drugs.
- Clinical trials. Melanoma has more active trials than almost any other cancer. Personalised mRNA vaccines combined with pembrolizumab cut recurrence by 49 percent at three years in a phase 2 trial and are now in phase 3 (Weber et al., Lancet 2024).
What happens after treatment
Once you have had one skin cancer, you are in a new category. Around 40 percent of people who have a basal cell carcinoma develop another within five years (Marcil and Stern, Archives of Dermatology 2000), and melanoma survivors have about nine times the general population's risk of a second melanoma. This is not the disease coming back. It is the same skin, with the same history, producing a new problem. It is why the follow up is lifelong and why the daily sunscreen habit matters more after diagnosis than before.
Two more things that help. Nicotinamide (vitamin B3) 500 mg twice daily reduced new basal and squamous cell cancers by 23 percent in people who had already had them (Chen et al., NEJM 2015). And body weight turns out to matter for how immunotherapy works: in a pooled analysis of 1,918 patients with metastatic melanoma, those with obesity treated with immunotherapy or targeted therapy lived longer than those with normal BMI, an odd and unexplained finding called the obesity paradox that is strongest in men (McQuade et al., Lancet Oncology 2018). It does not mean gaining weight is a strategy; obesity raises the risk of getting melanoma in the first place. It does mean that if you are heavier and facing immunotherapy, that is not a reason for pessimism. Our BMI calculator is there if you want to know where you stand, and the diet and exercise guide covers how to eat and move during and after treatment.
Questions worth asking your team
- What type, and for melanoma, what Breslow thickness and is it ulcerated?
- What is my stage, and what were the margins on the excision?
- Do I need a sentinel node biopsy, and what would the result change?
- Has the tumour been tested for BRAF?
- Am I a candidate for neoadjuvant treatment before node surgery?
- If adjuvant therapy is offered: what is my recurrence risk with and without it, and what is the chance of a permanent side effect?
- Are there trials I qualify for?
- How often will I be seen, and who do I call if I find a new spot between visits?
My mother's dermatologist once told her, with a kindness she still talks about, that having lots of skin cancers is a nuisance, not a tragedy, as long as she keeps turning up. She keeps turning up. If you have just been diagnosed, the odds are that your story ends the way hers did: a scar, a follow up appointment, and a slightly larger hat. And if you are in the harder columns of the table, please know that the numbers you are reading are from a field that has changed more in the last decade than in the previous fifty, and they keep moving in the right direction.
Read next
- How to prevent skin cancer: risk factors, sunscreen evidence and self checks
- Skin cancer diet and exercise: foods to eat, foods to limit, and how to move safely
- BMI calculator with Asian and Black thresholds
- Is kidney cancer curable? Survival rate by stage
Frequently asked questions
Is skin cancer curable?
Yes, in most cases. Basal and squamous cell carcinomas are cured by surgery more than 95 percent of the time. Stage I melanoma has a five year survival of about 98 percent. Even stage IV melanoma now has around 40 to 50 percent of patients alive at ten years on combination immunotherapy.
What is the survival rate for melanoma?
Around 99 percent for stage 0, 98 percent for stage I, 80 percent for stage II, 60 percent for stage III and roughly 50 percent for stage IV treated with modern immunotherapy, measured at five years. Thickness at diagnosis is the strongest predictor.
Does skin cancer always need surgery?
Almost all melanomas do. Superficial basal cell carcinomas can sometimes be treated with imiquimod cream, photodynamic therapy or curettage, and radiotherapy is an option for people who cannot have an operation.
How fast does melanoma spread?
It varies enormously. Some melanomas grow in place for years; nodular melanomas can thicken by half a millimetre a month. This is why any new or changing mole should be seen within weeks, not months.
Can melanoma come back after treatment?
Yes. Recurrence risk depends on stage, from under 5 percent for thin stage I to over 50 percent for stage III without adjuvant therapy. Survivors also have around nine times the average risk of a new, separate melanoma, so lifelong skin checks and daily sun protection matter.
This article is for general information and does not replace advice from your own oncology or dermatology team. Statistics are averages from published trials and registries; your situation is individual.
