Basal Cell Carcinoma

It is the most common form of skin cancer, affecting 800,000 Americans each year. In fact, it is the most common of all cancers. One out of every three new cancers is a skin cancer, and the vast majority are basal cell carcinomas, often referred to by the abbreviation, BCC. These cancers arise in the basal cells, which are at the bottom of outer skin layer (epidermis). Until recently, those most often affected were older people, particularly men who had worked outdoors. Although the number of new cases has increased sharply each year in the last few decades, the average age of onset of the disease has steadily decreased. More women are getting BCC’s than in the past; nonetheless, men still outnumber them greatly.

The Major Cause:Chronic exposure to sunlight is the cause of almost all basal cell carcinomas, which occur most frequently on the sun-exposed parts of the body. Face, ears, neck, scalp, shoulders, and back are the common sites of involvement. Rarely, however, tumors develop on non-exposed areas. In a few cases, contact with arsenic, exposure to radiation, and complications of burns, scars, vaccinations, or even tattoos are contributing factors.

Who Gets Basal Cell Carcinoma: Anyone with a history of frequent sun exposure can develop a basal cell carcinoma. But people who have fair skin, blonde or red hair, and blue, green, or gray eyes are at highest risk. Those whose occupations require long hour’s outdoors or who spend extensive leisure time in the sun are in particular jeopardy.

What to Look For: The five most typical characteristics of basal cell carcinoma are an open sore, a reddish patch, a shiny bump, a pink growth, a scar-like area. Frequently, two or more features are present in one tumor. In addition, basal cell carcinoma sometimes resembles non-cancerous skin conditions such as psoriasis or eczema. Only a trained physician, usually a specialist in diseases of the skin, can decide for sure. Learn the signs of basal cell carcinoma, and examine your skin regularly. Examine once a month, or more often if you are at high risk. Be sure to include the scalp, backs of ears, neck, and other hard-to-see areas. A full-length mirror and a hand-held mirror can be very useful. If you observe any of the warning signs or some other change in your skin, consult your physician. The Skin Cancer Foundation advises people to have a total-body skin exam by a dermatologist at regular intervals. The physician will suggest the correct time frame for follow-up visits, depending on your specific risk factors, such as skin type and history of sun exposure.

Signs of a Basal Cell Carcinoma:
An Open Sore that bleeds, oozes, or crusts and remains open for three or more weeks. A persistent, non-healing sore is a very common sign of an early basal cell carcinoma.

Reddish Patch, or irritated area that frequently occurs on the chest, shoulders, arms, or legs. The patch can form a crust. It may also itch or hurt. At other times, it persists with no noticeable discomfort.

Shiny Bump, or nodule, that is pearly or translucent and is often pink, red, or white. The bump can also be tan, black, or brown, especially in dark-haired people, and can be confused with a mole.

Pink Growth with a slightly elevated rolled border and a crusted indentation in the center. As the growth slowly enlarges, tiny blood vessels may develop on the surface.

A Scar-like Area, which is white, yellow or waxy, and often has poorly, defined borders. The skin itself appears shiny and taut. This warning sign can indicate the presence of an aggressive tumor.

Treatment Options:
If skin cancer is suspected, a biopsy must be taken and examined microscopically. If the diagnosis is confirmed, there are many treatment options from which to choose.

Topical Medications
In addition to being used to treat actinic keratosis (AK), the most common skin precancer, Imaquimod and 5-FU are also approved for the treatment of superficial basal cell carcinoma (sBCC).

Curettage and Electrodesiccation
The growth is scraped off with a curette and the tumor site desiccated with an electrocautery needle.  The procedure is typically repeated a few times to help assure that all cancer cells are eliminated. Local anesthesia is required.

Excisional Surgery
Along with the above procedure, this is one of the most common treatments for BCC’s and SCC’s. Using a scalpel; the physician removes the entire growth along with a surrounding border of apparently normal skin as a safety margin. The incision is closed, and the growth is sent to the laboratory to verify that all cancerous cells have been removed.

X-ray beams are directed at the tumor. Total destruction usually requires several treatments a week for a few weeks. This is ideal for tumors that are hard to manage surgically and for elderly patients who are in poor health.

Moh’s Micrographic Surgery
The physician removes the visible tumor with a curette or scalpel and then removes very thin layers of the remaining surrounding skin one layer at a time. Each layer is checked under a microscope, and the procedure is repeated until the last layer viewed is cancer-free.  This technique has the highest cure rate and can save the greatest amount of healthy tissue. It is often used for tumors that have recurred or are in hard-to-treat places such as the head, neck, hands, and feet.

Liquid nitrogen is applied to the growths with a cotton-tipped applicator or spray device. This freezes them without requiring any cutting or anesthesia. They subsequently blister or become crusted and fall off. The procedure may be repeated to ensure total destruction of malignant cells. Some temporary redness and swelling can occur. In some patients, pigment may be lost.

Laser Surgery
The skin’s outer layer and variable amounts of deeper skin are removed using a carbon dioxide or erbium YAG laser. Lasers are effective for removing actinic cheilitis from the lips and actinic keratoses from the face and scalp. They give the physician good control over the depth of tissue removed, much like chemical peels. Lasers are also used as a secondary therapy when topical medications or other techniques are unsuccessful. However, local anesthesia may be required. The risks of scarring and pigment loss are slightly greater than with other techniques.

Photodynamic Therapy (PDT)
PDT can be especially useful for lesions on the face and scalp, and when patients have multiple BCC’s. Topical, 5-aminolevulinic acid (5-ALA) is applied to the lesions at the physician’s office. As soon as an hour later, those lesions treated with 5-ALA can be treated with a strong light. This treatment selectively destroys BCC’s while causing minimal damage to surrounding normal tissue. Some redness and swelling can result from this therapy.