Basal Cell Carcinoma

Nodular Basal Cell Carcinoma

Of all skin cancers, basal cell carcinoma (BCC) is the most common.  This cancer is usually found on areas exposed to the sun such as head/scalp, face, arms, and hands, but it can appear anywhere on the body.  This cancer is rarely fatal and usually grows slowly.  However without treatment, it can grow deep and wide into the surrounding tissues resulting in ulcerations, necrosis, and disfiguration.

Basal cell carcinoma: Signs and symptoms

Basal cell carcinoma (BCC) shows up on the skin in different ways.  If you see any of the following on your skin, you should immediately make an appointment to see a dermatologist:

• Dome-shaped skin growth with visible blood vessels. Often pink or skin-colored, it can also be brown, black, or have flecks of these colors. BCC grows slowly. It may flatten in the center, ooze, and crust over. It also tends to bleed easily.
• Shiny pink or red, slightly scaly patch, especially on the trunk. It grows slowly and may be mistaken for a patch of eczema.
  Waxy feeling, hard, pale-white to yellow or skin-colored growth that looks like a scar. You may have difficultly seeing the edges.
• BCCs may look like a sore that:
  • Bleeds easily.
  • Won’t heal, or heals and returns.
  • Oozes or crusts over.
  • Has a sunken center, like a crater.
  • Has visible blood vessels in or around it.
• Although rare, BCC can feel painful or itch. Usually, the only sign of BCC is a growth on the skin.

Basal cell carcinoma: Who gets it and what causes it

Anyone can get basal cell carcinoma.  There are some activities and traits that make you more prone to having BCC.  You are predisposed to having BCC if you any of the following applies to you:

• Your physical traits
  • Your skin is light-colored or freckled.
  • You have light colored eyes:  blue, green, or gray.
  • You have blond or red hair.
  • You don’t tan when you sunburn.
• What you’ve done
  • Spent a lot of time outdoors for work or leisure, without using sunscreen or covering up with clothing.
  • Frequently used tanning beds.
• Your medical history
  • If you had one BCC, your risk for developing a second one increases by about 40%.
  • Close blood relative had BCC.
  • Taking one or more drugs that suppress the body’s immune system. People take these drugs after receiving an organ transplant and to treat a medical condition, such as severe arthritis, lymphoma, or human immunodeficiency virus (HIV).
  • Overexposure or long-term exposure to x-rays, such as patients who received x-ray treatments for acne.

Basal Cell Carcinoma

Risk of developing many BCCs by 20 years of age

Some people are born with a rare condition that makes them more likely to develop many skin cancers, including basal cell cancers, early in life. BCC can develop by 20 years of age in people who have a rare medical condition known as basal cell nevus syndrome.

What causes BCC?

The majority of basal cell carcinomas are caused by ultraviolet rays from either the sun or tanning beds.  When the UV rays hit skin, it damages the DNA in our cells.  Normally, our skin can repair the damage.  However, if the damage is repeated enough times, it becomes irreparable and forms a skin cancer.

This usually will not happen until a person is 50 years of age or older as it takes many exposures to UV rays to cause permanent.

There is one exception to this age generality.  BCC is growing among younger women due to tanning in tanning beds.  Many of these BCC could have been prevented by simply avoiding tanning beds.

Basal cell carcinoma: Diagnosis and treatment

The only way to affirmatively diagnose skin cancer is with a skin biospy.  This is a simple procedure done in the office, normally during your scheduled office visit.  It is done with a local anesthetic and is relatively quick.  During the biopsy, your dermatologist will remove the lesion (or part of the lesion) and send it to a pathologist for examination.

The pathologist will send a report back to your dermatologist who will then decide on a course of treatment if the report shows you have BCC.  There are several ways to treat BCC and each depends on a number of factors including the type of BCC (superficial vs deep), location of BCC, and your medical history.

Some of the treatments for BCC include the following:

• Excision of the lesion
• Curettage and electrodessication
• Mohs Surgery – This is a specialized surgery designed to treat non-melanoma skin cancers.  The Mohs surgeon will cut out the tumor and a small amount of surrounding tissue.  This will be examined under a specialized microscope to see if any cancer remains while you wait.  If cancer remains, the surgeon will remove more tissue and re-examine.  This will be repeated until all signs of the cancer are gone.
• Medicated creams: Creams that contain a drug, such as imiquimod or 5-fluorouracil, can be used to treat early BCC.
• Radiation: This treatment usually is reserved for BCCs that cannot be cut out, or when surgery may not be the best choice. A patient may need 15 to 30 radiation treatments.

Outcome

Nearly every basal cell cancer can be cured, especially when the cancer is found early and treated.