Basal Cell Carcinoma

What is Basal Cell Carcinoma?

Basal cell carcinoma (BCC) is the most common type of skin cancer. It starts in the top layer of the skin called the epidermis. Most BCCs show up on sun-exposed areas of the body, especially the face and neck. But they can occur in other areas too. BCC is often found early and can be cured. But sometimes it can grow back, and rarely it can spread to other parts of the body.
Fortunately, most BCCs are found early and cured. Still, it is very important to pay attention to sun safety. Here are some tips to make sure you and your family are staying safe:

  • Avoid being in the sun during peak daylight hours
  • Always apply (and reapply) sunscreen
  • Wear protective clothing, sunglasses, and wide-brimmed hats
  • Talk to your family and friends about the importance of skin cancer prevention
  • See your dermatologist regularly for skin exams
  • Pay close attention to any sores or bumps that might develop on your skin
  • Try to do regular skin self-exams. Make a date with your partner to check areas you can’t see like your back, scalp back of your legs or buttocks.

Often, you first notice BCC as a lesion on the skin that you think should heal in a week or two. However, one month later it is still there, getting red, raw, and irritated. If lesions do not resolve on their own, they need to be examined by a board-certified dermatologist.

Help Create Materials for Cutaneous Squamous Cell Carcinoma & Basal Cell Carcinoma

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Risk Factors

Certain people are more likely to have skin cancer. For example, people with fair skin, light-colored eyes or blond or red hair are especially prone to developing basal cell carcinoma (BCC).
Other risk factors include:

  • Spending too much time in the sun (without protection) or using tanning beds
  • Frequent sunburns (especially at an early age)
  • A previous BCC or other skin cancer
  • Family history of skin cancer
  • Certain medical conditions or medications (mostly conditions and medications that suppress your immune system)
  • Radiation therapy
  • Very rarely people can have genetic syndromes where they develop numerous BCCs (>25). The most well-known is called Basal Cell Carcinoma Nevus Syndrome (BCCNS). 

 

Signs & Symptoms

Basal Cell Carcinoma (BCC) will look and feel different. This depends on the type it is. There are 6 types: superficial, pigmented, nodular, micronodular, infiltrative, or morpheaform.

Often, you first notice BCC as a lesion on the skin that you think should heal in a week or two. However, one month later it is still there, getting red, raw, and irritated. If lesions do not resolve on their own, they need to be examined by a board-certified dermatologist.

It might appear as a:

  • Smooth, shiny, pearly or waxy bump
  • Firm red or flesh-colored bump
  • Growth with unusual blood vessels in and around it
  • Sore that might bleed and doesn’t seem to be healing
  • Flat spot or patch of skin (usually red or brown) that is rough, dry, or scaly 
  • Area of scar-like tissue with no previous procedure done at the site

Regardless of what it looks like, if you notice something on your skin that worries you, or if an existing growth starts to change or irritate you, get it checked out. Try to do regular skin exams, too. Getting comfortable with the look and feel of your skin will help you know what is normal and what’s not.

Spotlight on Skin Cancer: Advanced SCC and BSSC Skin Cancers

In this episode of our special series Spotlight on Skin Cancer, we take a look at 2 forms of advanced skin cancer: advanced basal and squamous cell skin cancers.

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Diagnosis

Your doctor will examine your skin. A biopsy is typically needed to confirm a diagnosis of skin cancer. A biopsy is a common procedure to remove a piece of the skin. The area will be numbed with a local anesthetic injected into the skin. Then the doctor (often a dermatologist or skin doctor) will cut a small piece of the skin to get a sample of tissue. A different doctor (called a pathologist, often a dermatopathologist) will look at this tissue under the microscope to check for cancer cells. There are several types of biopsies.

Questions to Ask Your Doctor:

  • What type of biopsy am I having?
  • How soon will I know the results?
  • How much of the skin/tissue will be taken? Will there be a lot of scarring?
  • What is the plan if it is cancerous (malignant)?
  • What treatment is most likely to work?
  • How likely is it that it will return?
  • What should I be doing to prevent skin cancer from coming back?
  • What Can I Do to Protect Myself Against Basal Cell Carcinoma?

Treatment

In most cases, basal cell carcinoma is easily cured using local surgery or medications applied to the skin (called topical therapies) Rarely, radiation can be used. Treatment will depend on where it is located, how big and deep the tumor is in the skin, and if local lymph nodes are involved. Additional treatment options are available for people with later stage disease.

Basal Cell Carcinoma Treatment Options

Surgery – to remove the tissue

There are several different types of surgical procedures that can be used:

  • Excision – the entire growth is removed along with a surrounding border of normal skin
  • Curettage and electrodesiccation – the tumor is scraped down to its base followed by pulses of electrical energy
  • Mohs surgery – the goal is to remove skin cancer one layer at a time to spare normal, healthy tissue. After each layer is removed, it is sent to an on-site laboratory to be examined by the surgeon. This allows your dermatologic surgeon to know whether more layers need to be removed in real-time.

Basal Cell Carcinoma can invade nearby tissue. If this happens, more tissue will need to be removed, leading to larger scars that some people may find upsetting. That's why it is important to get things checked out early. When found early, they are usually much easier to remove and your surgery site will be smaller.

Medications for the Skin

If BCC is “superficial” (in other words, not very deep in the skin), creams containing medications (imiquimod or 5-florouracil) can be applied to the skin.

Radiation Therapy

Learn More About Radiation Therapy

Radiation is most often used in patients who cannot undergo surgery for one reason or another. It may also be used in patients who have BCC that has spread to lymph nodes. It may not be recommended for people with BCCNS because they are at higher risk of forming numerous new skin cancers after radiation exposure.

Advanced Basal Cell Carcinoma

For patients who have had extensive surgeries and can no longer undergo any more procedures because of how advanced the disease is locally and patients with stage IV disease, where the primary tumor is a certain size and can involve local lymph nodes and, rarely, distant metastasis (most often lungs, bones, and liver), other treatments such as (intravenous) chemotherapy, targeted therapy (that work to block signals that tell cancer to grow in certain people), palliative care (to help with physical and emotional symptoms), immunotherapy, and clinical trials may be available.

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