Basal Cell Cancer

What is Basal Cell Cancer?

Basal Cell Carcinoma (BCC) is the most common type of skin cancer in white populations. BCC is caused by DNA mutations in one or more of the skin’s basal cells, forcing them to multiply rapidly and generate skin growths. It often presents itself on sun-exposed areas such as the ears, face, and neck as a translucent bump with visibility of tiny blood vessels. However, BCC might also be observed on the torso and genital skin.

What are the risk factors?

● Fair complexion

● Severe UV radiation (i.e. sunlight, tanning beds)

● Radiation therapy

● Aging Skin (> 50)

● Family history of skin cancers

● Immune-suppressing medications

● Arsenic exposure

● Rare genetic diseases (i.e. Gorlin-Goltz syndrome, xeroderma pigmentosum)

How is BCC diagnosed?

Initially your dermatologist will likely conduct a medical history and general exam (ask questions about changes you’ve noticed and probable symptoms). They will examine skin on all parts of the body and look out for any additional lesions. Your dermatologist may also perform a skin biopsy in order to further assess the skin abnormality or growth.

What are my treatment options?

● Surgical Excision: The lesion is surgically excised with appropriate margins. Resulting skin defect is then sutured in layers. The internal layers dissolve on their own in a few weeks to a few months, and the top layer is left in the skin for 5-14 days, depending on the type of repair, location of surgery on the body, and types of sutures used.

● Mohs Micrographic Surgery: This is a tissue-sparing procedure in which the cancer is excised in layers to confirm negative margins, by processing tissue on the same day, while the patient waits for the confirmation. Once all cancer is removed, the defect is closed with sutures, repaired with a skin graft or flap, or allowed to heal on its own, through second intention. This is the preferred method of treatment for large cancers or tumors on cosmetically sensitive areas like face, ears, scalp, fingers, toes and sometimes neck.

● Electrodessication & Curettage (ED&C): Also known as “scrape and burn” technique, in this method, the cancer is scraped with a sharp tool, and burned with an electrical needle called hyfrecator. This wound heals on its own in a few weeks. There are no sutures required so there is no post-op visit to have sutures removed. This method leaves a white depressed scar compared to linear scar from surgical treatment.

● Photodynamic Therapy: If cancer is superficial, a combination of light and photosensitizing medications may be used. A liquid that sensitizes cancer cells to a specific wavelength of light is applied to the affected area. Then the light unit is directed on the treatment area to destroy the skin cancer cells. This treatment typically results in a robust inflammatory reaction with marked redness, and sometimes scaling and peeling, much like a severe sunburn. It is important to avoid sun and any skin products on treated skin, unless recommended by your dermatologist, until healing is complete, in 1-2 weeks. Regular sunscreen use can result in the best clinical outcome.

● Radiation Therapy : This is an option for difficult to treat tumors, very large tumors spanning over multiple cosmetic units on face and ears, or for patients, usually elderly, who are not candidates for surgical excision.

● Topical Treatments : Early stage, superficial lesions may be treated through prescription ointments and creams when surgery is not suggested.

● Cryosurgery (freezing) : Liquid nitrogen is used to freeze cancer cells of superficial skin lesions.

● Targeted Drug Therapy : This method blocks molecular signals that promote the growth of cancer cells. Targeted drug therapy may be considered when other treatments prove to be ineffective.

● Chemotherapy : Very powerful drugs are used to kill cancer cells and prevent spread to other sites on the body. This method in many cases is a last resort when other treatments do not prove to be effective.

What prevention measures can I take?

● Sunscreen

● Increase skin coverage (i.e. clothing, hats, sunglasses)

● Chemoprevention (i.e. nonsteroidal anti-inflammatory medications, oral nicotinamide, topical fluorouracil)

Patients who develop any suspicious lesions that are changing, growing, bleeding or not healing, should consult a dermatologist for evaluation. Patients with a history of sun damage, precancerous lesions, or skin cancers may need routine skin examinations. Our dermatologist can help determine the right course of treatment for you.