Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the most common form of skin cancer, affecting approximately one million Americans each year. It is the most common of all cancers. These cancers arise in the basal cells, which line the deepest layer of the epidermis (top skin layer).

Almost all basal cell carcinomas occur on parts of the body excessively exposed to the sun — especially the face, ears, neck, scalp, shoulders, and back. On very rare occasions, tumors develop on unexposed areas.

In a few cases, contact with arsenic, exposure to radiation, open sores that resist healing, chronic inflammatory skin conditions, and complications of burns, scars, infections, vaccinations, or even tattoos are contributing factors.

At what age can Basal Cell Carcinoma exist?

Anyone with a history of sun exposure can develop basal cell carcinoma. Those most often affected are older, but in the last few decades, the average age of patients has steadily decreased. Patients in their twenties and thirties are being treated for this skin cancer.

What do warning signs of basal cell carcinoma look like?

You can see images of the warning signs on skincancer.org

Treatment for basal cell carcinoma:

After an examination, the diagnosis of basal cell carcinoma is confirmed with a biopsy. If tumor cells are present, treatment is required. Fortunately, there are several effective treatments for basal cell carcinoma.

Choice of treatment is based on the type, size, location, and depth of penetration of the tumor, the patient’s age and general health, and the likely cosmetic outcome of specific treatments.

Treatment is performed on an outpatient basis in the clinic.

Options for treatment of basal cell carcinoma:

MOHS MICROGRAPHIC SURGERY

Using local anesthesia, the tumor is removed with a very thin layer of tissue around it. The layer is immediately checked under a microscope thoroughly. If tumor is still present in the depths or peripheries of this surrounding tissue, the procedure is repeated until the last layer examined under the microscope is tumor-free.

This technique saves the greatest amount of healthy tissue and has the highest cure rate, generally 98 percent or better. It is frequently used for tumors that have recurred, are poorly demarcated, or are in critical areas around the eyes, nose, lips, and ears. After removal of the skin cancer, the wound may be allowed to heal naturally or be reconstructed using cosmetic surgery methods.

EXCISIONAL SURGERY

After numbing the area with local anesthesia, we remove the entire growth along with a surrounding border of normal skin as a safety margin. The skin around the surgical site is then closed with stitches, and the excised tissue is sent to the laboratory for microscopic examination to verify that all malignant cells have been removed.

The effectiveness of the technique does not match that of Mohs, but is highly effective.

CURETTAGE AND ELECTRODESICCATION

Using local anesthesia, the physician scrapes off the cancerous growth with a curette (a sharp, ring-shaped instrument). The heat produced by an electrocautery needle destroys residual tumor and controls bleeding. This technique may be repeated twice or more to ensure that all cancer cells are eliminated. It can produce cure rates approaching those of surgical excision, but may not be as useful for aggressive basal cell carcinomas or those in high-risk or difficult sites.

CRYOSURGERY

Tumor tissue may be destroyed by freezing with liquid nitrogen, without the need for cutting or anesthesia. The procedure may be repeated at the same session to ensure total destruction of malignant cells.

The growth becomes crusted and scabbed, and usually falls off within weeks. Cryosurgery is effective for the most common tumors and is the treatment of choice for patients with bleeding disorders or an intolerance to anesthesia.

PHOTODYNAMIC THERAPY

TOPICAL MEDICATIONS

Imiquimod is FDA-approved only for superficial basal cell carcinomas, with cure rates generally between 80 and 90 percent. The 5% cream is rubbed gently into the tumor five times a week for up to six weeks or longer. It is the first in a new class of drugs that work by stimulating the immune system.

5-Fluorouracil (5-FU) is also FDA-approved for superficial basal cell carcinomas, with similar cure rates to imiquimod. The 5% liquid or ointment is gently rubbed into the tumor twice a day for three to six weeks.

Trials with more invasive basal cell carcinomas are under way for both imiquimod and 5-FU. Side effects are variable, and some patients do not experience any discomfort, but redness, irritation, and inflammation are predictable.