What You Should Know About Basal Cell Carcinoma
Basal cell carcinoma (BCC) is the most common form of skin cancer. It originates in the deep layers of the epidermis, specifically from the basal cells, where new skin cells are produced as the old ones die. When exposed to UV radiation, the DNA in these basal cells can mutate, causing them to begin growing at an uncontrolled rate, resulting in a cancerous lesion. These lesions tend to occur on areas of the skin that are most often exposed to the sun.
Basal cell carcinoma is diagnosed in around 80% of non-melanoma skin cancers, with an estimated 3.6 million cases in the U.S. each year. However, they are mostly curable and cause minimal damage because they typically grow slowly and rarely metastasize to other body parts.
Types of Basal Cell Carcinoma
BCC falls into several different subtypes:
Nodular Basal Cell Carcinoma
The most common subtype, nodular BCC, appears as a bump with a pearly or waxy appearance and often with visible blood vessels called telangiectasias. It typically appears on sun-exposed areas, particularly the face and neck. Nodular BCC grows slowly and is generally confined to a localized area, but if untreated, it can penetrate deeper into the skin and adjacent tissues. An alternative name is “rodent ulcer,” because the center of the nodule can break down, causing an open ulcer with a rolled edge.
Superficial Basal Cell Carcinoma
Named for the fact that it only affects the uppermost layers of skin, superficial BCC often looks like a pinkish or skin-colored scaly patch that can look quite similar to psoriasis or eczema. It’s most common in the trunk area. Because the lesion is so shallow, it takes many years for the patch to ulcerate and requires less aggressive therapies to treat.
Sclerosing Basal Cell Carcinoma
Sclerosing BCC looks like a white, waxy, scar-like lesion that can be particularly hard to diagnose because it looks so similar to the surrounding skin. It’s more likely to grow deeper into the skin layers and has indistinct layers that complicate surgical removal.
Pigmented Basal Cell Carcinoma
Pigmented BCC causes the nodule to appear black or brown and is most common in those with darker skin. Because of its coloration, it can be mistaken for the much more serious melanoma and can only be differentiated by conducting a biopsy.
Diagnosing the Severity of Basal Cell Carcinoma
While many cancers are assigned a particular stage based on the TNM system– tumor size, the number of cancer cells in the nearby lymph nodes, and whether the cancer has metastasized– that’s not the case for BCC because it so rarely spreads to other organs. Instead, it falls into three overarching categories based on the likelihood of recovery and/or recurrence:
- Early-Stage Disease: During the earliest phase of BCC, the tumor or nodule is small and has not spread to the deeper layers of the skin. Excisional surgery is typically enough to treat the lesion.
- Locally Advanced Disease: If left undiagnosed and untreated for several years or when earlier treatment was unsuccessful, basal cell carcinoma can grow into the deeper skin, muscle, and nerve tissues.
- Metastatic Disease: In BCC’s final stages, it has metastasized or spread to other organs, such as the bones or lymph nodes. Basal cell carcinoma only reaches the metastatic stage in 1% of cases, as annual skin exams are typically enough to catch carcinoma when it’s still at its earliest stages.
Treatment Options
Depending on the location, size, and whether the basal cell carcinoma is recurring, there are a number of different treatment options that your doctor will recommend with the goal of removing the cancerous growth completely.
Surgical Excision
Most cases of BCC are treated with surgical excision, during which the doctor cuts out the affected tissue in addition to a certain margin of healthy skin to better ensure that each and every cancer cell is removed. This option is most often used in areas that are unlikely to redevelop cancerous growth, such as the hands or feet.
Mohs Surgery
We’ll be looking into Mohs surgery in more detail before the end of May, but the brief summary is that it involves removing cancerous skin layer by layer until, when examined under a microscope, there are no more cancerous cells. Unlike an excision, this prevents having to remove as much healthy skin and is typically performed in cases where the lesion is on the face, is large, or goes deeper into the skin.
Curettage and Electrodessication
In cases of particularly small BCC growths, you may be eligible for a simple curettage and electrodesiccation (C&E) procedure. During this treatment, the doctor will scrape the surface layer of the cancerous growth with a curet and then use an electric current to remove the lesion.
Radiation
In cases where there is an increased risk of recurrence, radiation is sometimes used after surgery to target cancer cells with high-energy X-ray or proton beams.
Freezing
Superficial (surface-level) lesions can sometimes be removed by freezing the cancer cells with liquid nitrogen in a treatment called cryosurgery. It’s ideal for small, thin BCCs when surgery isn’t a viable option.
Topical Treatments
Superficial BCCs may also respond well to topical ointments like imiquimod cream, which acts as an immunostimulant that encourages your body’s natural defense system to target and kill cancerous cells. Another option is 5-fluorouracil, or 5-FU, to stop the cancerous cells from growing and promoting cell death.
Chemotherapy
Once BCC has metastasized or recurs continually despite using other treatments, chemotherapy may be necessary to kill cancer cells with extremely powerful drugs.
4 Tips for Preventing Basal Cell Carcinoma
- Always, always, always wear a broad-spectrum sunscreen with SPF 30 or higher, even if you’re not planning on spending a lot of time outside, it’s wintertime, or it’s gloomy outside. UV rays can still reach your skin, causing DNA damage that leads to cancerous growth in the basal cells.
- Avoid using tanning beds, as it also exposes your skin to targeted UV radiation. Consider sunless tanning options from St. Tropez to get a summer glow without risking your skin health.
- Conduct monthly skin exams to check for any atypical growths or sudden changes to your skin. If you find a suspicious spot, contact your dermatologist immediately so that they can perform an examination and biopsy.
- Don’t skip your annual skin exam! Early detection vastly improves the chances that your dermatologist can treat the lesion with outpatient surgery to remove the cancerous cells. If you don’t already have annual visits scheduled with a Board-Certified dermatologist, we encourage you to call for an appointment with Dr. Elizabeth Briden to get started this year. It’s the best way to ensure long-term skin health and the most effective basal cell carcinoma treatment outcomes.
