What is Basal Cell Carcinoma?
Basal cell carcinoma is the most common cancer in the world. With three to four million people in the United States diagnosed with basal cell carcinoma each year, this cancer affects more people than all other cancers combined.
Fortunately, basal cell carcinoma is also the least serious of all cancers. 99% of basal cell carcinoma cases stay local, meaning it only affects the area where it starts. Sometimes it’s more complicated — they can invade structures locally near the eyes, nose, or ears — but true metastasis from basal cell carcinoma is extraordinarily rare.
Other cancers can spread, or metastasize, throughout the body to other organs and threaten lives, but basal cell carcinoma spreads only in rare circumstances.
What Are the Signs of Basal Cell Carcinoma?
Basal cell carcinoma is most commonly pink, pearly, and translucent, with fine vessels, or telangiectasia, within. It is also commonly described by patients as a persistent, or variably recurrent pimple like lesion that easily bleeds when scratched. We all get pimples — they come and go. But if a pimple isn’t disappearing, it might indicate something more serious.
Basal cell carcinoma can also appear as a reddish-pink, variably scaled area. Men may notice difficulty shaving over these lesions because the skin breaks and bleeds.
There are also many look-alike conditions, or mimickers of basal cell carcinoma, benign and cancerous. Biopsy of a suspicious lesion is appropriate to definitively diagnose and appropriately treat the condition.
The telltale sign of a basal cell carcinoma is bleeding without a good reason. If you have a lesion that bleeds without explanation, get it checked out. Basal cell skin cancer, like most cancers, stimulates blood vessel growth to feed its out-of-control cancerous growth. These blood vessels, as well as abnormal cell-cell connections lead to more easily bleeding lesions.
What Causes Basal Cell Carcinoma?
Like most skin cancers, basal cell carcinoma is primarily found in fair-skinned individuals. It’s directly related to sun exposure. Cumulative lifetime sun exposure puts you at a higher risk of basal cell carcinoma, particularly if you have spent a lot of time in high altitude conditions. This type of high altitude, more intense UV exposure, and UV exposure from tanning beds dramatically increases your risk and likelihood for basal cell carcinoma, as well as all types of skin cancer.
There’s also a strong genetic component to this form of cancer. If one family member has a basal cell carcinoma, chances are that someone else in the family will have it too.
What are the Treatment Options for Basal Cell Carcinoma?
When basal cell carcinoma is detected early, patients have many treatment options. The best treatment for basal cell carcinoma depends on several factors:
- The patient’s characteristics
- The subtype of basal cell carcinoma
- The area in which it is detected
Considering these factors, a dermatologist will guide you towards the basal cell carcinoma treatment option that will be most effective for your particular cancer.
Curettage and Electrodesiccation (electrosurgery)
If the spot is not on the face, a dermatologist’s frequent preference is scraping the basal cell off the skin with a curette and treating the base with an energy (like an electric needle) or a chemical. This treatment is extremely effective. When performed serially, all in one treatment session, cure rates are around 90% for small basal cell carcinoma. It’s fast, effective, and leaves minimal scarring.
If the spot is in a cosmetically sensitive area like the face or neck, or if the margins of the tumor are clinically unclear, dermatologists often prefer an excision. Excisions can be done with a standard margin (3-4 mm).
For an excision on a narrow-margin tumor, dermatologists commonly use a technique called Mohs surgery. In Mohs surgery, dermatologists use local anesthesia, then scrape the base of the tumor to debulk and better delineate tumor extension.
We take a margin of 1.5-2 mm around the tumor area and process it in frozen horizontal sections. In about 30-40 minutes, we can determine if the surrounding margins are positive or negative. If any positive margins remain, we can repeat the process to clear the basal cell carcinoma. With Mohs surgery, we usually get a same-day closure and patients are highly satisfied with the cosmetic outcome.
Some subtypes of basal cell carcinoma are best to treat with a cream. When lesions are isolated to small, superficial spots on the trunk or extremities, we can treat them with a topical agent over an extended period (usually 4-6 weeks).
In patients who are poor surgical candidates or have a basal cell on the head or neck, we sometimes opt for radiotherapy. Radiotherapy can be effective because basal cell carcinoma is somewhat radiosensitive. With a course of three to six weeks of radiotherapy, 90+% of basal cells can be treated successfully.
Oral Treatment Options
For very complicated cases and poor-surgical candidates, we have two oral treatment options for basal cell carcinoma. Hedgehog inhibitors can block growth pathways of basal cell carcinoma and can greatly reduce the size or even put the cancer into remission.
Basal Cell Carcinoma FAQ’s
Is basal cell carcinoma dangerous?
Basal cell carcinoma is rarely fatal in the United States. Patients with healthy immune systems who seek appropriate treatment will not suffer long-term negative side effects from their diagnosis.
Basal cell carcinoma can become life threatening in patients who are immune-compromised, immunosuppressed, or suffer from genetic abnormalities.
It can also develop into a more serious issue when left untreated. While these cells do not have the capability to metastasize, they will continue to grow in their current location. A cancer growing unchecked will continue to be deforming, destructive, and disfiguring. If a patient waits long enough, it can kill by direct extension if overlying critical structures.
Why do I need to get it removed if it’s not life-threatening?
We strongly recommend complete basal cell carcinoma removal. If even one cell is left behind, it will come back. It may take months or years to reappear, but recurrences are often a deeper, wider problem than the first appearance.
Is basal cell carcinoma like melanoma?
Basal cells are a different cell line than melanoma. While we still treat basal cell carcinoma immediately and aggressively, it is not melanoma and will not turn into melanoma.
What are the basal cell carcinoma stages?
Basal cell carcinoma isn’t diagnosed in stages like other cancers. Stages typically indicate a cancer’s progression. Because it is not likely to spread, basal cell carcinoma stages are unnecessary.
If I have basal cell carcinoma, am I at a higher risk for other skin cancers?
This skin cancer appeared for a combination of reasons including genetics, immune system characteristics, and cumulative sun damage over the years. Sun damage isn’t typically isolated to one appearance of skin cancer. Once you have one skin cancer, you are several times more likely than a person who has not had a skin cancer to have a second skin cancer within a few years.
How often should I follow up with my dermatologist after I’ve had one skin cancer?
After any skin cancer diagnosis, the American Academy of Dermatology recommends patients follow up for routine skin checks with their dermatologist every six months for the next three years. We want to identify any future skin cancers early and treat them when they are as small as possible.
In addition, take responsibility for your own skin. Check your skin once a month to look for any new moles or spots that may indicate a potential skin cancer. Basal cell carcinoma usually only affects sun-exposed skin, but melanoma can occur anywhere on the body. If you notice a spot, move up your next appointment so you can have it checked and evaluated as soon as possible. When you observe your skin monthly, you’re more likely to notice new occurrences, recognize problematic issues, and bring them to your dermatologist’s attention.
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