Basal cell carcinoma

Basal cell carcinoma: This skin cancer often forms on skin that has received years of sun exposure.

Basal cell carcinoma: Overview

Basal cell carcinoma (BCC) is the most common type of skin cancer. It’s also the most commonly diagnosed cancer in the United States. Every year, millions of people learn that they have BCC.

This skin cancer usually develops on skin that gets sun exposure, such as on the head, neck, and back of the hands. BCC is especially common on the face, often forming on the nose. It is possible to get BCC on any part of the body, including the trunk, legs, and arms.

People who use tanning beds have a much higher risk of getting BCC. They also tend to get BCC earlier in life.

This type of skin cancer grows slowly. It rarely spreads to other parts of the body. Treatment is important because BCC can grow wide and deep, destroying skin tissue and bone.

Photograph used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

References:
American Cancer Society. “Cancer Facts and Figures: 2016. Last accessed April 28, 2016.
Carucci JA, Leffell DJ. “Basal Cell Carcinoma” In: Wolff K et al. Fitzpatrick’s Dermatology in General Medicine, 7th edition. USA. McGraw Hill Medical; 2008, p. 1036-42.
Ferrucci LM, Cartmel B, Molinaro AM et al. “Indoor tanning and risk of early-onset basal cell carcinoma.” J Am Acad Dermatol 2012;67(4):552-62.
Jarell AD, Mully TW. “Basal cell carcinoma on the ear is more likely to be of an aggressive phenotype in both men and women.” J Am Acad Dermatol 2012 May;66(5):780-4.
Wong CS, Stragne RC, Lear JT et al. “Clinical review: Basal cell carcinoma.” BMJ 2003 Oct 4;327:794-798.

Nodular basal cell carcinoma: This skin cancer often looks like a translucent, dome-shaped growth with visible blood vessels.

Basal cell carcinoma: Signs and symptoms

Basal cell carcinoma (BCC) shows up on the skin in different ways. That’s because there are different types of this skin cancer. If you see any of the following on your skin, you should immediately make an appointment to see a dermatologist:

• Dome-shaped skin growth with visible blood vessels. Often pink or skin-colored. Can also be brown or black or have flecks of these colors in the growth. Grows slowly. May flatten in the center, ooze, and crust over. Tends to bleed easily.
• Shiny pink or red, slightly scaly patch, especially when appears on the trunk. It grows slowly and may be mistaken for a patch of eczema.
• Waxy feeling, hard, pale-white to yellow or skin-colored growth that looks like a scar. Can be difficult to see the edges.

BCCs may look like a sore that:

• Bleeds easily.
• Won’t heal, or heals and returns.
• Oozes or crusts over.
• Has a sunken center, like a crater.
• Has visible blood vessels in or around it.

Although rare, BCC can feel painful or itch. Usually, the only sign of BCC is a growth on the skin.

Nodular basal cell carcinoma: On this man’s nose, the basal cell cancer looks like a sore that will not heal.

Pigmented basal cell carcinoma: Basal cell cancer can cause a brown or black growth.

Superficial basal cell carcinoma: On the trunk, basal cell cancer often looks like a reddish, scaly patch.

Sclerosing basal cell carcinoma: The pinkish skin on this man’s nose looks like a scar, but it is basal cell cancer.

Basal cell carcinoma recur: Even with proper treatment, this skin cancer can return as shown here on this woman’s nose.

Look at your skin: If you see anything growing or changing, immediately make an appointment to see a dermatologist.

Image 2 used with permission of Journal of the American Academy of Dermatology. J Am Acad Dermatol 2006;55:747.

References:
Carucci JA, Leffell DJ. ”Basal Cell Carcinoma” In: Wolff K et al. Fitzpatrick’s Dermatology in General Medicine, 7th edition. USA. McGraw Hill Medical; 2008, p. 1036-42.
Habif TP, Campbell JL, Chapman JGH, et al. “Basal cell carcinoma,” In:Dermatology DDxDeck. China; 2006. Images 1, 3, 4, 5, and 6 used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Basal cell carcinoma: Who gets and causes

Anyone can get this common skin cancer, but some people have a greater risk. People with a greater risk of getting basal cell carcinoma (BCC) have one or more of the following risk factors:

Your physical traits

• Light-colored or freckled skin.
• Blue, green, or gray eyes.
• Blond or red hair.
• An inability to tan.

What you’ve done

• Spent a lot of time outdoors for work or leisure, without using sunscreen or covering up with clothing.
• Frequently used tanning beds.

Your medical history

• If you had one BCC, your risk for developing a second one increases by about 40%.
• Close blood relative had BCC.
• Taking one or more drugs that suppress the body’s immune system. People take these drugs after receiving an organ transplant and to treat a medical condition, such as severe arthritis, lymphoma, or human immunodeficiency virus (HIV).
• Overexposure or long-term exposure to x-rays, such as patients who received x-ray treatments for acne in the 1940s.

Risk of developing many BCCs by 20 years of age

Some people are born with a rare condition that makes them more likely to develop many skin cancers, including basal cell cancers, early in life. BCC can develop by 20 years of age in people who have a rare medical condition known as basal cell nevus syndrome.

What causes BCC?

Unlike many cancers, the cause of BCC is well known:

• Ultraviolet (UV) rays from the sun or tanning beds cause BCC.

When UV rays from the sun or tanning beds hit our skin, these rays damage the DNA in the cells of our skin. The body tries to repair this damage. When the rays repeatedly hit our skin, the body cannot repair the damage.

When the body cannot repair the damage, skin cancer develops. Skin cancer usually develops after years of sun exposure. Around 50 years of age, the risk of developing skin cancer increases significantly.

People much younger than 50 years of age also get BCC. Most of these people are women who use indoor tanning beds. Many of these BCCs could be prevented if the women never tanned indoors.

References:
American Cancer Society, Cancer Facts and Figures 2012. p. 21-22.
Carucci JA, Leffell DJ.”Basal Cell Carcinoma” In: Wolff K et al. Fitzpatrick’s Dermatology in General Medicine, 7th edition. USA. McGraw Hill Medical; 2008, p. 1036-42.
Ferrucci LM, Cartmel B, Molinaro AM et al. “Indoor tanning and risk of early-onset basal cell
Carcinoma.” J Am Acad Dermatol 10.1016/j.jaad.2011.11.940. (Article in Press).
Telfer NL et al. “Guidelines for the management of basal cell carcinoma.” Brit J of Dermatol 2008 159;35-48.
Wong CSM, et al. “Clinical review: Basal cell carcinoma.” BMJ 2003 Oct 4;327:794-798.

Basal cell carcinoma: Diagnosis and treatment

The only way to diagnose any type of skin cancer, including basal cell carcinoma (BCC), is with a skin biopsy. Your dermatologist can perform this procedure during an office visit.

A skin biopsy should not cause anxiety. To perform a skin biopsy, your dermatologist will remove the entire growth or part of it. Your dermatologist may send this to a laboratory or look at it under a microscope. The findings will be communicated in a biopsy report.

If the biopsy report states that you have BCC, your dermatologist will consider many factors to determine which treatment will be best for you. There are several ways to treat BCC:

Excision: This is a surgical procedure that your dermatologist often can perform during an office visit. It involves numbing the area to be treated and cutting out any remaining tumor plus some normal-looking skin around the tumor.

Like the skin biopsy, this removed skin is examined under the microscope. This may be done at a laboratory or by your dermatologist. The doctor who looks at the removed skin needs to see whether the normal-looking skin is free of cancer cells. If not, more skin will need to be removed. This is a common way to treat BCC.

Curettage and electrodessication: This treatment consists of two steps. First, your dermatologist scrapes away the tumor. Then electricity is used to destroy any remaining cancer cells. The two steps are then repeated.

Mohs surgery: Named for the doctor who developed this surgery, Mohs (pronounced "moes") is a specialized surgery used to remove some skin cancers. It offers the highest cure rate for difficult-to-treat basal cell cancers. Your dermatologist will tell you if Mohs is right for you.

If Mohs is recommended, this is what you can expect. The surgeon will cut out the tumor plus a very small amount of normal-looking skin surrounding the tumor. While the patient waits, the Mohs surgeon uses a microscope to look at what was removed. The surgeon is looking for cancer cells.

If necessary, the Mohs surgeon will continue to remove a very small amount of skin and look at it under the microscope. This continues until the surgeon no longer sees cancer cells.

Cryosurgery: This treatment uses liquid nitrogen to freeze cancer cells, causing the cells to die.

Radiation: This treatment usually is reserved for BCCs that cannot be cut out, or when surgery may not be the best choice. A patient may need 15 to 30 radiation treatments.

Photodynamic therapy (PDT): This treatment uses light to remove early skin cancers. PDT is a two-step process. First, a chemical is applied to the skin. The chemical remains on the skin for some time so that it can be absorbed. Then the skin is exposed to a special light to kill the cancer cells.

Medicated creams: Creams that contain a drug, such as imiquimod or 5-fluorouracil, can be used to treat early BCC. A patient applies the medicated cream at home as directed by his or her dermatologist.

Pills: While extremely rare, there are reports of BCC spreading to other parts of the body. Patients who have BCC that spreads may be prescribed vismodegib. This medication also may be prescribed for patients who have advanced BCC that cannot be cut out or treated with radiation.

Outcome

Nearly every basal cell cancer can be cured, especially when the cancer is found early and treated.

References:
Carucci JA, Leffell DJ. “Basal Cell Carcinoma” In: Wolff K et al. Fitzpatrick’s Dermatology in General Medicine, 7th edition. USA. McGraw Hill Medical; 2008, p. 1036-42.
National Cancer Institute, “FDA Approval for Vismodegib,” January 30, 2012. Neville JA et al. “Management of nonmelanoma skin cancer” In: 2007 Nat Clin Pract Oncol. 2007 Aug; 4(8):462-9.
Telfer NL et al. “Guidelines for the management of basal cell carcinoma.” Brit J of Dermatol 2008;159;35-48.
Sterry, W. “Nonmelanoma skin cancer.” EJD, 2007; Nov-Dec; 17(6):562-563.

Basal cell carcinoma: Tips for managing

If you have been diagnosed with basal cell carcinoma (BCC), your prognosis is excellent. Most BCCs are cured with the prescribed treatment.

Risks

• It is possible for BCC to recur. These BCCs are almost always cured with additional treatment.
• People who have had BCC have a higher risk for getting another skin cancer.

To help patients manage these risks, dermatologists recommend the following:

Keep all follow-up appointments with your dermatologist. When found early, skin cancer usually can be cured. Even melanoma, the deadliest skin cancer, has a cure rate of nearly 100% when found early and treated.

Perform skin self-exams. Patients who are diagnosed with skin cancer are taught how to examine their skin for signs of skin cancer. Be sure to examine your skin as often as recommended by your dermatologist.

If you see anything on your skin that is growing, bleeding, or in any way changing, immediately call your dermatologist’s office. A change could be an early sign of skin cancer. Found early and treated, skin cancer can be cured.

Protect your skin from the sun and indoor tanning. This is essential to prevent further damage, which can increase the risk of getting another skin cancer. These tips will help you protect your skin:

• Wear sunscreen and lip balm that offer sun protection. Apply these daily, even in the winter, and be sure to use sunscreen and lip balm that offer: 
  
  • SPF 30 or higher.
  • Broad-spectrum (UVA/UVB) protection.
  • Water resistance.

• Apply the sunscreen and lip balm to dry skin 15 minutes before going outdoors.
• Apply the sunscreen to every part of your body that will not be covered by clothing.
• Whenever possible, wear a wide-brimmed hat, long sleeves, and pants.
• Wear sunglasses to protect the skin around your eyes.
• Avoid outdoor activities when the sun is strongest — between 10 a.m. and 2 p.m.
• Avoid getting a tan and never use a tanning bed or sun lamp.

Related resources:

• American Cancer Society
• Basal Cell Carcinoma Nevus Syndrome Life Support Network (BCCNS)
• National Cancer Institute

References:
Carucci JA, Leffell DJ. “Basal Cell Carcinoma” In: Wolff K et al. Fitzpatrick’s Dermatology in General Medicine, 7th edition. USA. McGraw Hill Medical; 2008, p. 1036-42.
Habif TP, Campbell JL, Chapman JGH et al. “Basal cell carcinoma,” In: Dermatology DDxDeck. China; 2006.
Kim RH, Armstrong AW. “Nonmelanoma skin cancer.” Dermatol Clin. 2012 Jan;30(1):125-39. Epub 2011 Oct 21.
Situm M et al. “The role of UV radiation in the development of basal cell carcinoma.” Coll Antropol. 2008 Oct;32 Suppl 2:167-70.
Wong CSM et al. “Clinical review: Basal cell carcinoma.” BMJ 2003 Oct 4;327:794-798.

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