Basal Cell Carcinoma: A Treatable Skin Cancer
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What is basal cell carcinoma?
Basal cell carcinoma (BCC) is the most common kind of skin cancer. It can develop almost anywhere on the body.
BCCs typically form in sun-exposed areas. They vary greatly in how they look—pink or red bumps, open sores, or waxy patches. For people with brown or black skin, BCCs may appear brown or almost black.
Most common symptoms
Patients should tell their doctor if their basal cell carcinoma is painful, bleeding, has a crawling sensation or other neurologic symptoms. Neurologic symptoms such as a crawling sensation can be a sign that the basal cell carcinoma is affecting the surrounding nerves, which can make removing it more difficult. —Dr. Mollie MacCormack
BCCs look like abnormal spots or bumps on the skin. Many varieties exist but most typically it is a shiny (waxy) new bump.
They are usually pink, red, or match the color of the surrounding skin, but with a pearly sheen. In people with brown or black skin, BCC’s may be darkly pigmented.
If you look closely at a BCC, many tiny blood vessels may be visible beneath the surface of the bump. In some cases, there may be an open sore (ulcer) in the middle, with a smooth, rolled border. BCCs rarely hurt or itch.
BCCs can come in almost any shape or color. Here are some of the more common symptoms to watch for:
- New spot or bump on the skin
- Shiny papule
- Pink, red, or skin-colored (brown or black in people with darker skin) with a pearly appearance to the surface
- Small blood vessels visible just beneath the skin
- Open sore with smooth, rolled borders
Less common symptoms
- Brown, purple, blue, grey, or black coloration
- Mostly flat waxy area on skin, ulcerated depressions
- Scaling (fine flakes of skin falling off like dandruff) or crusting (hardened shell like a scab)
- Tightening and discoloration of skin resembling an old scar, where there was no scar before
What is the best treatment for a basal cell carcinoma?
If treated when small, basal cell carcinomas are easily removed. —Dr. MacCormack
If you think you may have skin cancer, make an appointment with a dermatologist (skin doctor). They will examine the lump or sore and also the rest of your body for any other suspicious spots.
If skin cancer is suspected, the doctor will want to scrape or cut off a small piece of the lesion (biopsy) so it can be examined and tested for basal cell carcinoma cells in a laboratory.
If a biopsy confirms BCC, the dermatologist will likely offer several treatment options. Possibilities include in-office surgical procedures to remove the lesion, radiation therapy, or certain medications.
The type of treatment will depend on the size and location of the tumor, plus patient preference where possible. Your dermatologist will help you decide which approach is right for you.
- Curettage and Electrodessication: Smaller lesions may be scraped off with a sharp tool called a curette. The remaining skin beneath is burned with an electrical tool to minimize the chance of recurrence. This procedure is performed using local anesthesia. Risk of recurrence may be higher than with the other common procedures—excisional and Mohs surgery. Additional risks include scarring and some discomfort.
- Excisional Surgery: The dermatologist uses a scalpel to remove the BCC and the surrounding skin (called the margin). Removing a margin of skin minimizes the chance of recurrence. This procedure is done under local anesthesia. Risks include scarring and some discomfort.
- Mohs Surgery: For larger or more aggressive BCCs, and those located in cosmetically sensitive areas like on the face, patients may be referred to a specialist called a Mohs surgeon. The tumor is removed layer by layer. It is examined while you wait. The doctor will continue to remove layers until the tissue is completely free of cancer. Achieving tumor-free margins with this technique ensures that the most minimal amount of skin is removed while also reducing the chance of recurrence. This procedure is performed under local anesthesia in a specialized dermatologist’s office. Risks include scarring and some discomfort.
- Other approaches: Occasionally, basal cell carcinomas may be removed or destroyed using lasers, radiation therapy, or with medications you apply to the skin that act as on-the-spot chemotherapies. They may also be frozen with liquid nitrogen. When the BCC is extensive or advanced, the doctor may try new immunologic agents such as vismodegib, which helps stop BCC development.
Causes of basal cell carcinoma
Newer treatments for severe, advanced basal cell carcinoma target the PTCH gene. PTCH is a tumor suppressor gene that normally prevents uncontrolled cell growth but has malfunctioned in many basal cell carcinomas, causing abnormal cell replication. —Dr. MacCormack
Cancers develop because of abnormal, uncontrolled cell growth. BCCs are caused by an overgrowth of basal cells. Often, the overgrowth occurs because cell DNA has been damaged.
The most likely reason you have a BCC is from being exposed to sunlight. Exposure to UV radiation, especially severe, intermittent sunburns, increases the risk of developing BCC. People with pale skin, blue eyes, and blond hair are a greater risk of BCC than individuals with darker complexions.
Basal cell DNA can also be damaged by other UV light exposure, such as from tanning beds, by ionizing radiation (X rays, radiation therapy), and from chemicals like arsenic, which can be found in well water.
Some genetic syndromes, diseases (such as chronic lymphocytic leukemia), and medical treatments that suppress the immune system, like chemotherapy, may impair cell DNA repair, increasing the likelihood of getting BCCs.
Is basal cell carcinoma life-threatening?
Fortunately, BCCs very rarely metastasize (spread) to other parts of the body. BCCs are rarely life-threatening.
Left untreated, however, BCC’s can create painful wounds, sources of infection, and loss of function of the surrounding tissue. For these reasons, BCCs should be removed as soon as possible.
Early detection and treatment can also reduce the risk of them growing back.
Once you have been diagnosed with BCC, your risk of developing additional skin cancers increases. Let your doctor know if you have had prior skin cancer, radiation therapy, or are immunosuppressed.
Follow up with your dermatologist for skin cancer screenings as directed.
The best way to prevent BCC is to follow sun safety guidelines.
- Avoid the sun during peak hours: The sun is strongest between 10 AM and 4 PM. Make sure you practice sun-protective behavior during these hours if you have to be outdoors. Remember that UV radiation is present on cloudy days, too. Seek shade.
- Sun protective clothing and broad-brimmed hats are widely available, stylish, and highly effective.
- Sunscreen should be applied to exposed skin (especially the face and neck) every day year-round: Choose a sunscreen that blocks UVA and UVB rays, with an SPF value of 30 or more, and re-apply as directed.
- There is no such thing as a healthy tan. If you notice that your skin is becoming tan, alter your behavior by changing the time of your outdoor activities, increasing use of sun-protective clothing, and applying sunscreen more frequently.
- Do not use tanning beds: They concentrate harmful radiation on the skin. They are never, ever safe.
William C. Fix is a resident physician specializing in dermatology at the Albert Einstein College of Medicine and Montefiore Medical Center in New York. He graduated from Brown University with a BA in Economics in 2012 and obtained his MD from the University of Pennsylvania Perelman School of Medicine in 2019. William has received grants from the American Society for Dermatologic Surgery, The National Institutes of Health and the Alex’s Lemonade Stand Foundation for oncology research, and was selected for the University of Pennsylvania’s Dermatology Oncology Center (PennDOC) Research Fellowship in Dermatology & Dermatologic Surgery. William’s interests include general and procedural dermatology, cutaneous oncology, technology, and quality improvement.