Basal Cell Carcinoma

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Basal Cell Carcinoma

Basal cell carcinoma is a slow growing non-melanoma skin cancer.  It is thought to be caused by over exposure to the harmful ultraviolet (UV) rays of the sun.  It can be highly disfiguring if allowed to grow, but almost never spreads beyond the original tumor site.  Only in rare cases can basal cell carcinoma spread to other parts of the body and become life-threatening.  This disease should be treated promptly due to its ability to destroy tissue in the areas that it infiltrates.

What do basal cell carcinomas look like?

Basal cell carcinomas are abnormal, uncontrolled growths or lesions that arise in the skin’s basal cells, which line the deepest layer of the outermost layer of the skin, known as the epidermis.  Basal cell carcinomas often look like open sores, red patches, pink growths, shiny bumps, or scars.

What are the consequences of basal cell carcinomas?

Basal cell carcinomas will continue to grow locally, bleed, and destroy tissue unless treated.  Serious problems can arise if the skin cancer is located near organs or is growing near a nerve.  People who have had basal cell carcinomas are at risk for developing others over the years, either in the same area or elsewhere on the body.  Therefore, regular visits to a dermatologist should be routine so that the entire skin surface can be examined.

Treatment

After the dermatologist’s examination, the diagnosis of basal cell carcinoma is confirmed with a biopsy.  In this procedure, the skin is first numbed with local anesthesia.  A piece of tissue is then removed and sent to be examined under a microscope in the laboratory to seek a definitive diagnosis.  If tumor cells are present, treatment is required.  Fortunately, there are several effective methods for eradicating 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.

There are various surgical and non-surgical options available.

  • Surgical excision – After numbing the area with local anesthesia, the dermatologist uses a scalpel to 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 a number of stitches, and the excised tissue is sent to the laboratory for microscopic examination to verify that all the malignant cells have been removed.
  • Electrodessication and curettage – Using local anesthesia, the dermatologist scrapes off the cancerous growth with a sharp, ring-shaped instrument.  The heat produced by an electro cautery needle destroys residual tumor and controls bleeding.  This technique may be repeated twice or more to ensure that all cancer cells are eliminated.
  • Radiation therapy (x-ray), and laser surgery (using wavelengths of light) – X–ray beams are directed at the tumor, with no need for cutting or anesthesia.  Total destruction generally requires several treatments per week for a few weeks.  Radiation may be used for tumors that are hard to manage surgically and for elderly patients or others who are in poor health.
    • Topical Therapy – 5% imiquimod 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.  Side effects are variable, and some patients do not experience any discomfort, but redness, irritation, and inflammation are predictable.
    • Mohs micrographic controlled surgery (a specialized technique) – Using local anesthesia, the dermatologist removes the tumor with a very thin layer of tissue around it.  The layer is immediately checked under a microscope thoroughly.  If a tumor is still present in the depths of the 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.  It is frequently used for tumors that have re-occurred, 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 plastic surgery methods.

Will there be a scar?

Excellent cosmetic results usually occur when the skin cancer is small.  If the skin cancer requires more specialized treatment such as Mohs surgery, reconstructive options are available.  Imiquimod, a topical medication, may help decrease scarring.

Follow Up

Since basal cell carcinoma can re-occur, it is important to monitor and keep follow-up appointments with a dermatologist.  Be alert to any non-healing sores and other changes that develop on the skin.  Use sunscreen and follow a good sun-protection regime.

Risks

Individuals who have had multiple basal cell carcinomas or other skin cancers, such as squamous cell carcinoma, are at an increased risk for developing melanoma.  People should do self-examinations regularly and have a full body skin examination by a dermatologist at least once a year to check for abnormal moles or lesions.

Prevention

Because basal cell carcinoma is frequently caused by UV radiation from the sun, proper sun protection may help in prevention.  It is especially important for children to have good sun protection.

  • Stay out of the sun when it is strongest, between 10 a.m. and 4 p.m.
  • Wear protective covering such as broad-brimmed hats, long pants, and long-sleeved shirts to reduce sun exposure.
  • Wear sunglasses that provide 100% UV ray protection
  • When outdoors, always wear a broad-spectrum sunscreen with a sun protection factor (SPF) of 15 or greater, which will block both UVA and UVB.  Apply the sunscreen 30 minutes before sun exposure and reapply every 1½ to 2 hours.
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