Where Does Bcc Develop
As the above pictures show, this skin cancer tends to develop on skin that has had lots of sun exposure, such as the face or ears. Its also common on the bald scalp and hands. Other common areas for BCC include, the shoulders, back, arms, and legs.
While rare, BCC can also form on parts of the body that get little or no sun exposure, such as the genitals.
What Are The Symptoms Of Basal Cell Carcinoma
A basal cell carcinoma is a stubborn, persistent spot that usually appears on areas that have been exposed to the sun, such as the head, neck, chest, arms and legs. The spot may take one of several forms: an open sore, a reddish irritated patch, a shiny red bump or nodule, a pink growth, or a small scar-like patch. In some people, the condition may resemble psoriasis or eczema. The spot will sometimes bleed, scab and heal up after a week or two, then bleed or become irritated again.
The main warning sign for basal cell carcinoma is that the spot doesn’t go away on its own. Patients often mistake basal cell carcinomas for minor injuries, says Dr. Christensen. They dont realize that an ordinary cut or scratch will heal within a month or so. So if something hasnt healed within a month, it should be examined by a dermatologist.
Tips For The Day Of The Procedure
“I have had Mohs with reconstruction 5 different times on my face. After the first surgery, I knew to bring ice packs for the 45-minute ride home. This does help until you get home.”
“If needles and cutting in you make you nervous, do not hesitate to ask for a light sedative.”
“Have a good support person with you, bring snacks, a book, or tablet to pass the time between procedures. Plan on staying all day.”
“The first time I had Mohs, I was not prepared and it was very deep. I had to have skin from under my eye to cover the hole in my nose. I didnt want a graft and my doctor had said, Why dont you take a look in the mirror now. I did not. Big mistake. When I got home, I fainted.”
Youll have a range of emotions during the day of your Mohs surgery. Anxiety for how many layers will be taken, fear of how the scar will look, relief that the cancer is finally being removed, etc. Take a loved one with you to the procedure. There may be a lot of downtime in between since the surgeon will examine each layer of skin he/she removes. Bring someone to talk to or an activity to keep you busy while you wait. Also, ask questions and get the answers your need to relieve some of the anxiety you may be feeling.
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Four Reasons To Treat Basal Cell Carcinoma
Even when lesions from basal cell carcinoma on your skins surface dont appear to be changing, the cancer might still be growing. Some BCCs grow in irregular patterns under the skin, making the cancer seem smaller than it is. The cancer can affect tissue and bones. While major organs are rarely affected, muscle and nerve damage can occur, according to the Skin Cancer Foundation.
When not treated, the growth of the cancer can cause disfigurement because of internal damage. Treatment, which usually includes excision of the tumor, can be quite extensive when the cancer continues to grow unchecked. The longer you wait, the more damage and disfigurement the tumor can do and the more difficult it is to treat without causing cosmetic issues, according to Rex Amonette, M.D., the co-founder of The Skin Cancer Foundation.
When treated early, BCC is highly curable. Mohs surgery, a common treatment for BCC, has a cure rate of 99 percent. Excision, where the physician cuts out the growth, has a cure rate above 95 percent.
Most treatments for BCC are done as outpatient and often can be performed in your doctors office. Treatment does not usually involve extended time away from work or family.
What Should I Do If I Think I Have A Basal Cell Carcinoma
If you notice a change to or growth on your skin, make an appointment to see your doctor straight away. Your doctor will assess the size, location and look of the growth. They will also ask you how long you have had it, whether it bleeds or itches, etc.
If your doctor thinks the growth may be cancer, they may take a small sample of tissue . The tissue sample will be sent to a laboratory and examined under a microscope. Your doctor will let you know whether the sample showed any cancer cells, and will recommend appropriate treatment if necessary.
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Treatment Of Basal Cell Carcinoma
Removal of the tumor
Doctors may remove the cancer in the office by scraping and burning it with an electric needle or by cutting it out. Doctors may destroy the cancer by using extreme cold .
Certain chemotherapy drugs may be applied to the skin. Photodynamic therapy , in which chemicals and a laser are applied to the skin, also may be used. Occasionally, radiation therapy is used.
A technique called Mohs microscopically controlled surgery may be required for some basal cell carcinomas that are large or regrow or occur in certain areas, such as around the nose and eyes.
People whose cancer has spread to nearby tissues or spread to other parts of the body and who are not candidates for surgery or radiation therapy may be given the drug vismodegib or sonidegib taken by mouth.
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Mohs Micrographically Controlled Excision
Mohs micrographically controlled surgery involves examining carefully marked excised tissue under the microscope, layer by layer, to ensure complete excision.
- Very high cure rates achieved by trained Mohs surgeons
- Used in high-risk areas of the face around eyes, lips and nose
- Suitable for ill-defined, morphoeic, infiltrative and recurrent subtypes
- Large defects are repaired by flap or skin graft
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What Are The Risk Factors For Superficial Basal Cell Carcinoma Of Skin
The risk factors that contribute to Superficial Basal Cell Carcinoma of Skin formation include:
- Prolonged sun exposure, exposure to ultraviolet light
- Use of tanning beds, tanning parlors
- Arsenic exposure
- Ionizing radiation
- The presence of certain genetic syndromes such as basal cell nevus syndrome increases the risk
- Caucasians are more vulnerable compared to other darker-toned individuals
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
Surgical Procedures For Basal & Squamous Cell Skin Cancers
Basal or squamous cell skin cancers may need to be removed with procedures such as electrodessication and curettage, surgical excision, or Mohs surgery, with possible reconstruction of the skin and surrounding tissue.
Squamous cell cancer can be aggressive, and our surgeons may need to remove more tissue. They may also recommend additional treatments for advanced squamous cell cancer, such as medications or radiation therapyenergy beams that penetrate the skin, killing cancer cells in the body.
Basal cell cancer is less likely to become aggressive, but if it does, our doctors may use surgery and other therapies to treat it.
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How Is Basal Cell Cancer Of The Head And Neck Diagnosed
Diagnosis is made by clinical exam and a biopsy. Basal cell cancers are staged by size and extent of growth. These cancers rarely metastasize to lymph nodes or other organs, but they can grow quite large and invade small nerves and local structures.
Biopsy can help determine if the basal cell cancer is a low-risk tumor or a high-risk tumor that requires more aggressive treatment. Low-risk tumors are often nodular and do not have nerve involvement. High-risk tumors in the head and neck are those that involve the central face, nose and eye area, as well as those tumors that are greater than or equal to 10 millimeters on the cheeks, scalp and neck tumors that are recurrent or arising from previously radiated tissue and tumors arising in patients who are immunosuppressed. An aggressive growth pattern on the pathology evaluation and perineural invasion are also features of high-risk basal cell cancers.
How Can I Prevent Basal Cell Carcinoma From Recurring
Most basal cell carcinomas can be treated and cured. However, it is possible for these types of cancers to recur or for new skin cancers to appear.
Do the following to reduce the risk of new cancers occurring:
- Keep all follow-up appointments with your GP or skin specialist.
- Regularly check all your skin . If you see anything that is growing, bleeding or in any way changing, go and see your doctor straight away. See skin checks
- Protect your skin from the sun and avoid indoor tanning. This is essential to prevent further damage, which will increase the risk of getting another skin cancer.
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What You Should Know About Basal Cell Carcinoma Symptoms
When it comes to BCC symptoms, they can vary significantly from one person to the next, according to physicians and other practitioners. For example, skin anomalies tend to appear darker in dark-skinned individuals compared to those who are fair-skinned. Additionally, some people with BCC will experience oozing, bleeding, or crusting of the skin while others will not. That said, it is best to avoid self-diagnosis and seek medical treatment if you notice any changes in the appearance of your skin. This is true even if they are small changes.
Physicians With Mohs Plastic Surgeon Los Angeles Weigh In On The Differences Between Electrosurgery And Mohs Surgery
Electrosurgery Despite the name, electrosurgery is not quite as invasive as some people might think. This approach to treating and curing BCC entails scraping or shaving off the cancer growths on the skin with what is known as a curette. For reference, a curette is a sharp medical instrument that has a ring-shaped tip attached to it. From there, the physician will use a chemical agent, such as Cisplatin, Busulfan, or Altretamine, to kill off any cancer cells left behind. This procedure, according to several MOHs plastic surgeon physicians, is a go-to for treating patients with early-stage BCC.
Mohs surgery Slightly more invasive than electrosurgery, Mohs surgery, named after Frederic E. Mohs, MD, is considered by most physicians to be a better choice for resolving tumors related to BCC. It is worth noting that the surgical procedure causes very little damage to nearby healthy skin tissue. To begin, the physician will cut away the tumor and a small amount of the tissue that surrounds it. That tissue is then examined by a lab technician who will determine whether or not it contains cancer cells. If cancerous cells are present, the physician will cut away more of the surrounding tissue to ensure the patient is cancer-free and to reduce the risk of a recurrence.
It is worth noting that radiation therapy and cryosurgery are also treatment options that many physicians will recommend to patients with BCC.
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What Is The Prognosis Of Basal Cell Carcinoma
The prognosis for patients with BCC is excellent, with a 100% survival rate for cases that have not spread to other sites. Nevertheless, if BCC is allowed to progress, it can result in significant morbidity, and cosmetic disfigurement is not uncommon.
Typically, basal cell tumors enlarge slowly, relentlessly and tend to be locally destructive. Periorbital tumors can invade the orbit, leading to blindness, if diagnosis and treatment are delayed. BCC arising in the medial canthus tends to be deep and invasive and more difficult to manage this type of BCC can result in perineural extension and loss of nerve function.
Although BCC is a malignant neoplasm, it rarely metastasizes. The incidence of metastatic BCC is estimated to be less than 0.1%. The most common sites of metastasis are the lymph nodes, lungs, and bones.
Although treatment is curative in more than 95% of cases, BCC may recur, especially in the first year, or develop in new sites. Therefore, regular skin screenings are recommended.
Cameron MC, Lee E, Hibler BP, Barker CA, Mori S, Cordova M, et al. Basal cell carcinoma: Epidemiology pathophysiology clinical and histological subtypes and disease associations. J Am Acad Dermatol. 2019 Feb. 80 :303-317. .
Cameron MC, Lee E, Hibler BP, Giordano CN, Barker CA, Mori S, et al. Basal cell carcinoma: Contemporary approaches to diagnosis, treatment, and prevention. J Am Acad Dermatol. 2019 Feb. 80 :321-339. .
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Key Points About Basal Cell Carcinoma
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Recurrent Basal Cell Carcinoma
Recurrent basal cell carcinoma refers to cancer that has come back after treatment and a period of time during which there is no trace of the cancer. Although basal cell carcinoma has an excellent cure rate, it is not uncommon for patients to develop multiple lesions during their lifetimes. People who have already had one skin cancer have a higher risk of developing additional skin cancers in the future, so anyone who has been diagnosed with one basal cell carcinoma should be especially watchful for signs of recurrence.
Most recurrences happen within three to five years of a patients original diagnosis. Although anyone can experience a basal cell carcinoma recurrence, several studies have shown recurrence is more likely in:
- People who had a history of eczema
- People who were exposed to high doses of UV light in their teens, 20s and 30s
- People whose original carcinomas were larger than 2 centimeters
- People whose original carcinomas were several layers deep in the skin
Although its impossible to predict whether basal cell carcinoma will come back, people who have undergone treatment for one lesion are often advised to schedule regular follow-up visits with their oncologists and/or dermatologists. These people should also consistently check for unusual changes in their skin and report any abnormalities to their physician right away.
Oral Medications For Advanced Bcc
It is rare for skin cancer to reach advanced stages, but when it does, oral medications may help. In addition to chemotherapy, targeted drugs may be used to treat advanced skin cancer. Targeted therapy means that the medication is able to directly target the cancer cells without destroying healthy cells. This can help to reduce side effects from treatment.
Vismodegib and sonidegib are hedgehog pathway inhibitors that work to prevent cancer cells from growing and spreading. The capsules are taken once per day and may be considered after surgery and other treatments. These medications come with several possible side effects and should never be taken during pregnancy since they can affect fetal growth.
Cetuximab is an EGFR inhibitor that can help to stop the spread of cancerous squamous cells. Its possible side effects include skin infections, diarrhea, mouth sores, and loss of appetite.
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Ask The Expert: Why Am I Having Surgery To Remove A Small Basal Cell Carcinoma
Although the nonmelanoma skin cancer basal cell carcinoma is rarely life-threatening, it can be troublesome, especially because 80 percent of BCCs develop on highly visible areas of the head and neck. These BCCs can have a substantial impact on a persons appearance and can even cause significant disfigurement if not treated appropriately in a timely manner.
The fact is, BCCs can appear much smaller than they are. On critical areas of the face such as the eyes, nose, ears and lips, they are more likely to grow irregularly and extensively under the skins surface, and the surgery will have a greater impact on appearance than might have been guessed. Even a small BCC on the face can be deceptively large and deep the extent of the cancer cannot be seen with the naked eye.
If such a BCC is treated nonsurgically , the chance of the cancer recurring is high. Unfortunately, treating a BCC that has returned is usually much more difficult than treating it precisely and completely when initially diagnosed.
BCCs on the trunk, arms and legs that cause concern are typically larger in size, but even a small BCC in these areas can have an irregular growth pattern under the skin if the initial biopsy shows the tumor is aggressive. In addition, a small BCC in an area previously treated with radiation may be much more aggressive than it appears on the surface. Again, treating such a tumor nonsurgically is likely to leave cancer cells behind.
About the Expert:
Answer: How Deep Does Moh’s Surgery Go In Removing Basal Cell Carcinoma On Scalp
Hello! Thank you for your question! Moh’s Surgery will serially excise thin slices and evaluate each slice under a microscope, ensuring complete excision of the skin cancer. Although very rare, BCC can be locally aggressive, but unlikely. If by chance, there is direct invasion to surrounding structures, your Moh’s surgeon will likely refer you to a surgeon for management of that particular area. This is a very unlikely scenario given a BCC. Moh’s Surgery has excellent literature showing minimal recurrence rate. Best wishes!
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