Yes I Had S Basal Cell Carcinoma
The next day, the doctor called to tell me I had a basal cell carcinoma. I immediately did some research on the internet about this type of cancer. I found that it is a more common skin cancer. It seldom kills, but it can cause significant destruction and disfigurement of the surrounding tissues. These cancers affect 3 out of 10 Caucasiansand in 80% of these cases, they are found on the head and neck.
Most of these are caused by chronic sun exposure, and people who are fair skinned are more likely to develop it. These usually start out as an open sore, a red patch, a bump, or just a scar-like area. I had none of these signs. As I said, I had not even noticed the tiny little thing.
He told me to return the following day for a procedure called Mohs Micrographic Surgery. He fully explained the procedure and what I could expect. It would be performed in his office under local anesthesia. The Mohs procedure offers the highest cure rate for basal cell carcinomas.
Basal Cell Carcinoma Squamous Cell Carcinoma Of The Skin And Actinic Keratosis Often Appear As A Change In The Skin
Not all changes in the skin are a sign of basal cell carcinoma, squamous cell carcinoma of the skin, or actinic keratosis. Check with your doctor if you notice any changes in your skin.
Signs of basal cell carcinoma and squamous cell carcinoma of the skin include the following:
- A sore that does not heal.
- Areas of the skin that are:
- Raised, smooth, shiny, and look pearly.
- Firm and look like a scar, and may be white, yellow, or waxy.
- Raised and red or reddish-brown.
- Scaly, bleeding, or crusty.
Basal cell carcinoma and squamous cell carcinoma of the skin occur most often in areas of the skin exposed to the sun, such as the nose, ears, lower lip, or top of the hands.
Signs of actinic keratosis include the following:
- A rough, red, pink, or brown, scaly patch on the skin that may be flat or raised.
- Cracking or peeling of the lower lip that is not helped by lip balm or petroleum jelly.
Actinic keratosis occurs most commonly on the face or the top of the hands.
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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Signs And Symptoms Of Basal Cell Carcinoma
Basal cell carcinomas may appear and grow so slowly that you may not detect them initially. It is important to see your dermatologist when you notice a change in your skin that might indicate basal cell carcinoma, such as:
- A smooth, pale growth that may have a dent or dimple in the middle
- A small, pearly or waxy bump
- A red patch or irritated area
- A sore that scabs, heals, and regrows
- A bleeding or oozing sore
Targeted Therapy Or Immunotherapy For Advanced Basal Cell Cancers
In rare cases where basal cell cancer spreads to other parts of the body or cant be cured with surgery or radiation therapy, a targeted drug such as vismodegib or sonidegib can often shrink or slow its growth.
If these drugs are no longer working , the immunotherapy drug cemiplimab can sometimes be helpful.;
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Surgery For Basal And Squamous Cell Skin Cancers
Surgery is a common treatment for basal cell and squamous cell skin cancers. Different surgical techniques can be used. The options depend on the type of skin cancer, how large the cancer is, where it is on the body, and other factors. Most often the surgery can be done in a doctors office or hospital clinic using a local anesthetic . For skin cancers with a high risk of spreading, surgery sometimes will be followed by other treatments, such as radiation or chemotherapy.
Skin Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Skin
The skin is the bodys largest organ. It protects against heat, sunlight, injury, and infection. Skin also helps control body temperature and stores water, fat, and vitamin D. The skin has several layers, but the two main layers are the epidermis and the dermis . Skin cancer begins in the epidermis, which is made up of three kinds of cells:
- Squamous cells: Thin, flat cells that form the top layer of the epidermis.
- Basal cells: Round cells under the squamous cells.
- Melanocytes: Cells that make melanin and are found in the lower part of the epidermis. Melanin is the pigment that gives skin its natural color. When skin is exposed to the sun, melanocytes make more pigment and cause the skin to darken.
Skin cancer can occur anywhere on the body, but it is most common in skin that is often exposed to sunlight, such as the face, neck, and hands.
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Mohs Microscopically Controlled Surgery
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Because skin cancer cells often have spread beyond the edges of the visible patch on the skin, doctors sometimes use a special surgical technique to make sure they remove all of the cancer. In this technique, called Mohs microscopically controlled surgery or Mohs micrographic surgery, doctors first remove the visible tumor and then begin cutting away the edges of the wound bit by bit. During surgery, doctors examine pieces of tissue to look for cancer cells. Tissue removal from the area continues until the samples no longer contain cancer cells. This procedure enables doctors to limit the amount of tissue removed and thus is especially useful for cancers near such important sites as the eye. After removing all of the cancer, doctors decide how best to replace the skin that has been cut away. They may bring the edges of the remaining skin together with sutures or use a skin graft or skin flap. Or they may place dressings on top of the wound and let the skin heal on its own. Mohs surgery reduces recurrence rates for skin cancers. This surgery is useful for basal cell and squamous cell cancers but is less often used for melanoma. |
Treating Basal Cell Carcinoma
Several types of treatment can be used to remove or destroy basal cell skin cancers. The options depend on factors such as the tumor size and location, and a persons age, general health, and preferences. These cancers very rarely spread to other parts of the body, although they can grow into nearby tissues if not treated.
All of the treatments listed here can be effective when used in appropriate situations. The chance of the cancer coming back ranges from less than 5% after Mohs surgery to up to 15% or higher after some of the others, but this depends on the size of the tumor. Small tumors are less likely to recur than larger ones. Even if a tumor does recur, it can often still be treated effectively.
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After Squamous Cell Cancer Of The Skin Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Skin Or To Other Parts Of The Body
The process used to find out if cancer has spread within the skin or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment for squamous cell carcinoma of the skin.
Basal cell carcinoma of the skin rarely spreads to other parts of the body. Staging tests to check whether basal cell carcinoma of the skin has spread are usually not needed.
The following tests and procedures may be used in the staging process for squamous cell carcinoma of the skin:
Skin Grafting And Reconstructive Surgery
After surgery to remove a large basal or squamous cell skin;cancer, it may not be possible to stretch the nearby skin enough to stitch the;edges of the wound together. In these cases, healthy skin can be taken from;another part of the body and grafted over the wound to help it heal and to;restore the appearance of the affected area. Other reconstructive surgical;procedures, such as moving ‘flaps’ of nearby skin over the wound, can also be helpful in some cases.
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Effective Options For Early And Advanced Bcc
When detected early, most basal cell carcinomas can be treated and cured. Prompt treatment is vital, because as the tumor grows, it becomes more dangerous and potentially disfiguring, requiring more extensive treatment. Certain rare, aggressive forms can be fatal if not treated promptly.
If youve been diagnosed with a small or early BCC, a number of effective treatments can usually be performed on an outpatient basis, using a local anesthetic with minimal pain. Afterwards, most wounds can heal naturally, leaving minimal scarring.
Options include:
Cancer May Spread From Where It Began To Other Parts Of The Body
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
- Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if skin cancer spreads to the lung, the cancer cells in the lung are actually skin cancer cells. The disease is metastatic skin cancer, not lung cancer.
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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.;
Topical 5% Imiquimod Cream
Imiquimod is an immune response modifier. It acts by binding to toll-like receptor. This induces proinflammatory cytokine production and subsequent cytotoxic T cell mediated cell death. It is licensed for use in the treatment of sBCCs.
Vehicle-controlled studies in the treatment of small sBCC by Geisse et al. have reported reasonable results. Twelve weeks following the 6 week treatment course the clearance rates were 82% , 79% and 3% . Moderate to severe local site reactions occurred in 87% with erosions and ulceration in 36% and 22%, respectively. However, it is worth noting that facial BCCs were not included in this study. Schulze et al. found similar clearance rates following a 6 weeks course of 7x/week topical imiquimod, with a 80% histological clearance compared to 6% for vehicle alone. However, long term clearance rates are lower. A prospective study of 182 patients who received topical imiquimod applied 5x/week for 6 weeks gave clearance rates of 69% at 5-years .
There is some data to suggest that imiquimod may be used in the treatment of nBCCs. A randomized dose-response study reported that 6 weeks after treatment with either a 6- or 12-week course of 7x/week imiquimod histological clearance rates were 71% and 76%, respectively . A further randomized trial on nBCCs reported complete clinical clearance in 78% following 3x/week imiquimod. However, 8 weeks later excision revealed residual BCC in 13% of the patients considered to have shown complete clinical clearance .
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What Does A Basal Cell Carcinoma Look Like
BCCs can vary greatly in their appearance, but people often first become aware of them as a scab that bleeds and does not heal completely or a new lump on the skin. Some BCCs are superficial and look like a scaly red flat mark on the skin.; Others form a lump and have a pearl-like rim surrounding a central crater and there may be small red blood vessels present across the surface. If left untreated, BCCs can eventually cause an ulcer; hence the name rodent ulcer. Most BCCs are painless, although sometimes they can be itchy or bleed if caught.
One Week After Surgery
One long week later, I went back to the doctors office to have my eye opened. I was nervous because, well, its my eye! and it was very sore after the surgery and being sewn shut. But it took seconds for the doctor to snip the stitches and didnt hurt at all. I was a bit scared to open my eye, but it opened just like normal and worked perfectly. In that opening and the next couple of blinks it was almost like the past week had never happened. Then the doctor handed me a mirror and my eye looked perfect. The upper and lower lid were a bit bruised and I had black stitches on my lower lid , but my lower eyelid looked perfect! And it worked perfectly! Within seconds if felt almost normal again.;
I was mildly bruised for a couple of weeks. But given what my eye had been through, the bruising was really nothing. This photo is three weeks after my surgery.;
Stitches ;I had internal stitches left in my lower eyelid. One of my stitches made its way out through my eyelid. My doctor told me this was unusual, but does happen. It wasnt painful, just a bit startling. It looked like a hairbrush bristle coming out of the edge of my lower eyelid. It ended up just falling right out. No big deal.
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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.
My Experience With The Mohs Procedure
I was very nervous on the day on the procedure. If I were a drinking person, I would have belted down a couple of stiff drinks that morning before I went in. After some warm reassurance by my doctor that everything would be just fine, he anesthetized the area on my forehead, waited about 15 minutes, and then removed the first layer of cells. He told me to just relax and give him time to examine the tissue under the microscope. He would be able to tell if he got all the cancer cells, and that would be the end of the procedure. After about 45 minutes, he came back and said he needed to remove some more of the lesion.
It took three additional attempts to make sure he got all of the cancer cells. He assured me that the Mohs procedure removes only tissue containing cancer cells. By this time, I could just imagine a big hole in the middle of my forehead. Then he explained that he would make a clean incision across the area and suture it up. Later on, I saw five sutures in a neat little row.
I was instructed to use the antibiotic cream he gave me twice a day on the area, and then return in seven days for suture removal, which I did. It has now been four weeks since I had the Mohs procedure done. It is healing very nicely. I dont think Ill even have a scar.
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Advice For Future Treatments
A suggestion from one who went through a biopsy on my nose followed by Mohs. Have them use Lidocaine cream to numb the area before the needle. Less painful. No fun for sure but at least it doesn’t hurt as much for the nose biopsy. – Donna
I ended up being hospitalized a week after surgery due to dehydration. Due to the pain I didn’t eat or drink much. Stay hydrated and fed after the procedure. – Linda
From the neck up, use a plastic surgeon. I have had several squamous removed from my head and face and you cant tell. One Mohs on my ear is more obvious. The ones on my legs have left dents. – Judith
Find a top notch doc that does MOHs procedure. Once you know you are prone to any skin cancers, be ever vigilant! I have alerted my dermatologist to each of my melanomas, several squamous cell and basil cell. You know your body. If something seems different, get it checked out. Use your sunblocks hats and protective clothing. – Mary
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