Is It Time For Your Annual Skin Check
One of the best ways to prevent basal cell carcinoma is to take steps to protect your skin from the sun, including daily sunscreen, protective clothing, and seeking shade whenever possible. If you have a high risk of developing skin cancer, then make sure that you dont miss your yearly skin check-up with your dermatologist.
Are you experiencing any symptoms that concern you? Schedule an appointment with the dermatologists at the Center for Surgical Dermatology. Were now accepting patients for telemedical appointments!
Untreated Basal Cell Carcinomas
Basal Cell Carcinomas seldom spread to vital organs and respond well to early treatment. If untreated the consequences could include:
- Disfigurement
- Nerve, or muscle injury, or other injury to nearby structures like eyelids
- Certain rare, aggressive forms can be lethal if not treated promptly.
The larger the tumour has grown, the more extensive any surgical treatment would be. This could result in increased scarring.
In 2016 it is estimated that there were 560 deaths in Australia from non-melanoma skin cancers. It is not possible to identify how many of these are Basal Cell Carcinomas as this data is not separately recorded.
What Is Skin Cancer
Cancer can start any place in the body. Skin cancer starts when cells in the skin grow out of control.
Skin cancer cells can sometimes spread to other parts of the body, but this is not common. When cancer cells do this, its called metastasis. To doctors, the cancer cells in the new place look just like the ones from the skin.
Cancer is always named based on the place where it starts. So if skin cancer spreads to another part of the body, its still called skin cancer.
The skin
Ask your doctor to use this picture to show you where your cancer is
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What Happens If I Dont Have A Basal Cell Carcinoma Treated
As mentioned above, basal cell carcinomas are almost never fatal, but they can be highly disfiguring if left to grow unimpeded. These lesions will grow wider and will penetrate more deeply into the skin, damaging underlying tissue and eventually bone. Removing these growths once they have become so established will involve removing much more surrounding tissue and possibly bone, which can be quite challenging if the growth is on an area such as the face.
Another thing about leaving a basal cell carcinoma untreated is that by doing so you are increasing the odds it will return even if it is removed at this point. Now youll have extra future costs of excision or another removal, along with more tissue loss.
None of this should happen. When basal cell carcinoma is diagnosed early on, removing the lesion is usually quite simple and the success rate is very high. If addressed early, its unlikely another basal cell carcinoma will return to that location, as well.
How Serious Is My Cancer
If you have skin cancer, the doctor will want to find out how far it has spread. This is called staging.
Basal and squamous cell skin cancers dont spread as often as some other types of cancer, so the exact stage might not be too important. Still, your doctor might want to find out the stage of your cancer to help decide what type of treatment is best for you.
The stage describes the growth or spread of the cancer through the skin. It also tells if the cancer has spread to other parts of your body that are close by or farther away.
Your cancer can be stage 0, 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread beyond the skin. Be sure to ask the doctor about the cancer stage and what it means for you.
Other things can also help you and your doctor decide how to treat your cancer, such as:
- Where the cancer is on your body
- How fast the cancer has been growing
- If the cancer is causing symptoms, such as being painful or itchy
- If the cancer is in a place that was already treated with radiation
- If you have a weakened immune system
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How Can A Basal Cell Carcinoma Be Treated
Thecommonest treatment for BCC is surgery. Usually, this means cuttingaway the BCC, along with some clear skin around it, using localanaesthetic to numb the skin. The skin can usually be closed with afew stitches, but sometimes a small skin graft is needed.
Othertypes of treatment include:
Difficultor neglected BCC -Mohs micrographic surgery. This involves the excision of the affectedskin that is then examined under the microscope straight away to seeif all the BCC has been removed. If any residual BCC is left at theedge of the excision further skin is excised from that area andexamined under the microscope and this process is continued until allthe BCC is removed. The site is then usually covered with a skingraft. This is a time consuming process and only undertaken forcertain BCC in difficult anatomical areas if simple surgery is notsuitable.
Radiotherapy-shining X-rays onto the area containing the BCC.
Verysuperficial BCC:
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Curettageand cautery– the skin is numbed with local anaesthetic and the BCC is scrapedaway and then the skin surface is sealed by heat.
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Cryotherapy-freezing the BCC with liquid nitrogen.
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Creams-these can be applied to the skin. The two most commonly used are5-fluorouracil and imiquimod.
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-a special cream is applied to the BCC which is taken up by the cellsthat are then destroyed by exposure to a specific wavelength oflight. This treatment is only available in certain dermatologydepartments.
Basal Cell Carcinoma Treatment Options
Afterthe physicians examination, the diagnosis of BCC is confirmedwith a biopsy. In this procedure, the skin is first numbed with localanesthesia. A piece of tissue is then removed and sent to be examinedunder a microscope in the laboratory to seek a definitive diagnosis.If tumor cells are present, treatment is required. Fortunately, thereare several effective methods for eradicating BCC. Choice oftreatment is based on the type, size, location, and depth ofpenetration of the tumor, the patients age and general health,and the likely cosmetic outcome of specific treatments.
Treatmentcan almost always be performed on an outpatient basis in thephysicians office or at a clinic. With the various surgicaltechniques, a local anesthetic is commonly used. Pain or discomfortduring the procedure is minimal, and pain afterwards is rare.
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What Are The Possible Complications Of Infiltrating Basal Cell Carcinoma Of Skin
The complications of Infiltrating Basal Cell Carcinoma of Skin could include:
- If the tumor becomes big, develops into a firm mass and ulcerates, it can get secondarily infected with bacteria or fungus
- Metastasis to regional lymph nodes can occur. The tumor can also infiltrate very deep into the surrounding structures
- Infiltrating BCC of Skin can cause cosmetic issues, since these skin tumors can cause large ulceration
- Recurrence of the tumor after a period of time recurrence is frequently common with large tumors. The risk of recurrence is also higher with Infiltrative BCC compared to other BCC subtypes
- Side effects of chemotherapy and radiation
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.
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What Are The Clinical Features Of Basal Cell Carcinoma
BCC is a locally invasive skin tumour. The main characteristics are:
- Slowly growing plaque or nodule
- Skin coloured, pink or pigmented
- Varies in size from a few millimetres to several centimetres in diameter
- Spontaneous bleeding or ulceration
BCC is very rarely a threat to life. A tiny proportion of BCCs grow rapidly, invade deeply, and/or metastasise to local lymph nodes.
Questions To Ask The Doctor
- Do you know the stage of the cancer?
- If not, how and when will you find out the stage of the cancer?
- Would you explain to me what the stage means in my case?
- What will happen next?
There are many ways to treat skin cancer. The main types of treatment are:
- Surgery
- Immunotherapy
- Chemotherapy
Most basal cell and squamous cell cancers can be cured with surgery or other types of treatments that affect only the spot on the skin.
The treatment plan thats best for you will depend on:
- The stage and grade of the cancer
- The chance that a type of treatment will cure the cancer or help in some way
- Your age and overall health
- Your feelings about the treatment and the side effects that come with it
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When Should I See My Doctor
If you have had one BCC, you have a 50% chance of developing another one, so it is important to check your skin regularly.
Most people find BCCs by checking their own skin and looking for changes. See a doctor if you find:
- a spot that is different from other spots on your skin
- a spot that has changed size, shape, colour or texture
- a sore that doesnt heal
- a sore that is itchy or bleeds
Can Basal Cell Carcinoma Invade Bone
Metastasis of BCC is extremely uncommon with an estimated rate ranging from 0.0028% to 0.55%. Only around 300 cases of metastatic BCC have been reported since the first reported case by Beadles in 1894. While bone invasion by BCC is well reported in the head and neck region,812 direct long bone invasion is not.
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Basal Cell Carcinoma Staging
Staging is the process of determining whether cancer has spread and, if so, how far. The stage of the disease may affect the treatment plan.
The stage is based on the size of the tumor, how deeply into the skin it has grown, and whether cancer has spread beyond the tumor to the lymph nodes. Your doctor will look at the results of the biopsy to determine the stage. In rare cases, your doctor may recommend imaging such as CT or PET-CT scan to see if the cancer has spread beyond the skin
Stages are numbered in Roman numerals between 0 and IV.
Most non-melanoma skin cancers are Stage 0 or Stage 1. Stage 3 and 4 are relatively rare. Based on the type of cancer, the stage of cancer, your overall health, and other factors, your doctor works with you to develop a treatment plan.
High risk features for primary tumor staging
- Depth/invasion: > 2 mm thickness , Clark level IV, Perineural invasion
- Anatomic: Primary site ear
- Location: Primary site hair-bearing lip
- Differentiation: Poorly differentiated or undifferentiated
How Is Infiltrating Basal Cell Carcinoma Of Skin Treated
In general, the treatment of Basal Cell Carcinoma of Skin depends upon a variety of factors including:
- The subtype of BCC
- The location of the tumor
- The number of tumors
- The size of the tumor
- Whether the tumor has metastasized
A combination of treatment methods may be used to treat Infiltrating Basal Cell Carcinoma of Skin. The type of surgery may include:
- Shave biopsy of skin: This procedure is used for small tumors. There is no requirement of sutures after the surgery
- Excision of tumor: In this procedure, the tumor and surrounding tissue are removed with clear margins. Depending upon the amount of skin removed, surgical sutures may be necessary
- Mohs surgery: In this procedure, the tumor is removed layer by layer precisely, until clear margins are achieved. Each layer removed is examined under a microscope through a âfrozen sectionâ procedure, for the presence of residual tumor
In most cases, a surgical removal of the entire tumor is the preferred treatment option. This can result in a cure. However, since the tumor infiltrates deep into the body, it is very difficult to completely remove them through a surgical excision
Other techniques to treat this skin cancer may include:
Note: If multiple lesions occur in children, then the possibility of basal cell nevus syndrome should be eliminated.
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When Is A Mole A Problem
A mole is a benign growth of melanocytes, cells that gives skin its color. Although very few moles become cancer, abnormal or atypical moles can develop into melanoma over time. Normal moles can appear flat or raised or may begin flat and become raised over time. The surface is typically smooth. Moles that may have changed into skin cancer are often irregularly shaped, contain many colors, and are larger than the size of a pencil eraser. Most moles develop in youth or young adulthood. Its unusual to acquire a mole in the adult years.
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Basal Cell Carcinoma Recurrence
Doctors at the Bondi Junction Skin Cancer Clinic have seen a significant increase in the number of patients in their twenties and thirties are being treated for Basal Cell Carcinoma over the last 17 years.
Men with Basal Cell Carcinoma have outnumbered women with the disease, but more women are getting Basal Cell Carcinomas than in the past.
Regular checks at the Bondi Junction Skin Cancer Clinic should be performed so that not only the site previously treated, but the entire skin surface can be examined, and mapped digitally and compared to the images taken at subsequent skin checks.
Basal Cell Carcinomas on the scalp and nose are especially troublesome, with higher rates of recurrence and with these recurrences typically taking place within the first two to three years following surgery.
Should a cancer recur, your Doctor might recommend a different type of treatment. Some methods, such as Mohs micrographic surgery, may be highly effective for recurrences.
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Melanoma Skin Cancer Growth Rate
Melanoma skin cancer is the most dangerous and aggressive type of skin cancer, but it is significantly less common than other, non-melanoma types of skin cancer like Squamous cell carcinoma and Basal cell carcinoma. Melanoma skin cancer has a rapid growth rate, which is what makes it so dangerous it can turn life-threatening in just six weeks and poses a high risk of spreading to other parts of the body if left untreated. The early form of squamous cell carcinoma is known as Bowens disease.
What About Other Treatments That I Hear About
When you have cancer you might hear about other ways to treat the cancer or treat your symptoms. These may not always be standard medical treatments. These treatments may be vitamins, herbs, special diets, and other things. You may wonder about these treatments.
Some of these are known to help, but many have not been tested. Some have been shown not to help. A few have even been found to be harmful. Talk to your doctor about anything youre thinking about using, whether its a vitamin, a diet, or anything else.
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Tests That May Be Done
The doctor will ask you questions about when the spot on your skin first showed up and if it has changed in size or the way it looks or feels. The rest of your skin will be checked. During the exam your doctor will check the size, shape, color and texture of any skin changes. If signs are pointing to skin cancer, more tests will be done.
Skin biopsy
In a biopsy, the doctor takes out a small piece of tissue to check it for cancer cells. A biopsy is the only way to tell for sure if you have skin cancer and what kind it is.
There are many types of skin biopsies. Ask your doctor what kind you will need. Each type has pros and cons. The choice of which type to use depends on your own case.
In rare cases basal and squamous cell skin cancer can spread to the nearby lymph nodes Ask your doctor if your lymph nodes will be tested.
Basal and squamous cell cancers dont often spread to other parts of the body. But if your doctor thinks your skin cancer might spread, you might need imaging tests, such as MRI or CT scans.
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Who Gets Infiltrating Basal Cell Carcinoma Of Skin
- Infiltrating Basal Cell Carcinoma of Skin is an uncommon skin cancer that generally affects elderly or older adults some cases rarely develop in children too
- It can occur in both males and females however
- Among the older age group, males are affected more than females
- In the younger age group, females are affected more than males, which may be attributed to their tendency to acquire sun-tanned bodies or visit skin tanning parlors more
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What Are The Risk Factors For Infiltrating Basal Cell Carcinoma Of Skin
The risk factors that contribute to Infiltrating Basal Cell Carcinoma of Skin formation include:
- Prolonged sun exposure, exposure to ultraviolet light
- Use of tanning beds, tanning parlors
- Arsenic exposure
- 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 ones 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.
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