Basal Cell Carcinoma: What You Need To Know
Basal cell carcinoma is the most common cancer in the world. One out of two people will have a BCC growth before age 65. Although BCC is rarely life threatening, it should be taken seriously. If left untreated, this cancer can be disfiguring, especially on the face.
The information in these pages will help you understand more about BCC: what it is, what causes it, how it is diagnosed and treated, and how you can prevent it.
What is basal cell carcinoma?
Basal cell carcinoma is a type of skin cancer. It begins in the basal cells, the deepest part of the skins outermost layer. Basal cell carcinomas almost never spread beyond their original site to other parts of the body, especially when treated early.
What do basal cell carcinomas look and feel like?
As shown below, basal cell carcinomas vary widely, with a number of different appearances:
Open sores that dont heal
A round ulcer that looks as though a bite has been taken out of the middle
Red patches that have a sandpapery feel
Shiny bumps that are raised, hard, pearly pink or gray
An area of thickened skin
A bump with a rolled edge
A lesion with blood vessels that look like the spokes of a wheel
Basal cell carcinomas can occur anywhere on the body they may appear to sit on top of the skin, or burrow into it. Most lesions are painless. Sometimes they can feel itchy. They may bleed easily if caught on clothing or nicked during shaving.
What causes basal cell carcinoma?
How is basal cell carcinoma diagnosed?
Answer: Risk Of Not Treating Basal Cell Carcinoma
Basal Cell Carcinoma is a locally destructive type of skin cancer that is notorious for recurrence when not adequately treated. It can become quite disfiguring if left untreated, especially when located in cosmetically sensitive areas such as the nose. Typically this type of skin biopsy is performed for diagnosis and is not adequate treatment for a skin cancer. Biopsies sample a portion of the lesion, leaving some behind. This type of sampling biopsy is not intended to remove the entire lesion. It is not advisable to leave a known skin cancer untreated as it will likely grow and become more of a problem to remove in the future. Mohs micrographic surgery allows for 100% margin control and is tissue-sparing, which means it offers the highest cure rate while preserving as much normal tissue as possible.
What Is A Basal Cell Carcinoma
Basal cell carcinoma is a type of skin cancer that occurs when there is damage to the DNA of basal cells in the top layer, or epidermis, of the skin. They are called basal cells because they are the deepest cells in the epidermis. In normal skin, the basal cells are less than one one-hundredth of an inch deep, but once a cancer has developed, it will spread deeper.
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What Happens If You Let Skin Cancer Go Untreated
Many patients who are diagnosed with skin cancer, especially in the earliest stages, find themselves wondering whether treatment is really necessary. Skin cancer, like other forms of cancer, is serious and requires proper treatment. According to Dr. Valerie Truong of U.S. Dermatology Partners in Dallas, Plano, Sherman, and Corsicana, Texas, The visible part of skin cancer can often be like the tip of an iceberg. What you see on the surface is only a small percentage of the actual cancer. Even if the skin cancer appears to be negligible, there is always a risk that it will grow and spread. I recommend that people who suspect they have skin cancer get a skin check for an earlier diagnosis, and therefore, earlier treatment. In this blog, Dr. Truong talks more about what happens if you let skin cancer go untreated and the potential risks that may arise for skin health as well as overall health and well-being.
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How Dermatologists Diagnose Basal Cell Carcinoma
When you see a board-certified dermatologist, your dermatologist will:
Examine your skin carefully
Ask questions about your health, medications, and symptoms
If your dermatologist finds a spot on your skin that could be any type of skin cancer, your dermatologist will first numb the area and then remove all of it. This can be done during an office visit and is called a skin biopsy. This is a simple procedure, which a dermatologist can quickly, safely, and easily perform.
Having a skin biopsy is the only way to know for sure whether you have any type of skin cancer. After your dermatologist removes the spot, a doctor, such as your dermatologist or a dermatopathologist, will examine it under a high-powered microscope. The doctor is looking for cancer cells.
If the doctor sees cancerous basal cells, the diagnosis is BCC.
After the doctor examines the removed skin under a microscope, the doctor writes a report. Called a biopsy report or a pathology report, this document explains in medical terms what was seen under the microscope.
If the diagnosis is any type of skin cancer, the information in this report will tell your dermatologist the key facts needed to treat the cancer, including:
The type of BCC you have
How deeply the cancer has grown
Your dermatologist will carefully consider your health and the findings in the report before choosing how to treat the cancer.
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Common Skin Cancer Can Signal Increased Risk Of Other Cancers
Frequent skin cancers due to mutations in genes responsible for repairing DNA are linked to a threefold risk of unrelated cancers, according to a Stanford study. The finding could help identify people for more vigilant screening.
Basal cell carcinomas are common. More than 3 million cases a year are diagnosed nationwide.jax10289/Shutterstock.com
People who develop abnormally frequent cases of a skin cancer known as basal cell carcinoma appear to be at significantly increased risk for developing of other cancers, including blood, breast, colon and prostate cancers, according to a preliminary study by researchers at the Stanford University School of Medicine.
The increased susceptibility is likely caused by mutations in a panel of proteins responsible for repairing DNA damage, the researchers found.
We discovered that people who develop six or more basal cell carcinomas during a 10-year period are about three times more likely than the general population to develop other, unrelated cancers, said Kavita Sarin, MD, PhD, assistant professor of dermatology. Were hopeful that this finding could be a way to identify people at an increased risk for a life-threatening malignancy before those cancers develop.
Sarin is the senior author of the study, which was published online Aug. 9 in JCI Insight. Medical student Hyunje Cho is the lead author.
What Are The Symptoms Of Basal Cell Carcinoma
BCCs usually develop on parts of the body that are often exposed to the sun, like the head, face, shoulders, arms and lower legs.
They often start with a subtle change in the skin, like a small bump or a flat red patch.
Signs of a BCC to look for include:
- a pearly spot or lump
- a scaly, dry area that is shiny and pale or bright pink in colour
- a sore that doesnt heal
- a sore that bleeds
See your doctor if you notice any new spots or an existing spot that changes size, shape or colour. Visit the Cancer Councils website for tips on how to check your skin.
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How Do Doctors Diagnose Basal Cell Skin Cancer
A doctor will get a medical history and perform a physical examination and then perform a skin biopsy to confirm the diagnoses of basal cell carcinoma. There are two types of skin biopsies that may be indicated:
- Shave biopsy: A small tool resembling a razor scrapes off a small area of the skin. This may be all that is needed.
- Punch biopsy: A circular tool punches through the deeper layers of skin.
Imaging studies are usually unnecessary, but if the cancer is suspected to have spread to deeper structures such as bone, then your doctor may use computed tomography scans or X-ray.
Prognosis Of Basal Cell Carcinoma
Treatment of basal cell carcinoma is nearly always successful, and the cancer is rarely fatal. However, almost 25% of people with a history of basal cell carcinoma develop a new basal cell cancer within 5 years of the first one. Thus, anyone with one basal cell carcinoma should have a yearly skin examination.
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How Serious Is Basal Cell Skin Cancer
Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology and Oncology at the New York Presbyterian Weill Cornell Medical Center.
Basal cell skin cancer, also called basal cell carcinoma, is usually very curable, but it can cause disfigurement and complications if it’s not treated. In the majority of cases, basal cell carcinoma is very treatable.
It is unusual for basal cell carcinoma to cause death. Approximately 2,000 people in the U.S. die each year from basal and squamous skin cancers. In most cases, people who die from these types of skin cancer tend to be older, immunosuppressed, or have been diagnosed at a very late stage.
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.
Ask your doctor to use this picture to show you where your cancer is
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Warning Signs Of Basal Cell Carcinoma That You Could Mistake As Harmless
Warning sign: A pink or reddish growth that dips in the centerCan be mistaken for: A skin injury or acne scar
A pink or reddish growth that dips in the center
The BCC on this patients cheek could be mistaken for a minor skin injury.
Warning sign: A growth or scaly patch of skin on or near the earCan be mistaken for: Scaly, dry skin, minor injury, or scar
A growth or scaly patch of skin on or near the ear
BCC often develops on or near an ear, and this one could be mistaken for a minor skin injury.
Warning sign: A sore that doesn’t heal and may bleed, ooze, or crust overCan be mistaken for: Sore or pimple
A sore that doesn’t heal, or heals and returns
This patient mistook the BCC on his nose for a non-healing pimple.
Warning sign: A scaly, slightly raised patch of irritated skin, which could be red, pink, or another colorCan be mistaken for: Dry, irritated skin, especially if it’s red or pink
A scaly, slightly raised patch of irritated skin
This BCC could be mistaken for a patch of dry, irritated skin.
Warning sign: A round growth that may be pink, red, brown, black, tan, or the same color as your skinCan be mistaken for: A mole, wart, or other harmless growth.
A round growth that may be same color as your skin
Would you recognize this as a skin cancer, or would you dismiss it as a harmless growth on your face?
When To Seek Medical Care
If you have developed a new bump on sun-exposed skin, or if you have a spot that bleeds easily or does not seem to be healing, then you should make an appointment with your primary care physician or with a dermatologist.Try to remember to tell your doctor when you first noticed the lesion and what symptoms, if any, it may have . Also, be sure to ask your parents, siblings, and adult children whether or not they have ever been diagnosed with a skin cancer, and relay this information to your physician.
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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.
Actinic Keratosis Signs And Symptoms
Many people have actinic keratosis , also called solar keratosis, on their skin. It shows that youÃ¢ve had enough sun to develop skin cancer, and it is considered a precursor of cancer, or a precancerous condition.
Usually AK shows up on the parts of your body that have received the most lifetime sun exposure, like the face, ears, scalp, neck, backs of the hands, forearms, shoulders and lips.
Some of the same treatments used for nonmelanoma skin cancers are used for AK to ensure it does not develop into a cancerous lesion.
This abnormality develops slowly. The lesions are usually small, about an eighth of an inch to a quarter of an inch in size. You may see a few at a time. They can disappear and later return.
- AK is a scaly or crusty bump on the skinÃ¢s surface and is usually dry and rough. It can be flat. An actinic keratosis is often noticed more by touch than sight.
- It may be the same color as your skin, or it may be light, dark, tan, pink, red or a combination of colors.
- It can itch or produce a prickling or tender sensation.
- These skin abnormalities can become inflamed and be encircled with redness. Rarely, they bleed.
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Basal Cell Carcinoma In Children And Young People
BCC is extremely rare in children under 15years of age, and when seen is generally in the context of inherited conditions such as Gorlin syndrome . Childhood BCC may also be seen in association with xeroderma pigmentosum, Bazex syndrome, Rombo syndrome, albinism, previous radiotherapy and naevus sebaceous., , Sporadic idiopathic BCC in childhood is also reported in the literature, with a total of 107 cases reported worldwide., All childhood BCC should be managed within the context of a specialist MDT including specialists experienced in treating skin cancer in children.,
The first-line treatment option for childhood BCC is surgery, with either standard surgical excision or Mohs micrographic surgery.- Other treatments described for treating childhood BCC include radiotherapy ,, , topical therapy, curettage and cautery, PDT and cryosurgery.- However, in view of the high recurrence rates for childhood BCC , these treatment options are not recommended.
Vismodegib has proven efficacy in treating BCCs associated with Gorlin syndrome, but its use in children is limited by side-effects, a high recurrence rate and incidence of new tumours on cessation of treatment. In addition, vismodegib is currently not recommended by NICE guidance in the UK.,
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 Life Expectancy For Basal Cell Skin Cancer
The prognosis for patients with basal cell carcinoma is very good, and the 5-year recurrence rate is about 5%. The cancer rarely spreads so patients can generally expect a normal life expectancy if doctors treat their cancer promptly.
Advanced basal cell carcinoma is rare, however, if the cancer is allowed to progress, it can cause significant illness.
Limitations Of The Guideline
This document has been prepared on behalf of the BAD and is based on the best data available when the document was prepared. It is recognized that under certain conditions it may be necessary to deviate from the guidelines and that the results of future studies may require some of the recommendations herein to be changed. Additionally, it is acknowledged that limited cost-effectiveness data in the context of the UK healthcare setting may impact on the availability of a given therapy within the NHS, despite evidence of efficacy. Failure to adhere to these guidelines should not necessarily be considered negligent, nor should adherence to these recommendations constitute a defence against a claim of negligence. Limiting the review to English-language references was a pragmatic decision but the authors recognize this may exclude some important information published in other languages.
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