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.
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.
There Are Three Ways That Cancer Spreads In The Body
Cancer can spread through tissue, the lymph system, and the blood:
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
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How Is Basal Cell Carcinoma Treated
BCCs can almost always be successfully treated. Treatment will depend on the type, size and location of the BCC, and on your age and health.
If the BCC was removed during the biopsy, you may not need any further treatment. Surgery is the most common treatment for a BCC. It involves cutting out the skin spot and nearby normal-looking tissue. A pathologist will check the tissue around the skin spot to make sure the cancer has been removed. If cancer cells remain, you may need more surgery.
Other treatment options include:
- freezing the spot with liquid nitrogen to kill the cancer cells
- scraping off the spot, then using low-level electric current to seal the wound and kill cancer cells
- immunotherapy creams, liquids and lotions, to treat superficial BCCs
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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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.
What Is A Basal Cell
One of three main types of cells in the top layer of the skin, basal cells shed as new ones form. BCC most often occurs when DNA damage from exposure to ultraviolet radiation from the sun or indoor tanning triggers changes in basal cells in the outermost layer of skin , resulting in uncontrolled growth.
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Diagnostic Tests For Basal Cell Carcinoma
The only way to diagnose cancer of the skin, including basal cell carcinoma, is with a skin biopsy. Your dermatologist will remove a small portion of tissue from the suspicious area, in which he or she will examine under a microscope. A skin biopsy is also an essential procedure to determine the best treatment plan for your case.
Skin Cancer Types: Basal Cell Carcinoma Overview
All content solely developed by the American Academy of Dermatology
The American Academy of Dermatology gratefully acknowledges the support from Sanofi Genzyme and Regeneron.
Basal cell carcinoma
What is basal cell carcinoma?The most common type of skin cancer, basal cell carcinoma can show up on the skin in many ways.
Is it contagious? No
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Nodular Basal Cell Carcinoma
Nodular basal cell carcinoma comprises about 60-80% of the cases and occurs most often on the skin of the head. Clinically it is presented by elevated, exophytic pearl-shaped nodules with telangiectasie on the surface and periphery . Subsequently, nodular BCC can extend into ulcerative or cystic pattern. The endophytic nodules are presented clinically as flat enduring plaques. The hemorrhagic lesions can resemble hemangioma or melanoma, especially if are pigmented. The lesions with big sizes and the central necrosis are defined as ulcus rodens. Histology revel nest-like infiltration from basaloid cells. . Differential diagnosis can be made by traumatically changed dermal nevus and amelanotic melanoma.
Nodular basal cell carcinoma. Peripheral palisading and retraction from surrounding stroma are clearly seen this case also shows keratinization
Related Services & Treatments
When detected early, most BCCs 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.
Treatment options depend on how many lesions you have, where they are, your age and overall health. They include:
Advanced BCC is treated with oral medications. Vismodegib and sonidegib are FDA-approved for treating adults with BCCs that are large or have penetrated the skin deeply, spread to other parts of the body or resisted multiple treatments and recurred. Both medications are targeted drugs taken by mouth.
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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.
Basal Cell Carcinoma Treatment
How is basal cell carcinoma treated?
The skin cancer specialists at Miami Cancer Institute are internationally renowned experts who offer the most advanced, innovative therapies available to treat your specific kind of cancer.
Every patients disease is unique, with different cells moving, changing or multiplying based on that persons individual genetic make-up. In addition to locating the tumor cells and determining what the genetic changes and markers are, other ways our specialists can create the best personalized treatment plan is to factor in a patients age, overall health, family history, medical history, and finally to stage the cancer, which helps identify how far the disease has progressed.
Immediately after diagnosis, our specialty teams provide additional tests to determine if the cancer has affected other areas of the body. Treatment recommendations are made that same day so that patients can receive the best individualized treatment therapies as soon as possible.
Your personalized treatment plan may include:
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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.
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
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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
How Is Superficial Basal Cell Carcinoma Of Skin Treated
In general, the treatment of Superficial Basal Cell Carcinoma of Skin depends upon a variety of factors including:
- The location of the tumor
- The number of tumors
- The size of the tumor
- Any health considerations of the patient
A number of treatment methods may be used to treat Superficial Basal Cell Carcinoma of Skin. The treatment types may include:
Topical medications can be used to treat Superficial Basal Cell Carcinoma. This is because the thinness of the tumor permits permeation of the active ingredient to the full depth of the carcinoma. The two most frequently used active ingredients are imiquimod and 5-Flurouracil.
- Imiquimod is an immune system signal which calls for the migration of T-cells into the area of the tumor, which actively kill the cancer cells
- 5-Flurouracil is a metabolic agent which toxically kills the more basal cell carcinoma cells. The surrounding normal skin does not absorb the medication and hence is safe from the toxicity
Both these topical applications take at least a few weeks to treat a typically sized lesion, longer for larger lesions. The actions will lead to redness, irritation, sometimes crusting and possibly secondary infection
One advantage of these creams is that it is sometimes possible to treat the Superficial Basal Cell Carcinoma without affecting the underlying skin at all, so after healing, little to no scarring is detectable.
Other techniques to treat this skin cancer may include:
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Who Gets Superficial Basal Cell Carcinoma Of Skin
- Superficial Basal Cell Carcinoma of Skin generally affects elderly adults some cases rarely develop in children and young adults too
- Superficial BCC of Skin constitutes approximately 15% of all Basal Cell Carcinoma of Skin types. It is the second most common type of BCC of Skin
- 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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Tests Or Procedures That Examine The Skin Are Used To Diagnose Basal Cell Carcinoma And Squamous Cell Carcinoma Of The Skin
The following procedures may be used:
- Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patients health habits and past illnesses and treatments will also be taken.
- Skin exam: An exam of the skin for bumps or spots that look abnormal in color, size, shape, or texture.
- Skin biopsy: All or part of the abnormal-looking growth is cut from the skin and viewed under a microscope by a pathologist to check for signs of cancer. There are four main types of skin biopsies:
- Shave biopsy: A sterile razor blade is used to shave-off the abnormal-looking growth.
- Punch biopsy: A special instrument called a punch or a trephine is used to remove a circle of tissue from the abnormal-looking growth. Enlarge Punch biopsy. A hollow, circular scalpel is used to cut into a lesion on the skin. The instrument is turned clockwise and counterclockwise to cut down about 4 millimeters to the layer of fatty tissue below the dermis. A small sample of tissue is removed to be checked under a microscope. Skin thickness is different on different parts of the body.
- Incisional biopsy: A scalpel is used to remove part of a growth.
- Excisional biopsy: A scalpel is used to remove the entire growth.
How Is Basal Cell Skin Cancer Treated When It Grows Deep Or Spreads
While this skin cancer tends to grow slowly, early treatment is recommended. Without treatment, BCC can grow deep, destroying what lies in its way. This can be disfiguring. The medical term for this is advanced basal cell carcinoma.
Its also possible for BCC to spread to other parts of your body, but this is rare. When the cancer spreads, it typically travels first to the lymph nodes closest to the tumor. From there, it tends to spread through the blood to bones, the lungs, and other parts of the skin. When this skin cancer spreads, it is called metastatic basal cell carcinoma.
For cancer that has grown deep or spread to the closest lymph nodes, treatment may involve:
Surgery to remove the tumor
Follow-up treatment with radiation to kill any remaining cancer cells
For some patients, medication that works throughout the body may be an option. Medication may also be used to treat cancer that:
Returns after surgery or radiation treatments
Has spread to another part of the body
Two such medications have been approved by the U.S. Food and Drug Administration . Both come in pill form and are taken every day. A patient only stops taking the medication if the cancer starts to grow, or the side effects become too severe.
The two medications are:
In clinical trials, these medications have been shown to stop or slow down the spread of the cancer and shrink the cancerous tumors in some patients.
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