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Where Does Basal Cell Carcinoma Occur

Basal Cell Carcinoma Is Common

Basal Cell Carcinoma Causes, Warning Signs, and Treatments

If youve been diagnosed with basal cell carcinoma or BCC, you have plenty of company. As the most common type of cancer in the world, doctors diagnose millions of people with BCC every year. In the United States alone, its estimated that about 2 million Americans hear, You have basal cell carcinoma, each year.1

Most people who develop this skin cancer have fair skin that they seldom protected with sunscreen or sun-protective clothing. Before they developed skin cancer, they often noticed signs of sun damage on their skin, such as age spots, patches of discolored skin, and deep wrinkles.

Dermatologist examining patient for signs of skin cancer

You have a greater risk of developing this skin cancer if youve seldom protected your skin from the sun throughout your life or used tanning beds.

Although BCC is most common in people who have fair skin, people of all colors get this skin cancer.

For most people, BCC is not life-threatening. It tends to grow slowly. It seldom spreads to another part of the body. Even so, treatment is important.

When found early, this skin cancer is highly treatable. An early BCC can often be removed during an appointment with your dermatologist.

Given time to grow, this skin cancer can grow deep, injuring nerves, blood vessels, and anything else in its path. As the cancer cells pile up and form a large tumor, the cancer can reach into the bone beneath. This can change the way you look, and for some people the change may be disfiguring.

How Dangerous Is A Basal Cell Carcinoma

While melanoma rightly deserves the attention it receives as the most dangerous form of skin cancer, basal cell carcinoma isnt something to brush off as harmless. Yes, this most common form of skin cancer rarely causes fatalities, but it can become quite disfiguring.

While basal cell carcinoma lesions rarely spread beyond the original tumor site, they should not be allowed to grow freely. These lesions can grow widely, penetrating deeply into the skin destroying skin, tissue, and bone. Plus, the longer you leave a basal cell carcinoma untreated, the more likely it is to come back. And because it will usually return in the same area, this can create problems removing the lesions without overly disfiguring the patient.

What Happens During Mohs Surgery

The procedure is done in stages, all in one visit, while the patient waits between each stage. After removing a layer of tissue, the surgeon examines it under a microscope in an on-site lab. If any cancer cells remain, the surgeon knows the exact area where they are and removes another layer of tissue from that precise location, while sparing as much healthy tissue as possible. The doctor repeats this process until no cancer cells remain.

Step 1: Examination and prep

Depending on the location of your skin cancer, you may be able to wear your street clothes, or you may need to put on a hospital gown. The Mohs surgeon examines the spot where you had your biopsy and may mark it with a pen for reference. The doctor positions you for best access, which may mean sitting up or lying down. A surgical drape is placed over the area. If your skin cancer is on your face, that may mean you cant see whats happening, but the doctor talks you through it. The surgeon then injects a local anesthesia, which numbs the area completely. You stay awake throughout the procedure.

Step 2: Top layer removal

Using a scalpel, the surgeon removes a thin layer of visible cancerous tissue. Some skin cancers may be the tip of the iceberg, meaning they have roots or extensions that arent visible from the surface. The lab analysis, which comes next, will determine that. Your wound is bandaged temporarily and you can relax while the lab work begins.

Step 3: Lab analysis

Step 4: Microscopic examination

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Histologic Forms Of Basal Cell Carcinoma

The most common histologic forms of basal cell carcinoma are superficial, nodular, ulcerative, metatypical, morpheaform, and infiltrative.

A superficial basal cell carcinoma appears as an erythematous scaly plaque with well-defined borders, and histologically is comprised of small nests of cells with oval and basophilic nuclei with scant cytoplasm along the basal layer of the epidermis. A nodular basal cell carcinoma appears as a translucent papule with telangiectasias, and histologically is comprised of basaloid cells with peripheral palisading of the nuclei and stromal proliferation. An ulcerated basal cell carcinoma appears as a nodular lesion with central ulceration, and histologically contains foci of epidermal ulceration. Metatypical basal cell carcinoma is not distinctive clinically, but histologically contains features of basal cell carcinoma in addition to foci of squamous differentiation resembling squamous cell carcinoma. Morpheaform basal cell carcinoma appears as a yellow-red firm plaque and histologically contains tumor nests and cords enmeshed in a fibrous, sclerotic stroma. Infiltrative basal cell carcinoma is not distinctive clinically, but histologically contains islands of tumor cells with a spiked appearance in narrow cords within a hyalinized stroma.

What Does A Basal Cell Carcinoma Look Like

Basal cell carcinoma

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.

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What Are The Signs And Symptoms Of Superficial Basal Cell Carcinoma Of Skin

Superficial Basal Cell Carcinoma of Skin signs and symptoms may include:

  • Superficial BCC of Skin is a slow-growing malignant tumor. The tumor has a typical presentation with a flat, pink, well defined patch, usually without scale
  • The surface of the patch appears red , when intact. Else, it may appear with small erosions, if the surface has been traumatized
  • The patches are often many in numbers and are typically observed on the chest and back , and other sun-exposed areas
  • In children, if it is associated with basal cell nevus syndrome, then multiple lesions may be observed
  • The lesions may range in size from a few millimeters to up to 10 cm
  • The lesion may grow and there may be itching sensation, ulceration, and bleeding

What Should I Do If I Think I Have A Basal Cell Cancer

There are several effective treatment options available for basal cell carcinoma. The first and most important step is to perform a biopsy and have a pathologist confirm the diagnosis. This is a simple and quick procedure that is typically performed by the primary care provider, the dermatologist, or the plastic surgeon.

The procedure involves injection a small amount of numbing medication in the skin and using a scalpel to shave off a portion of the tumor. The biopsy site is typically covered with Vaseline or antibiotic ointment and a band-aid. Typically 4-5 days are needed to process and examine the removed tissue and to make a diagnosis.

Basal cell carcinoma can be easily diagnosed with a simple shave biopsy procedure.

If you have a biopsy-proven basal cell carcinoma and would like to have Dr. Naficy assist you in removal of the skin cancer and reconstruction of your face, you may contact us through our website. A member of our nursing staff will contact you at a convenient time and perform a telephone interview.

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Preventing Basal Cell Carcinoma

Basal cell carcinoma prevention is the same as prevention methods for all skin cancers, with the goal of protecting skin from harmful UV rays.

The number one thing people can do is to practice good sun protection and sun avoidance, meaning wear sunscreen and protect the skin from getting sun damage, says Stevenson. Its also important to get skin checks regularly for early detection.

Stevenson says if someone is prone to skin cancers for example, has very fair skin, sunburns as a child, or a history of skin cancer in the family its better to go out in the late afternoon or early morning when the sun isnt as strong, or stay primarily in the shade.

Anyone spending time in the sun, regardless of complexion, should practice sun protective behaviors, including wearing sunscreen.

The Centers for Disease Control and Prevention recommends a sunscreen with a minimum sun protection factor of 15, and UVA and UVB broad spectrum protection. It also advises people to stay in the shade as much as possible and wear protective clothing including brimmed hats and sunglasses. Stevenson suggests looking for a SPF over 30.

Lebwohl says the SPF number directly correlates with the amount of protection it gives you. He says to divide the amount of time in the sun by the SPF number. For example, if someone is in the sun for 60 minutes, and wearing SPF 30, its as if they were exposed to two minutes of damaging rays rather than the full 60 minutes.

What Are The Risk Factors For Basal Cell Carcinoma Of Vulva

Basal Cell Carcinoma (BCC) 101 – Dermpath Basics Explained by a Dermatopathologist

The following are some risk factors that may contribute to Basal Cell Carcinoma of Vulva:

  • Exposure to ultraviolet light
  • Prolonged and repeated sun exposure
  • Use of tanning beds, tanning parlors
  • Exposure to the toxic metal arsenic
  • Exposure to ionizing radiation
  • Certain genetic syndromes, such as basal cell nevus syndrome
  • Being fair-skinned

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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How Is Bcc Diagnoses And Treated

Diagnosis and treatment is often the same, with surgical excision of the area and examination by the pathologist to make sure all of the areas has been removed. If surgery is not possible, some topical agents and even radiation may be used to treat this slow growing skin cancer.

As with other types of skin cancer, your Dermatologist will help you decide the best diagnostic treatment regimen for you.

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?

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    Basal Cell Carcinoma Treatment Options

    No matter how treatable cancer is, facing it can still feel overwhelming. You may wonder whether treatment will leave a scar, or if your cancer can come back. Mercy understands your concerns. Well make sure you feel comfortable and confident before beginning any treatment.

    Your treatment strategy will depend on several factors. These include the size and location of your basal cell carcinoma. Your doctor may recommend you have one or more types of treatment, including:

    • Medication, especially topical creams or ointments
    • Cryotherapy
    • Surgery to remove the cancer from your skin. Your surgeon will preserve as much healthy skin as possible.
    • Radiation therapy

    Your relationship with Mercy wont end when your treatments end. Well continue to watch your skin closely, so you can take your mind off cancerand turn it back to the people and activities you love.

    Diagnosis And Treatment Of Basal Cell And Squamous Cell Carcinoma

    Basal Cell Carcinoma

    JONATHON M. FIRNHABER, MD, East Carolina University, Brody School of Medicine, Greenville, North Carolina

    Am Fam Physician. 2012 Jul 15 86:161-168.

    Nonmelanoma skin cancer, which includes basal cell carcinoma and squamous cell carcinoma, is the most common cancer in the United States. Approximately 80 percent of nonmelanoma skin cancers are basal cell carcinoma and 20 percent are squamous cell carcinoma. Although the National Cancer Institute does not formally track the incidence and prevalence of nonmelanoma skin cancers, multiple longitudinal studies indicate that the incidence has risen sharply over the past two decades.1

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    Types Of Basal Cell Carcinoma

    Basal cell carcinomas are divided into different types to help physicians evaluate the progression of the disease and determine which course of treatment is best. Understanding the different ways that basal cell carcinomas grow in the skin helps determine the most optimal treatment approach.

    Physicians also assess whether the basal cell carcinoma has any of the following high-risk features:

    • Aggressive microscopic growth pattern
    • Spread to lower dermis or subcutis layers of the skin
    • Spread to the small nerves in the skin

    Additionally, the health of the individual must be taken into consideration. Patients who are immunosuppressed due to certain medical conditions or medications may have basal cell carcinomas that behave more aggressively.

    The classification of basal cell carcinomas is based on how they appear at a microscopic level and includes the following types most commonly:

    Superficial basal cell carcinoma = the cancer originates at the basal layer of the epidermis and has spread only slightly deeper than this. These cancers are well less than 1 mm in depth

    Nodular basal cell carcinoma = the cancer grows as a ball of cancer cells, spreading into the dermis, or collagen layer, of the skin. These nodular basal cell carcinomas often extend 1 mm or more into the skin

    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 .

    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 Skin Tissue transplantation is the removal of various tissues, such as skin cells, corneas, cartilage, or bone, from a body and then inserting that tissue into the same or another person who has… read more 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.

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    What Causes Basal Cell Carcinoma

    The commonest cause is exposure to ultraviolet light from the sun or from sunbeds. BCCs can occur anywhere on the body, but are most common on areas that are exposed to the sun such as your face, head, neck and ears. It is also possible for a BCC to develop in a longstanding scar. BCCs are not infectious.

    BCCs mainly affect fair skinned adults, but other skin types are also at risk. Those with the highest risk of developing a basal cell carcinoma are:

    • People with pale skin who burn easily and rarely tan .
    • Those who have had a lot of exposure to the sun, such as people with outdoor hobbies or outdoor workers, and people who have lived in sunny climates.
    • People who have used sun beds or have regularly sunbathed.
    • People who have previously had a basal cell carcinoma.

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    Rarer Types Of Non Melanoma Skin Cancer

    Patient story: diagnosing basal cell carcinoma (skin cancer)

    There are other less common types of skin cancer. These include:

    • Merkel cell carcinoma

    These are all treated differently from basal cell and squamous cell skin cancers.

    Merkel cell carcinoma

    Merkel cell carcinoma is very rare. Treatment is with surgery or radiotherapy, or both. This usually works well, but sometimes the cancer can come back in the same place. And sometimes it spreads to nearby lymph nodes.

    Sebaceous gland cancer

    Sebaceous gland cancer is another rare type of skin cancer affecting the glands that produce the skinâs natural oils. Treatment is usually surgery for this type of cancer.

    Kaposiâs sarcoma

    Kaposis sarcoma is a rare condition. Itâs often associated with HIV but also occurs in people who donât have HIV. Itâs a cancer that starts in the cells that form the lining of lymph nodes and the lining of blood vessels in the skin. Treatment is surgery or radiotherapy, and sometimes chemotherapy.

    T cell lymphoma of the skin

    T cell lymphoma of the skin can also be called primary cutaneous lymphoma. Itâs a type of non Hodgkin lymphoma. There are a number of different types of treatment for this type of cancer.

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