Basal Cell Carcinoma

Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the most common type of skin cancer. It’s also the most commonly diagnosed cancer in the United States. Every year, millions of people learn that they have BCC.

This skin cancer usually develops on skin that gets sun exposure, such as on the head, neck, or back of the hands. BCC is especially common on the face, often forming on the nose. While BCC often develops on skin that has had the most sun, BCC can appear on any part of the body, including the trunk, legs, and arms.

People who use tanning beds also get BCC, and they also tend to get it earlier in life.

This type of skin cancer grows slowly. It rarely spreads to other parts of the body. Treatment is important because BCC can grow wide and deep, destroying skin, tissue, and bone.

Signs and Symptoms

Basal cell carcinoma (BCC) shows up on the skin in different ways. That’s because there are different types of this skin cancer. If you see any of the following on your skin, you should immediately make an appointment to see a dermatologist:

  • Dome-shaped skin growth with visible blood vessels. Often pink or skin-colored, it can also be brown, black, or have flecks of these colors. This BCC grows slowly. It may flatten in the center, ooze, and crust over. It also tends to bleed easily.
  • Shiny pink or red, slightly scaly patch, especially on the trunk. It grows slowly and may be mistaken for a patch of eczema.
  • Waxy feeling, hard, pale-white to yellow or skin-colored growth that looks like a scar. You may have difficultly seeing the edges.

BCCs may look like a sore that:

  • Bleeds easily.
  • Won’t heal, or heals and returns.
  • Oozes or crusts over.
  • Has a sunken center, like a crater.
  • Has visible blood vessels in or around it.

Although rare, BCC can feel painful or itch. Usually, the only sign of BCC is a growth on the skin.

Who Can Get and Causes

Anyone can get this common skin cancer, but some people have a greater risk. People with a greater risk of getting basal cell carcinoma (BCC) have one or more of the following risk factors:

Your physical traits

  • Light-colored or freckled skin
  • Blue, green, or gray eyes
  • Blond or red hair
  • An inability to tan
What you’ve done
  • Spent a lot of time outdoors for work or leisure, without using sunscreen or covering up with clothing
  • Frequently used tanning beds
Your medical history
  • If you had one BCC, your risk for developing a second one increases by about 40%
  • Close blood relative had BCC
  • Taking one or more drugs that suppress the body’s immune system. People take these drugs after receiving an organ transplant and to treat a medical condition, such as severe arthritis, lymphoma, or human immunodeficiency virus (HIV)
  • Overexposure or long-term exposure to x-rays, such as patients who received x-ray treatments for acne

Risk of developing many BCCs by 20 years of age
Some people are born with a rare condition that makes them more likely to develop many skin cancers, including basal cell cancers, early in life. BCC can develop by 20 years of age in people who have a rare medical condition known as basal cell nevus syndrome.

What causes BCC?

Unlike many cancers, the cause of BCC is well known:

  • Ultraviolet (UV) rays from the sun or tanning beds cause BCC

When UV rays from the sun or tanning beds hit our skin, these rays damage the DNA in the cells of our skin. The body tries to repair this damage. When the rays repeatedly hit our skin, the body cannot repair the damage.

When the body cannot repair the damage, skin cancer develops. Skin cancer usually develops after years of sun exposure. Around 50 years of age, the risk of developing skin cancer increases significantly.

People much younger than 50 years of age also get BCC. Most of these people are women who use indoor tanning beds. Many of these BCCs could be prevented if the women never used tanning beds.

Diagnosis and Treatment

The only way to diagnose any type of skin cancer, including basal cell carcinoma (BCC), is with a skin biopsy. Your dermatologist can perform this procedure during an office visit.

A skin biopsy should not cause anxiety. To perform a skin biopsy, your dermatologist will remove the entire growth or part of it. Your dermatologist may send this to a laboratory or look at it under a microscope. The findings will be communicated in a biopsy report.

If the biopsy report states that you have BCC, your dermatologist will consider many factors to determine which treatment will be best for you. There are several ways to treat BCC:

  • Excision: This is a surgical procedure that your dermatologist often can perform during an office visit. It involves numbing the area to be treated and cutting out any remaining tumor plus some normal-looking skin around the tumor.

    Like the skin biopsy, this removed skin is examined under the microscope. This may be done at a laboratory or by your dermatologist. The doctor who looks at the removed skin needs to see whether the normal-looking skin is free of cancer cells. If not, more skin will need to be removed. This is a common way to treat BCC.

  • Curettage and electrodessication: This treatment consists of two steps. First, your dermatologist scrapes away the tumor. Then electricity is used to destroy any remaining cancer cells.
  • Mohs surgery: Named for the doctor who developed this surgery, Mohs (pronounced "moes") is a specialized surgery used to remove some skin cancers. It offers the highest cure rate for difficult-to-treat basal cell cancers. Your dermatologist will tell you if Mohs is right for you.

    If Mohs is recommended, this is what you can expect. The surgeon will cut out the tumor plus a very small amount of normal-looking skin surrounding the tumor. While you wait, the Mohs surgeon uses a microscope to look at what was removed. The surgeon is looking for cancer cells.

    If necessary, the Mohs surgeon will continue to remove a very small amount of skin and look at it under the microscope. This continues until the surgeon no longer sees cancer cells.

  • Cryosurgery: This treatment uses liquid nitrogen to freeze cancer cells, causing the cells to die.
  • Radiation: This treatment usually is reserved for BCCs that cannot be cut out, or when surgery may not be the best choice. A patient may need 15 to 30 radiation treatments.
  • Photodynamic therapy (PDT): This treatment uses light to remove early skin cancers. PDT is a two-step process. First, a chemical is applied to the skin. The chemical remains on the skin for some time so that it can be absorbed. Then the skin is exposed to a special light to kill the cancer cells.
  • Medicated creams: Creams that contain a drug, such as imiquimod or 5-fluorouracil, can be used to treat early BCC. A patient applies the medicated cream at home as directed by his or her dermatologist.
  • Pills: While extremely rare, there are reports of BCC spreading to other parts of the body. Patients who have BCC that spreads may be prescribed vismodegib or sonidegib. This medication also may be prescribed for patients who have advanced BCC that cannot be cut out or treated with radiation.

Outcome

Nearly every basal cell cancer can be cured, especially when the cancer is found early and treated.

Learn More By Visiting American Academy of Dermatology