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Basal Cell Carcinoma

shutterstock 208005643 1024x683 - Basal Cell CarcinomaWhat is Basal Cell Carcinoma?

Basal cell carcinoma is the most common form of skin cancer. It’s also the most easily treated and the least likely to spread. Although basal cell carcinomas are rarely fatal, they can cause extensive damage to surrounding tissue and bone if they’re not removed. If you’ve had one basal cell carcinoma, you have a good chance of developing another within five years.

Most basal cell carcinomas are caused by long-term exposure to ultraviolet (UV) radiation from sunlight. Avoiding sun exposure and wearing sunscreen is the best protection.

What are the symptoms of basal cell carcinoma?

Basal cell carcinomas usually develop on sun-exposed parts of your body, especially your head and neck. A smaller number occur on the trunk, arms and legs. Basal cell carcinoma can also occur on parts of your body that rarely see the light of day.  Talk with family members to find out whether any of your close relatives have been diagnosed or treated for skin cancer, and what kind. This will help your provider diagnose your condition and plan the most effective treatment and follow-up care plan for you.  Although a general warning sign of skin cancer is a sore that won’t heal or that repeatedly bleeds and scabs over, basal cell tumors are likely to take one of these forms:

A pearly white or pink bump: Often with visible blood vessels on your face, ears or neck. The bump may bleed, develop a crust or form a depression in the center. In darker skinned people, this type of tumor is usually brown or black.

A flat, scaly, pink brown or flesh-colored patch: On your back or chest. Over time, these patches can continue to grow if not treated.

More rarely, a white, waxy scar-like area: This type of basal cell carcinoma is easy to overlook, but it may be a sign of a special type called morpheaform basal cell carcinoma.

When should you see a doctor?

Some basal cell carcinomas may be difficult to distinguish from ordinary sores. Yet the sooner they’re diagnosed and treated, the better the outcome. See your provider if you have:  A skin sore that bleeds easily or doesn’t heal, a sore that repeatedly crusts or oozes, visible blood vessels in or around a sore, or a scar in an area where you haven’t injured yourself.

What are the causes of basal cell carcinoma?

Your skin consists of three layers – the epidermis, which is closest to the surface, the dermis and the subcutis. Basal cells, which produce new skin cells, are at the bottom or basal layer of the epidermis. These cells may grow out of control and eventually form a cancerous tumor.

Are there environmental factors that cause basal cell carcinoma?

As with many other diseases, basal cell carcinomas seem to result from a combination of genetic and environmental factors. Most of the environmental damage to skin cells comes from exposure to UV radiation from sunlight. Although some studies show that the greatest harm occurs during childhood and adolescence, UV damage also appears to be cumulative, so the more time you spend in the sun, the greater your chance of developing skin cancer. Your risk increases even more if most of your outdoor exposure takes place in locales or at times of day when the sun is strongest.

Are there other factors that can lead to basal cell carcinoma?

Therapeutic radiation: Psoralen plus ultraviolet A (PUVA) treatments for psoriasis and X-rays to the head or neck increase your risk of basal cell carcinoma as well as of other, more serious forms of skin cancer. It can take years for skin cancers to develop, and many radiation-induced carcinomas that occur later in life may have had their origins in radiation treatments in childhood.

Chemical toxins: Arsenic, a toxic metal that’s found widely in the environment, is a well-known cause of basal cell carcinoma and other cancers.

Immunosuppressant drugs: People who take medications to prevent organ rejection after transplant surgery have a greatly increased risk of basal cell carcinoma, though symptoms may not appear for years after the immunosuppression begins.

What are the risk factors of basal cell carcinoma?

Chronic sun exposure: A lifetime spent in the sun — or in commercial tanning booths — is the most common cause of basal cell carcinoma. The threat is greater if you live in a sunny or high-altitude climate, such as the Northern Nevada or Lake Tahoe areas, both of which expose you to more UV radiation. The risk is also higher if most of your exposure occurred before the age of 18.

Fair skin: If you have very light skin or you freckle or sunburn easily, you’re more likely to develop skin cancer than is someone with a darker complexion.

Your gender: Men are far more likely to develop basal cell carcinoma than women are, though the incidence in women is increasing.

Your age: Because basal cell carcinomas often take decades to develop, about 80 percent of basal cell carcinomas occur in people age 50 or older. In recent years, however, the tumors have become much more common in younger people and are increasing every year among adults of all ages.

A personal or family history of skin cancer: If you’ve had basal cell carcinoma one or more times, you have a good chance of developing it again. You’re also at greater risk if a close relative has had skin cancer.

Immune-suppressing drug: Taking medications that suppress your immune system, especially after transplant surgery, significantly increases your risk of skin cancer. Tumors in people with a weakened immune system generally are more aggressive than they are in otherwise healthy people.

What are the complications of basal cell carcinoma?

Basal cell carcinomas that are diagnosed and treated early may leave a scar in the area, but usually no further issues arise. But, if left untreated they can invade and destroy nearby muscles, nerves and bone.

What are the tests and diagnosis?

In addition to taking a complete medical history and checking the affected area of skin, your provider may remove a small skin sample (biopsy) for examination under a microscope. Often, the biopsy is sent to a pathologist who has special expertise in diagnosing skin samples. A suspected basal cell carcinoma is often biopsied by shaving off the top layers of skin with a surgical blade. Tumors that have spread deeper into the skin may be partially or completely removed (incisional or excisional biopsy). Because all biopsies leave a small scar, talk to your provider about the types of biopsies and their potential for scarring before having the procedure.

What are the procedures, treatments, therapies and drugs used to combat basal cell carcinoma?

A number of therapies exist for treating basal cell carcinoma; the most appropriate one depends on the type, location and severity of the tumor. Some commonly used basal cell carcinoma treatments include: Topical treatments: Some superficial basal cell carcinomas are treated with creams. These prescription medications require careful supervision because they can cause severe skin irritation as well as systemic side effects.  Electrodessication and curettage (ED and C): This treatment can successfully remove new basal cell carcinomas, but is less effective for recurrent basal cell carcinomas. It’s often used for tumors located on your trunk, arms or legs. During the procedure, your provider removes the surface of the skin cancer with a scraping instrument (curette), and then sears the base of the tumor. Surgical excision: This procedure is used for both new and recurring tumors; your provider cuts out the cancerous tissue and a surrounding margin of healthy skin. In some cases, you may have a wide excision, which involves removing additional normal skin around the tumor. Mohs’ surgery: This is the most effective treatment for recurring basal cell carcinomas and those that are large, deep, fast-growing, morpheaform or on your face. If you require MOHS surgery your provider will refer you to a Dr. Ewanowski who will remove the tumor layer by layer, examining each layer under the microscope until no abnormal cells remain. This allows the entire cancer to be removed without taking an excessive amount of surrounding healthy tissue.

Can basal cell carcinoma be prevented?

The short answer is not really, but there are some recommendations for reducing your risk factors.

Avoid the midday sun: Sunlight is strongest between 10 a.m. and 4 p.m., so try to schedule outdoor activities for other times of the day, even in winter or when it’s cloudy. You absorb UV radiation year-round, and clouds offer little protection from damaging rays. Keep in mind that sunlight is more intense when it reflects off water, sand and snow.

Use sunscreen year-round: Sunscreens don’t filter out all harmful UV radiation, but they play a major role in an overall sun protection program. Wear a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 15 when you go outside, year-round. Apply the amount that fits in your palm — to cover your entire body, including your lips, ears and the backs of your hands and neck. Apply sunscreen 20 to 30 minutes before sun exposure and reapply it every two hours throughout the day, as well as after swimming or exercising.

Wear protective clothing: Wear tightly woven clothing that covers your arms and legs and a broad-brimmed hat rather than a baseball cap or visor. Photo-protective clothing is now available as well. We carry a line of high quality clothing in our office.  Don’t forget sunglasses, look for a pair that provides full protection from both UVA and UVB rays.

Be aware of sun-sensitizing medications: These include antibiotics, certain cholesterol, high blood pressure and diabetes medications, as well as the acne medication isotretinoin (Accutane). Ask your pharmacist about the side effects of any medications you take. If they make you more sun sensitive, take extra precautions.

Perform regular skin checks: Examine your skin often for new growths or changes in existing moles, freckles, bumps and birthmarks. Don’t forget to check your scalp, ears, and even your buttocks. If you have had one or more basal cell carcinomas in the past, you and your provider should be especially vigilant about checking for recurring tumors.

The information above was adapted from the Mayo Clinic medical information on Basal Cell Carcinoma.

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