Basal Cell Carcinoma

Nonmelanoma skin cancers include basal cell carcinoma and squamous cell carcinoma.

Basal Cell Carcinoma is the most common type of nonmelanoma skin cancer, accounting for 80% of cases, and cases are rising by 4-8% annually. The remaining 20% of skin cancer cases is due to squamous cell carcinoma. It is estimated that 3.6 million new cases of BCC are diagnosed each year in the U.S. One in five Americans will develop skin cancer by the age of 70.

What is basal cell carcinoma?

Basal cell carcinoma arises from the basal cells in the lower layers of the skin. It is a slow-growing skin cancer that very rarely spreads to other parts of the body but can be locally destructive. BCC commonly develops on the face, head and neck and scalp but can appear anywhere on the body, including the arms and legs and trunk.

What causes basal cell carcinoma?

About 90% of nonmelanoma skin cancers are associated with chronic exposure to the ultraviolet (UV) rays of the sun and tanning beds.  UV rays damage the skin’s DNA (the genes that controls cell growth and function) causing the skin cells to grow out of control.

Who is at risk for BCC?

Fair-skinned individuals with blond or red hair and blue, green or gray eyes are at greatest risk. However, anyone with a history of long hours outdoors in the sun, through occupation or leisure pursuits is at risk. The average age at diagnosis is 67. However, teenagers and people in their twenties, thirties and forties are being diagnosed with BCC. Men develop more BCCs, but women are catching up.

What are the risk factors?

• A positive family history of BCC strongly predicts the development of BCC.
• A personal history of BCC or SCC is associated with a 20% increased risk of a recurrent BCC or development of Squamous Cell Carcinoma.
• If not completely removed, BCC can recur in the same location; and people who develop BCC are at risk for new BCCs on other parts of the body.
• People who have had radiation therapy for cancer have a higher risk of developing skin cancer.
• People who have a compromised immune system are more likely to develop skin cancer, including organ transplant recipients.
• People exposed to arsenic found in well water and pesticides.
• Long term skin inflammation or injury like burns and scarring.

What are the warning signs?

1. A lesion or bump with an ulcerated center and a pearly rim.
2. A flat, scaly plaque with pearly borders that can be confused with eczema or psoriasis.
3. An open, non-healing sore that bleeds, oozes or crust over but comes back. If a sore doesn’t heal within a week see your dermatologist.
4. A shiny bump that is clear, pink or red and may have blue, brown or black areas.
5. A raised red patch or irritated area with spider veins that can itch or hurt.
6. A lesion that looks like a scar.

How is BCC diagnosed?

Dr. Higgins will review your medical history, ask questions about your symptoms and conduct a thorough examination. While BCC is readily identifiable by a specialist, an accurate diagnosis is essential.  A biopsy is the only way to determine if the lesion is cancer and the type of skin cancer.

Dr. Higgins will take a biopsy of the suspected lesion. The area will be numbed with a local anesthetic, and she will remove all or part of the lesion. The tissue sample will be sent to a lab for microscopic analysis. The lab will return a report telling her the type of skin cancer.

If BCC does spread, it can destroy local tissues like cartilage and bone. Early diagnosis is especially important to avoid the risk of spread. When caught early and treated most BCC can be cured.

What are the treatment options?

Choice of treatment depends on the size, location, and depth of the tumor, as well as your age and health, and how likely treatment will affect your appearance. Since BCC is typically found on the face, eyes, lips and nose standard excision can be disfiguring. Consequently, microscopic surgery called Mohs surgery can spare healthy tissues, create a cosmically acceptable repair and reduce the risk of recurrence.

Standard excision

Excision involves the removal of the entire lesion and a margin of healthy skin around the lesion. The excised tissue is sent to a lab for microscopic analysis and confirmation of a diagnosis. The cure rate is above 95%, but a subsequent excision may be needed.  The 5- year recurrence rate is less than 3% on the face.

Mohs Micrographic Surgery

Mohs surgery requires specialized training. The procedure involves the removal of thin layers of the tumor, which are examined under a microscope to see if any cancer cells remain. This is repeated until the sample is free of cancer cells. While Mohs surgery takes several hours, the result is the preservation of healthy skin and an almost invisible scar.

Curettage and Electrodessication

This procedure is typically reserved for lesions on the trunk, arms and legs. It involves surgically removing the lesion and treating the area with heat to destroy any remaining cancer cells.

Topical Therapy

There are a variety of topical treatments including topical drugs and photodynamic therapy (PDT). Topical chemotherapy drugs are used to kill cancer cells. Topical therapies are reserved for low-risk superficial tumors that don’t extend deep into the skin. If the BCC is superficial topical medications can provide an 80-90% cure rate.

Dr. Heather Higgins is a board-certified dermatologist in Asheville, North Carolina who is devote to the health and well – being of her patients. Contact her at Ashville Dermatology to schedule a consultation today.