Overview

Basal Cell Carcinoma, often called BCC, is the most common type of skin cancer. It begins in the basal cells, which are found in the lower part of your skin's top layer (the epidermis). BCC is primarily caused by long-term exposure to ultraviolet (UV) radiation from sunlight or tanning beds.

It most commonly affects adults, especially those over 50 with fair skin, but anyone can develop BCC. The good news is that BCC is not contagious. While it rarely spreads to other parts of the body, it can grow deeper into the skin and damage nearby tissue if not addressed, which can be concerning and affect appearance.

Symptoms

You might notice a few different things if you have a BCC. It's important to remember that these can look different on everyone.

• A pearly or waxy bump, often skin-colored, pink, or brown/black (on darker skin).
• A flat, flesh-colored or brown scar-like lesion.
• A sore that bleeds, heals, and then reopens, sometimes repeatedly.
• A pinkish patch of skin that may be scaly or slightly raised.
• A growth with raised, rolled edges and a central indentation.
• Tiny blood vessels may be visible on the surface of the growth.
• Itching or tenderness in the area, though often BCCs are painless.
• These spots usually appear on sun-exposed areas like the face, ears, neck, scalp, shoulders, and back.

Diagnosis

Diagnosing Basal Cell Carcinoma usually starts with a careful skin examination by a healthcare professional, like a dermatologist. They will look at the size, shape, color, and texture of any suspicious spots.

If a spot looks concerning, a skin biopsy is typically performed. This involves taking a small sample of the skin lesion, which is then sent to a lab to be examined under a microscope by a pathologist. This test confirms whether cancer cells are present and what type they are.

Management & Treatment

When you receive a skin cancer diagnosis from your healthcare provider it can be unsettling, but please know that Basal Cell Carcinoma is extremely treatable, especially when it's caught early. The goal of treatment is to remove the cancer completely while leaving the smallest possible scar.

The good news is that most treatments are highly effective and can be performed right in your dermatologist's office. The right approach for you will depend on the tumor's size, location, and type.

• Surgical Excision: This is a very common treatment where your doctor numbs the skin, surgically removes the tumor along with a small margin of healthy-looking skin, and then stitches the area closed. The removed tissue is checked under a microscope to ensure all cancer cells are gone.
• Mohs Surgery: This specialized surgery is considered the gold standard for BCC, especially for those in sensitive or visible areas like the face, or for larger, recurrent tumors. The surgeon removes the visible tumor and then removes surrounding skin one layer at a time, checking each layer under a microscope until no cancer cells remain. This technique saves the maximum amount of healthy tissue and has the highest cure rate.
• Curettage and Electrodesiccation: For small, low-risk BCCs, your doctor might scrape off the tumor with a spoon-shaped instrument (a curette) and then use an electric needle to destroy any remaining cancer cells and stop the bleeding.
• Cryotherapy: This method uses liquid nitrogen to freeze and kill the cancer cells. The frozen tissue then blisters and peels away over a few weeks. It can be a good option for small, superficial tumors.
• Topical Treatments: For BCCs that are only on the surface of the skin, prescription creams or ointments can be applied at home. These medications, like Imiquimod or 5-fluorouracil (5-FU), stimulate the body's immune system to attack the cancer cells or kill them directly.
• Radiation Therapy: Radiation uses high-energy X-ray beams to destroy the cancer. It's often reserved for tumors that are difficult to treat with surgery or for older patients who may not be good candidates for a surgical procedure.

Important Note: It's important to know that with treatments like cryotherapy, radiation, and topical creams, no tissue is examined under a microscope. This means there isn't a way to be 100% certain that the entire tumor was removed. Your dermatologist will discuss this with you and help you choose the safest, most effective path forward.

If you see any signs of the BCC returning after treatment, please see your doctor right away. A different treatment method may be needed to ensure the cancer is fully removed.

Duration & Outlook

Basal Cell Carcinoma is generally a slow-growing cancer. If left unaddressed, it is a chronic condition that will continue to grow. However, when BCC is detected and addressed early, the outlook is excellent, with a very high chance of successful removal.

It's important to be aware that BCCs can recur, sometimes in the same spot or nearby. Warning signs for complications include a lesion that grows rapidly, becomes painful, bleeds easily, or seems to be spreading quickly. While rare, untreated BCCs can invade deeper tissues, potentially affecting nerves or muscles.

Prevention

The best way to prevent Basal Cell Carcinoma is to protect your skin from UV radiation. This is something you can do every single day!

• Seek shade, especially between 10 a.m. and 4 p.m. when UV rays are strongest.
• Wear sun-protective clothing, including a wide-brimmed hat and UV-blocking sunglasses.
• Use a broad-spectrum sunscreen with an SPF of 30 or higher daily, even on cloudy days, and reapply every two hours, or after swimming or sweating.
• Avoid tanning beds and sunlamps completely, as these are direct sources of harmful UV radiation.
• Examine your skin head-to-toe every month and see a dermatologist annually for a professional skin exam, especially if you have risk factors.

Causes & Triggers

The primary cause of Basal Cell Carcinoma is long-term exposure to ultraviolet (UV) radiation. This radiation comes from sunlight and artificial sources like tanning beds. UV rays damage the DNA in your skin cells, which can lead to the cells growing out of control and forming a cancer.

Common triggers are essentially repeated or intense sun exposure.

• Who is most likely to develop it? People with fair skin, light-colored eyes, and blond or red hair are at higher risk. Those who have had many sunburns, especially blistering ones, or who have spent a lot of time outdoors without sun protection are also more susceptible.
• Risk factors include:
  • Older age (though it can occur in younger people)
  • A personal or family history of skin cancer
  • A weakened immune system (e.g., from medications or certain medical conditions)
  • Exposure to certain chemicals like arsenic
  • Previous radiation therapy

When to see a doctor

It's so important to be aware of your skin and to reach out for professional help if you notice changes. You should see a doctor, preferably a dermatologist, if you notice:

• Any new skin growth - that looks unusual, is growing, or doesn't go away after a few weeks.
• A mole or spot that changes - in size, shape, color, or texture.
• A sore that doesn't heal within 3-4 weeks, or heals and then comes back.
• A spot that bleeds easily, crusts over, or becomes itchy or tender.
• Any skin lesion that just seems different or worries you.

Remember, catching skin cancer early makes a big difference. Don't hesitate to get a professional opinion; it's always better to be sure.

Frequently Asked Questions (FAQs):

• Q: Is Basal Cell Carcinoma serious? BCC is the least dangerous type of skin cancer because it rarely spreads to other parts of the body. However, it can be disfiguring if not addressed early, as it can grow deep and damage surrounding tissue.
• Q: Can BCC go away on its own? No, Basal Cell Carcinoma does not go away on its own. It requires professional evaluation and attention.
• Q: If I had one BCC, am I likely to get another? Yes, having one BCC increases your risk of developing others, either in the same area or elsewhere on your body. Regular skin checks are very important.
• Q: Is BCC painful? Often, BCCs are not painful, but they can sometimes become itchy, tender, or bleed.
• Q: How quickly does BCC grow? BCCs are typically slow-growing, often developing over months or even years. However, some can grow more rapidly.

This information is for educational purposes and is not a substitute for professional medical advice. Always consult with a healthcare provider for diagnosis and management of any health concerns.

References

• The Skin Cancer Foundation. (n.d.). Basal Cell Carcinoma Treatment. Retrieved from https://www.skincancer.org/skin-cancer-information/basal-cell-carcinoma/bcc-treatment-options/
• American Cancer Society. (2022). Treating Basal Cell Carcinoma. Retrieved from https://www.cancer.org/cancer/types/basal-and-squamous-cell-skin-cancer/treating/basal-cell-carcinoma.html
• Mayo Clinic. (2023). Basal cell carcinoma - Diagnosis & treatment. Retrieved from https://www.mayoclinic.org/diseases-conditions/basal-cell-carcinoma/diagnosis-treatment/drc-20354193