Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the most common skin cancer. It is slow growing and rarely spreads to other parts of the body. Among white Americans the lifetime risk for developing BCC is 30 percent.

Five types of basal cell carcinoma include:
•Nodular basal cell carcinoma, which appears as a pearly white or pink dome and ulcerates frequently.
•Pigmented basal cell carcinoma, which is darkly pigmented and ulcerates frequently.
•Superficial basal cell carcinoma, which appears as a red round scaly plaque on the trunk, arms and legs, and is least aggressive of all basal cell carcinomas.
•Micronodular basal cell carcinoma, which is similar to nodular but recurs more often and looks differently under the microscope.
•Morpheaform basal cell carcinoma is the least common basal cell carcinoma and looks like a yellow waxy scar.

Risk factors include:
•UV light exposure leading to frequent sunburns
•Fair skin and blue eyes
•Exposure to therapeutic radiation
•Immunosuppression
•Blond to red hair
•Chronic arsenic exposure
•Basal cell nevus syndrome, which is a rare genetic disorder
•Living in an area closer to the equator

Symptoms include:
•Small pearly white bumps in the skin with tiny streaked blood vessels across them
•The bumps or nodules that grow slowly, flatten in the center and develop a raised translucent edge
•Red scaly plaques on the trunk, arms or legs

Diagnosis always involves a biopsy of the lesion, which can be a simple punch biopsy, where a small portion of the suspect lesion is removed, or a removal of the entire tumor. The biopsy is then sent to the laboratory for proper identification by a pathologist.

Treatment includes complete removal of the lesion and varies with the size and location of the cancer. Nodular and superficial basal cell carcinoma can typically be treated with curettage, which is removal of the lesion by scraping with a sharp instrument called a curette. The cancer can also be cut out in the office if it is well defined and not a recurring cancer. The more aggressive types of basal cell carcinoma can be removed with Mohs surgery.

Mohs surgery is done in the office and uses the microscope to determine if the margins are clear of cancer. The obvious large portion of the tumor is removed and then small thin slices of skin are taken around the edges. These slices are then chemically treated so that abnormal cells will appear under the microscope. Marginal segments continue to be removed until they are clear from abnormal cells.

Other treatment options include:
•Radiation for surgically sensitive areas such as the eyelids, or for those who could not tolerate surgery.
•Topical immune modulators, such as Aldara, which causes an immune response that eradicates the cancer. This is used only to treat superficial basal cell carcinoma currently.

The best prognosis occurs with aggressive treatment to completely remove the cancer; otherwise the lesion will enlarge and ulcerate. However, basal cell carcinoma rarely is life threatening and almost never metastasizes.

Remission and recurrence (five-year cure rates) are:
•Curettage--92 percent for primary tumors and 60 percent for recurring lesions
•Office surgical excision--90 percent for primary tumors and 83 percent for recurring lesions
•Mohs surgery--99 percent for primary tumors and 96 percent for recurring lesions
•Radiation therapy--approximately 90 percent
•Topical treatment--approximately 85 percent effective

Therefore, it is very important to do self exams and seek the care of your health care professional the moment that you have any concerns about a skin lesion.