BASAL CELL

Basal cell carcinoma (BCC) is the most common form of cancer, with about a million new cases estimated in the U.S. each year. Basal cells line the deepest layer of the epidermis. An abnormal growth, a tumor, in this layer is, therefore, a basal cell carcinoma.

Basal cell carcinoma can usually be diagnosed with a simple biopsy and is fairly easy to treat when detected early. However, 5 to 10 percent of BCCs can be resistant to treatment or locally aggressive, damaging the skin around them, and sometimes invading bone and cartilage. When not treated quickly, they can be difficult to eliminate. Fortunately, however, this is a cancer that has an extremely low rate of metastasis, and although it can result in scars and disfigurement, it is not usually life threatening.

Cause

The sun is responsible for over 90 percent of all skin cancers, including BCCs, which occur most frequently on the sun-exposed areas of the body: face, ears, neck, scalp, shoulders, and back.

Am I at risk?

Anyone with a history of frequent or intermittently intense sun exposure can develop BCC, but a number of factors increase risk.

Time Spent Outdoors - People who work outdoors, construction workers, groundskeepers, lifeguards, etc., are at greater risk than people who work indoors, as are those who spend their leisure hours in the sun.

Skin Type - Fair-skinned individuals who sunburn easily and tan minimally or not at all have a higher incidence of skin cancer than dark-skinned individuals.

Hours of sunlight - The more hours of sunlight in the day, the greater the incidence of skin cancer. For example, there are more cases in Arizona, Texas and Florida, states that are closer to the equator and get more sun, than in the more northern states of Maine, Oregon and Washington.

Warning Signs

The five most typical characteristics of basal cell carcinoma are shown in the pictures below. Frequently, two or more features are present in one tumor. In addition, BCC sometimes resembles noncancerous skin conditions such as psoriasis or eczema. Only a trained physician can decide for sure. If you observe any of the warning signs or some other change in your skin, consult your physician immediately.

Open Sore - A sore that bleeds, oozes or crusts and remains open for a few weeks. A persistent, non-healing sore is a very common sign of an early basal cell carcinoma.

A Reddish Patch - A patch or irritated area, frequently occurring on the chest, shoulders, arms or legs. Sometimes the patch crusts. It may also itch or hurt. At other times, it persists with no noticeable discomfort.

A Shiny Bump - A bump or nodule that is pearly or translucent and is often pink, red or white. The bump can also be tan, black or brown, especially in dark-haired people, and can be confused with a mole

A Pink Growth - Slightly elevated rolled border and a crusted indentation in the center. As the growth slowly enlarges, tiny blood vessels may develop on the surface.

A Scar-Like Area - White, yellow or waxy, and often has poorly defined borders. The skin itself appears shiny and taut. This warning sign can indicate the presence of small roots, which make the tumor larger than it appears on the surface.

Types of Basal Cell Carcinomas

Nodular basal cell carcinoma - Most common type. This tumor usually resembles a smooth, round, waxy pimple, pale yellow or pearl gray, and may vary in size from a few millimeters to 1 centimeter. Often, the skin covering the nodule is so thin that the slightest injury will cause it to bleed. These tumors are often depressed in the middle and show ulceration. As the tumor grows, it destroys healthy structures in its path, including nerves, muscles and blood vessels. Large tumors are easily diagnosed, but smaller ones are often difficult to tell from noncancerous skin conditions, such as warts, seborrheic keratoses, moles, and psoriasis.

Superficial - This is a less common form of BCC. It is a progressively spreading, slow-growing cancer that differs greatly from other types. The tumor is red, with a slightly raised, ulcerated or crusted surface, often bordered with pearly or threadlike formations. Tumors usually appear as patches on the torso, but can develop more extensively on the face and neck. This is often mistaken for other skin conditions such as fungal infections, eczema or psoriasis.

Sclerosing or Fibrosing - Fibrosing basal cell carcinoma is also called morphea-like carcinoma. This fibrosing type of tumor begins as a flat or slightly depressed, shiny, hard, yellow-white patch with an irregular border. Sometimes, it may be present for years without growing or being recognized. More often, though, the lesion grows quickly, reaching a diameter of several centimeters within a few months. This is a fairly uncommon type of skin cancer, and can be difficult to eradicate because of invisible root-like extensions of the tumor that reach into the underlying tissue.

Pigmented - Pigmented basal cell carcinoma is similar to nodular basal cell carcinoma, but is more likely to appear in people with dark hair or dark eyes. As its name implies, this growth is almost black and can easily be mistaken for the more aggressive melanoma.

Fibroepithelioma - This is a rare type of basal cell carcinoma appearing as one or more slightly elevated, reddish lesions. Usually they arise on the back.

Basosquamous carcinoma - Squamous and basal cell carcinoma can coexist as one tumor growth at the same time. Clinically, it can look like a basal cell or squamous cell carcinoma. Basosquamous cell carcinomas are believed by some researchers to have a greater tendency to metastasize. These tumors require immediate and aggressive treatment.

Basal cell nevus syndrome - Rarely, basal cell carcinoma may develop as part of an inherited condition, commonly referred to as nevoid basal cell carcinoma syndrome or Gorlin syndrome. Unlike other skin cancer conditions, this syndrome may develop during childhood or adolescence, and as many as 50-100 cancers may be involved. Sometimes, the skin cancers increase in number as the person reaches adulthood. Clinically, they have the same appearance as basal cell carcinomas.

Treatment

The vast majority of BCCs are not serious if detected early and treated quickly. The BCCs that cause trouble are the ones that have been neglected until they have become so thick that they are hard to treat.

There is no one best method to treat all skin cancers and precancers. The choice is determined by many factors, including the location, type and size, whether it is a primary tumor or a recurrent one, the health and preference of the patient, and the physician's experience with the technique. For example, a treatment that has a high cure rate and is painless but leaves a large scar might be acceptable for a tumor on the body, but not on the face.

Almost all treatments can be performed in the physician’s office or in a special surgical facility. Most skin cancer removal can be done using a local anesthetic. Rarely, extensive tumors may require general anesthesia and hospital admission.