Basal cell carcinoma (BCC) is the most common type of cancer in humans. It is very rarely a threat to life.
|Appearance||A firm, flesh coloured or reddish bump
A sore or pimple-like growth that bleeds, crusts over and then reappears
|Location||Sun exposed areas, most commonly on face or neck, but also on trunk and limbs|
|Causes||Frequent severe sunburns and intense sun exposure in childhood|
|Who is at risk?||Fair-skinned people
Incidence increases as you get older
More common in men
Organ transplant or immunosuppressed patients are at higher risk
|Treatment||Depends on the tumour size, location
Therapies include: anti-cancer creams, surgery, radiation
Who is prone to basal cell carcinoma?
BCC typically affects adults, particularly those with a fair complexion who have had a lot of sun exposure, or repeated episodes of sunburn. Although more common in the elderly, young sun-lovers often develop BCC in their early 40s, though they may appear at even younger ages.
Types of basal cell carcinoma
BCCs arise in otherwise normal appearing skin. They generally grow slowly, sometimes over months or years. When they are detected, this means they can vary in size from a few millimetres to several centimetres in diameter. There are many different clinical types.
Treatment of BCC
The treatment of BCC depends on its type, size and location, the number of spots to be treated, and the preference or expertise of the doctor. Biopsy may be recommended to confirm the diagnosis and the subtype of BCC prior to deciding the most suitable and effective treatment.
Various treatments are available for BCC and are described below.
Cryotherapy is the treatment of a superficial skin lesion through freezing. Treatment of small, superficial BCCs with liquid nitrogen can be effective. This treatment typically results in a blister which can scar. As the treatment is very inexpensive, it is often considered a suitable method, especially for lesions in covered sites.
5-Fluorouracil cream is a chemotherapy cream. It is used for superficial BCCs and is used twice daily for 3-12 weeks. The treated area is expected to get sore and crusty during the treatment. The skin heals once the treatment is complete.
Imiquimod cream is a topical immune-modulator. It activates your immune system to find cancerous and precancerous cells and kill it. It is used for superficial BCCs, once daily for 6-12 weeks. The treated area is expected to get sore and crusty. The area will heal once the treatment is complete.
Superficial skin surgery
Some treatment options include shave excision, curettage and cautery. Many small, well-defined nodular or superficial BCCs can be successfully treated simply by removing just the top layers of the skin. The wound is relatively superficial and generally does not require stitches or any other post-surgery care.
Excision refers to the lesion being cut out and, because the cut goes deeper, the skin is then stitched up. This is the most appropriate treatment for nodular and infiltrative BCCs. Large lesions may require a skin graft to repair the area.
If the tumour is not completely excised, there is a risk of recurrence which can result in additional surgery and the removal of a wider area of skin.
Mohs micrographic excision
Mohs surgery is a method used for excision of BCCs and other skin cancers growing in special areas on the face, particularly around the eyes, lips and nose. The Mohs technique involves examining the tissue under the microscope layer by layer and removing each layer that is affected.
Radiotherapy refers to an X-ray treatment that is less commonly used than in the past. The treatment may be suitable for skin cancers on the face in the elderly. The best cosmetic results are achieved using multiple fractions, e.g. once-weekly treatments for several weeks.
Vismodegib, may be used for locally advanced or metastatic BCCs. Vismodegib is used for patients who are not candidates for surgery or radiation therapy.
What happens after treatment?
Whatever the chosen treatment, BCC can almost always be cured.
BCCs may recur at the same site (particularly if the initial site was not completely removed). They can be treated again by the same or a different method. The highest cure rates are obtained by Mohs surgery because of the depth of examination and layer by layer removal.
Patients with BCC are at increased risk of developing further BCCs. They are also at increased risk for other skin cancers, especially melanoma. It is recommended that people who experience a BCC plan to arrange a complete skin examination regularly. Patients should be checked, and check themselves, for any persisting or growing lumps, sores or unusual skin lesions. Early detection means easier treatment, and less scarring.
Can BCCs be prevented?
People who avoid sunburn in childhood and early life are at lower risk of BCC. Fair skinned people and those with a family history of BCC should practice stringent sun protection lifelong.
Sun protection tips
- Stay indoors or under the shade in the middle of the day
- Wear covering clothing
- Apply broad spectrum sunscreens to exposed skin if you are outdoors for prolonged periods, especially during the summer months.