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Basal Cell Carcinoma

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On this page: About Basal Cell | Risk Factors | Prevention | Diagnosis & Treatment | Videotutorial | References

About Basal Cell Skin Cancer

Most skin cancer can be prevented, yet one in five Americans will develop some form of skin cancer during their lifetime(1). Basal cell carcinoma (BCC) is the most common type of skin cancer and appears most often on sun-exposed areas of the body. BCC usually develops slowly, and as a result can often be detected and treated early. Both basal cell carcinoma and squamous cell carcinoma have a better than 95 percent cure rate if detected and treated early.(1) If left untreated,  however, it can be locally invasive, aggressive, and destructive of surrounding and underlying tissue, such as muscles and bones. Fortunately it is rare that basal cell carcinoma metastasizes (spreads) to other parts of the body.(3)


Photos of Basal Cell Skin Cancer

Basal Cell Nodular Pigmented Basal Cell Basal Cell

Nodular Basal Cell

Pigmented Basal Cell

Basal Cell

Key Warning Signs of Skin Cancer

  • New growth,
  • A spot or bump that’s changing in character (i.e. getting larger, changing in color, getting darker, causing symptoms such as itching) or
  • A sore that doesn’t heal within 3 months.(4)

What factors increase the risk of developing basal cell carcinoma?

  • Heavy sun exposure
    • Especially in childhood: 80 percent of a person’s lifetime sun damage occurs before the age of 18
    • Five or more sunburns double your risk of developing skin cancer. (1)
       
  • Working outside without using protection from the sun
  • Living close to the equator  
  • Light skin color
  • Poor tanning capacity
  • Freckling in childhood
  • Blond or red hair
  • Blue or light-colored eyes
  • Celtic ancestry, such as Irish or Scottish
  • Age over 40
  • Family history or a personal history of skin cancer 
  • History of infection with the human papillomavirus.
  • History of therapy with x-rays for facial acne
  • History of ingestion of Arsenic (1,3) 

Prevention and Detection

  • Wear a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 15, ideally 30 or more
  • Use sunscreens every day if you are going to be in the sun for more than 20 minutes.
  • Apply sunscreens to dry skin 15 to 30 minutes before going outdoors.
  • When applying sunscreen, generously coat the skin that is not covered by clothing and pay particular attention to the face, ears, hands and arms, back of the neck, and exposed areas of the scalp. 
  • Reapply sunscreens every two hours or immediately after swimming or strenuous activity
  • Avoid outdoor activities between 10 a.m. and 4 p.m. when the sun’s rays are the strongest; Follow the “Shadow Rule” – if your shadow is shorter than you are, the sun’s damaging rays are at their strongest and you are likely to sunburn;
  • Seek shade whenever possible;
  • Wear sun-protective clothing and accessories, such as wide-brimmed hats. 
  • Wear sunglasses that are UV protective 
  • Avoid tanning beds  (2)
  • Regular skin exams are important: The American Cancer Society recommends a cancer-related checkup, including a skin exam when you have your regular health exams. You should also check you own skin once a month. This is best done in front of a full-length mirror. A hand-held mirror can be used for areas that are hard to see. You should know the pattern of moles, freckles, and other marks on your skin so that you’ll notice any changes.

    Be sure to show your doctor any area that concerns you. The key warning signs are:
  • a new growth,
  • a spot or bump that’s changing in character (i.e. getting larger, changing in color, getting darker, causing symptoms such as itching) or
  • a sore that doesn’t heal within 3 months.(4)

Diagnosis and Treatment

A skin biopsy, performed in the doctor's office, is required to confirm the diagnosis and to further identify the histologic subtype.   (To read more details about a skin biopsy, click here.) Additional workup is rarely necessary, unless a genetic disorder is suspected.  If the lesion turns out to be BCC, surgical treatment is essential so that malignant tissue cannot proliferate further.  Although it rarely metastasizes, it can be locally invasive and destructive of surrounding and underlying tissue.  Most common surgical methods are curettage, excision with margin examination, and Mohs micrographic surgery. Treatments that are effective for most nonaggressive BCCs include radiotherapy and cryotherapy.(5)  (To read about these procedures in detail, click here.)


After Treatment

After the skin cancer has been removed, it will either be allowed to heal naturally, or reconstructive surgery using a skin flap or skin graft may need to be performed.
It's very important to follow the above preventive measures and keep your physician's follow-up appointments because:
1) Skin cancer often recurs even after it has been completely removed and thought to be cured.
2) If the cancer does recur, it is most likely to recur within 5 years of treatment.
3) If you have had one skin cancer, you are at high risk for developing another one.


Videotutorial

Educational Video Tutorial about Skin Cancer from Medline Plus   Locate the "Interactive  Tutorials" button  in the upper R hand column.  This will take you to an extensive list of available videos; scroll down to "Skin Cancer" and follow the directions. Medline Plus is a service of the National Library of Medicine and the National Institute of Health.

References for Basal Cell Skin Cancer

(1) American Academy of Dermatology, Skin Cancer Fact Sheet at www.aad.org
(2) American Academy of Dermatology Timothy M. Johnson, MD, chair of the American Academy of Dermatology's Melanoma/Skin Cancer Committee and Associate Professor, Department of Dermatology, University of Michigan, Ann Arbor, Mich
(3)
Leffell DJ, Fitzgerald DA (1999). Basal cell carcinoma. In IM Freedberg et al., eds., Fitzpatrick's Dermatology in General Medicine, 5th ed., pp. 857–864. New York: McGraw-Hill.
(4) American Cancer Society How is nonmelanoma skin cancer found?  Cancer Reference Information at www.cancer.org
(5)
Basal Cell Carcinoma from emedicine.com


Read more at:

US National Library of Medicine & Nat'l Institute of Health
This site provides extensive information and links to the latest news, overview of the basics, treatment, disease management, nutrition, emotional coping, clinical trials, research, and national organizations skin cancer
--Written by N Thompson, ARNP in collaboration with M Thompson, MD, Internal Medicine, Last updated January 2009

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