Basal Cell Cancer

Basal cell carcinoma (BCC) is the most common type of skin cancer, with majority of incidence in adults over the age of 50. It typically develops in individuals who have spent a lot of time in the sun or in indoor tanning beds, getting exposed to the harmful ultraviolet (UV) rays, especially during their childhood. The most commonly affected areas are head and neck, about 80% of all BCC, but BCC can develop anywhere on the exposed skin. BCC is particularly common in white individuals, being very uncommon in darker-skinned individuals. The incidence of BCC in white Americans, has increased by more than 10 percent per year, with lifetime risk of developing a BCC being 30 percent. Residents of Hawaii and California, that are closer to equator and hence get more sun exposure, have double the incidence of BCC compared to residents of Midwestern United States.

 

What causes Basal Cell Cancer?

UV rays cause basal cell carcinoma by damaging the DNA in skin cells and turning normal cells into abnormal cells. Damaging effects of UV rays build up over time and the body is unable to repair the damage, causing skin cancers to develop. This is especially true for genetic conditions, including Xeroderma Pigmentosum and Gorlin Syndrome (basal cell nevus syndrome), in which the cumulative damage and inability of the body to repair the damage, causes development of multiple skin cancers, even as early as childhood. Although UV radiation is the most important risk factor for BCC, other established risk factors include chronic arsenic exposure, radiation therapy and long-term immunosuppressive therapy. Chronic arsenic exposure can come from ingestion of contaminated drinking water, seafood, or medications. Ionizing radiation for treatment of acne, psoriasis, tinea capitis, childhood cancers, thymic enlargement in infancy, ankylosing spondylitis and as pre-treatment of prior to stem cell transplant, all increase risk for the subsequent development of BCC. Organ transplant recipients that are maintained on anti-rejection medications for chronic immunosuppression, and patients infected with HIV are also at increased risk for development of BCC.

What does a Basal Cell Cancer look like?

  • Nodular BCC looks like a pink or flesh-colored, pearly or translucent bump with rolled border and at least one large blood vessel, with or without ulceration

  • Superficial BCC presents on trunk as pink, slightly scaly patch, sometimes with depressed center and shiny rim

  • Morpheaform/infiltrative BCC looks like a pink or flesh colored smooth and firm plaque, with ill-defined borders

Is there a test for Basal Cell Cancer ?

Basal cell carcinoma can present in many different ways. A board-certified dermatologist is trained to clinically identify lesions suspicious for BCC. A dermatoscope can further help with identification by highlighting key dermoscopic features. Any lesion that is oozing, bleeding or non-healing sore should be evaluated. If your dermatologist suspects a BCC, they will perform an in office skin biopsy to both confirm a skin cancer diagnosis and identify the skin cancer type.

How is Basal Cell Cancer treated?

Treatment for basal cell carcinoma depends on the severity and location of the cancer. 

  • Surgery – Skin cancer is usually treated with surgery to remove the cancer. This can be done via excisional surgery or Mohs surgery, a tissue sparing surgery that is used for cosmetically sensitive areas to minimize removal of normal skin.

  • Radiation therapy – Radiation kills cancer cells and can be used for patients who are not good candidates for surgery.

  • Topical chemotherapy creams – Prescription anti-cancer or immunomodulator creams can be used for certain superficial cancers that kill cancer cells.

  • Photodynamic therapy – Photodynamic therapy kills cancer cells. For this therapy, a doctor or agent applies a special medicine that concentrates in cancerous and pre-cancerous cells before using a special light to kill those cells in the treatment area.

  • Cryosurgery, a chemical freezing technique can be used to cause cryo-destruction of cancer cells.

  • Electrodessication and curettage is a technique of scraping the friable cancer cells and destroying remaining cells with electrical current.

How can I prevent Basal Cell Cancer?

  • Sun protection: The primary prevention measure is protection from sun exposure. It’s important to protect your skin from UV damage at any age. Aggressive sun protection before the age of 18, could reduce the incidence of skin cancers, including BCC, by almost 80 percent, according to one estimate. Remember to always apply SPF 30 or higher sunscreen 15 minutes before going outdoors and reapply every 90 minutes if staying outdoors. Avoid UV from indoor tanning.

  • NSAIDS (non-steroidal anti-inflammatory drugs): Results from one research trial suggested that taking Celecoxib (200 mg twice daily for 9 months in this study) may reduce incidence of BCC in treatment group vs placebo group. In contrast, case control population studies out of Denmark and UK, failed to find any between the use of celecoxib or other prescription NSAIDs and overall risk for BCC.

  • Nicotinamide (Vitamin B3): oral nicotinamide, a dietary supplement available over-the-counter taken 500 mg twice daily, has been shown in phase III randomized clinical trials to reduce the number of BCC, with reduction rate of 20% at end point of 12 months.

  • Topical 5-Fluorouracil: 5FU is a topical chemotherapy agent that has been shown to reduce the number of new actinic keratoses, pre-cancerous lesions for both BCC and SCC. However it is not effective in prevention of BCC in high risk patients.

  • Perform frequent skin self-exams and notify your dermatologist if you notice anything that is sore, non-healing, growing, changing or bleeding.