What is basal cell carcinoma?
Basal cell carcinoma is a slow growing cancer that does not metastasize but can be locally damaging. BCC is the most common type of skin cancer accounting for 80% of non-melanoma skin cancers. More than 3 million people are diagnosed every year. BCC commonly appears on the face, ears, neck, scalp, chest, shoulders, arms and legs, but has also been diagnosed on the trunk.
What causes basal cell carcinoma?
The main cause is chronic exposure of unprotected skin to the ultraviolet (UV) rays of the sun and tanning beds. UV rays damage the skin’s DNA (the genes that controls cell growth and function) causes the skin cells to grow out of control.
Who is at risk for BCC?
People with the highest risk are fair-skinned with blond or red hair and blue, green or gray eyes, but anyone with a history of long hours outdoors in the sun, through occupation or leisure pursuits is at risk. The average age at diagnosis is 60. However new data reports that more young people in their twenties and thirties are being diagnosed with BCC. Men develop more BCCs, but women are catching up.
- A positive family history of BCC strongly predicts the development of BCC.
- A personal history of BCC or SCC is associated with a 20% increased risk of a recurrent BCC or development of Squamous Cell Carcinoma.
- People who have had radiation therapy for cancer have a higher risk of developing skin cancer.
- People who have a compromised immune system are more likely to develop skin cancer, including organ transplant recipients.
- People exposed to arsenic found in well water and pesticides
- Long term skin inflammation or injury like burns and scarring
What are the warning signs?
- A lesion or bump with an ulcerated center and a pearly rim.
- A flat, scaly plaque with pearly borders that can be confused with eczema or psoriasis.
- An open, non-healing sore that bleeds, oozes or crust over but comes back. If a sore doesn’t heal within a week see your dermatologist.
- A shiny bump that is clear, pink or red and may have blue, brown or black areas.
- A raised red patch or irritated area that can itch or hurt.
- A lesion that looks like a scar.
Dr. Sedrak will conduct an examination. BCC is readily identifiable but Dr. Sedrak will confirm the diagnosis with a biopsy (a small tissue sample that is sent to for microscopic analysis). If BCC does spread, it can destroy local tissues like cartilage and bone. Early diagnosis is especially important to avoid the risk of spread. Prognosis is excellent when caught early.
Choice of treatment depends on the size, location, and depth of the tumor, as well as your age and health, and how likely treatment will affect your appearance. Since BCC is typically found on the face, eyes, lips and nose standard excision can be disfiguring. Consequently, microscopic surgery called Mohs surgery can spare healthy tissues and reduce the risk of recurrence.
Excision involves the removal of the entire lesion and a margin of healthy skin around the lesion. The excised tissue is sent to a lab for microscopic analysis and confirmation of diagnosis. The cure rate is above 95%, but a subsequent excision may be needed. The 5- year recurrence rate is less than 3% on the face.
Mohs Micrographic Surgery
Mohs surgery requires specialized training. The procedure involves the removal of thin layers of the tumor, which are examined under a microscope to see if any cancer cells remain. This is repeated until the sample is free of cancer cells. While Mohs surgery takes several hours, the result is the preservation of healthy skin and an almost invisible scar.
There are a variety of topical treatments including topical drugs and photodynamic therapy (PDT). Topical chemotherapy drugs are used to kill cancer cells. Topical therapies are reserved for low-risk superficial tumors that don’t extend deep into the skin. If the BCC is superficial topical medications can provide an 80-90% cure rate.
Dr. Joseph Sedrak is a board-certified, fellowship trained dermatologist and Mohs surgeon. At the Texas Skin Cancer Center with offices in Houston, Kingwood and Sugarland, Texas you will always receive private, respectful and compassionate care in a state-of-the-art facility. Contact Texas Skin Cancer Center to schedule a consultation today.