Basal Cell Carcinoma

What is Basal Cell Carcinoma

Basal cell carcinoma is the most common form of skin cancer. It begins in the basal cells, which are at the bottom of the outer skin layer (epidermis). It occurs most often on parts of the body that are frequently exposed to the sun, such as:

• Parts of the head, including the scalp or face.
• Ears.
• Neck.
• Arms or legs.
• Backs of the hands.

Basal cell carcinoma can almost always be cured. It rarely spreads to other areas of the body (metastasizes). Basal cell carcinoma may come back at the same location (recur), but it can be treated again if this occurs.

21 Interesting Facts of Basal Cell Carcinoma

1. Nonmelanoma, locally invasive skin cancer
2. May be clinically indistinguishable from Merkel cell cancer; however, basal cell carcinoma is more prone to ulceration or bleeding
3. Single lesion, rather than multiple lesions as in molluscum contagiosum
4. Papules or nodules that usually have a central ulceration, erosion, or central depression. Tend to have a rolled edge and telangiectatic vessel within the lesion
5. Verruca plana (flat warts)May be single or multiple
6. Flesh-colored papules with an irregular surface
7. Ectopic sebaceous glandsIn men, commonly occur on the skin of the penis (corona, inner foreskin, and shaft)
8. In women, occur on labia minora and labia majora
9. Pinhead-sized, whitish-yellow papules
10. Sebaceous hyperplasia Lesions are small (2-6 mm), cream-colored to yellowish umbilicated papules 
11. Predilection for forehead, temples, and infraorbital areas
12. Most common after age 40 years, but may occur at younger age in familial form, with extensive lesions over upper body sparing periorificial areas
13. Syringoma (syringomata) Benign appendageal tumors of the intraepidermal eccrine sweat duct most common in adolescent females. Familial types have been described
14. Usually multiple and symmetrical and commonly involve the lower eyelids; may occur at other sites
15. Flesh-colored papules with a rounded or flat surface, 1 to 5 mm in diameter 
16. KeratoacanthomaSolitary lesion that starts as a minute papule on sun-exposed skin
17. When mature is a dome-shaped, umbilicated nodule with a hyperkeratotic plug in the center
18. Epidermoid cystsNodules commonly seen on face, neck, and trunk of children
19. Dome-shaped, sharply circumscribed, flesh-colored, compressible, and freely movable
20. Larger lesions (0.5 cm or larger) than molluscum contagiosum, but like molluscum contagiosum these lesions often have a central punctum (plugged, dilated pore of a pilosebaceous follicle), which may excrete cheesy material
21. Differentiated from Merkel cell cancer by histopathologic characteristics and by immunohistochemical staining of primary lesion 
    • Shares similar histologic features with Merkel cell cancer (eg, mucinous stroma, stromal artifactual retraction) 
    • Distinguishing cytologic feature is widespread peripheral palisading 
    • Negative for cytokeratin 20 in most patients

What are the causes?

This condition is usually caused by exposure to ultraviolet (UV) light. UV light may come from the sun or from tanning beds. Other causes include:

• Exposure to arsenic.
• Exposure to radiation.
• Exposure to toxic tars and oils.
• Certain genetic conditions, such as xeroderma pigmentosum.

What increases the risk?

This condition is more likely to develop in:

• People who are older than 40 years of age.
• People who have fair skin (light complexion).
• People who have blonde or red hair.
• People who have blue, green, or gray eyes.
• People who have childhood freckling.
• People who have had sun exposure over long periods of time, especially during childhood.
• People who have had repeated sunburns.
• People who have a weakened immune system.
• People who have been exposed to certain chemicals, such as tar, soot, and arsenic.
• People who have chronic inflammatory conditions.
• People who have chronic infections.
• People who use tanning beds.

What are the symptoms of Basal Cell Carcinoma?

The main symptom of this condition is a growth or lesion on the skin. The shape and color of the growth or lesion may vary. The five main types include:

• An open sore that may remain open for 3 weeks or longer. The sore may bleed or crust. This type of lesion can be an early sign of basal cell carcinoma. Basal cell carcinoma often shows up as a sore that does not heal.
• A reddish area that may crust, itch, or cause discomfort. This may occur on areas that are exposed to the sun. These patches might be easier to feel than to see.
• A shiny or clear bump that is red, white, or pink. In people who have dark hair, the bump is often tan, black, or brown. These bumps can look like moles.
• A pink growth with a raised border. The growth will have a crusted and indented area in the center. Small blood vessels may appear on the surface of the growth as it gets bigger.
• A scarlike area that looks like shiny, stretched skin. The area may be white, yellow, or waxy. It often has irregular borders. This may be a sign of more aggressive basal cell carcinoma.

How is this diagnosed?

This condition may be diagnosed with:

• A physical exam.
• Removal of a tissue sample to be examined under a microscope (biopsy).

How is this treated?

Treatment for this condition involves removing the cancerous tissue. The method that is used for this depends on the type, size, location, and number of tumors. Possible treatments include:

• Mohs surgery. In this procedure, the cancerous skin cells are removed layer by layer until all of the tumor has been removed.
• Surgical removal (excision) of the tumor. This involves removing the entire tumor and a small amount of normal skin that surrounds it.
• Cryosurgery. This involves freezing the tumor with liquid nitrogen.
• Plastic surgery. The tumor is removed, and healthy skin from another part of the body is used to cover the wound. This may be done for large tumors that are in areas where it is not possible to stretch the nearby skin to sew the edges of the wound together.
• Radiation. This may be used for tumors on the face.
• Photodynamic therapy. A chemical cream is applied to the skin, and light exposure is used to activate the chemical.
• Electrodesiccation and curettage. This involves alternately scraping and burning the tumor while using an electric current to control bleeding.
• Chemical treatments, such as imiquimod cream and interferon injections. These may be used to remove superficial tumors with minimal scarring.

Follow these instructions at home:

• Avoid unprotected sun exposure.
• Do self-exams as told by your health care provider. Look for new spots or changes in your skin.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Avoid the sun when it is the strongest. This is usually between 10:00 a.m. and 4:00 p.m.
• When you are out in the sun, use a sunscreen that has a sun protection factor (SPF) of at least 30.
• Apply sunscreen at least 30 minutes before exposure to the sun.
• Reapply sunscreen every 2–4 hours while you are outside. Also reapply it after swimming and after excessive sweating.
• Always wear hats, protective clothing, and UV-blocking sunglasses when you are outdoors.
• Do notuse tanning beds.

Contact a health care provider if:

• You notice any new spots or any changes in your skin.
• You have had a basal cell carcinoma tumor removed and you notice a new growth in the same location.