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).

CAUSES

Sun exposure is the most common cause of basal cell carcinoma. Basal cell carcinoma occurs most often on parts of the body that are frequently exposed to the sun, including the:

  • Scalp.

  • Ears.

  • Neck.

  • Face.

  • Arms.

  • Backs of the hands.

  • Legs.

However, basal cell carcinoma can occur anywhere on the body. Rarely, tumors develop on areas not exposed to the sun. Other causes of basal cell carcinoma can include:

  • Exposure to arsenic.

  • Exposure to radiation.

  • Certain genetic syndromes, such as xeroderma pigmentosum.

RISK FACTORS

People at highest risk for basal cell carcinoma include those with:

  • Fair skin.

  • Blonde or red hair.

  • Blue, green, or gray eyes.

  • Childhood freckling.

Factors that increase your risk for basal cell carcinoma include:

  • Sun exposure over long periods of time. Childhood sun exposure appears to be a more significant factor than sun exposure as an adult.

  • Repeated sunburns.

  • Use of tanning beds.

  • Having a weakened immune system.

SYMPTOMS

Five signs of basal cell carcinoma are:

  • An open sore that bleeds, oozes, or crusts. The sore may remain open for 3 or more weeks. This can be an early sign of basal cell carcinoma. Basal cell carcinoma can mimic a pimple that will not heal.

  • A reddish or irritated area which may crust, itch, or cause discomfort. This may occur on areas exposed to the sun. These patches might be easier felt than seen.

  • A shiny, pearly, or translucent bump that is pink, red, or white. The bump may also be tan, black, or brown, especially in dark haired people. These bumps can be confused with moles.

  • A pink growth with a slightly elevated, rolled border, and a crusted indentation in the center. As the growth slowly enlarges, tiny blood vessels may develop on the surface.

  • A scar-like white, yellow, or waxy area that looks like shiny, stretched skin. It often has irregular borders. This may be a sign of more aggressive basal cell carcinoma.

DIAGNOSIS

Your caregiver may be able to tell what is wrong by doing a physical exam. Often, a tissue sample (biopsy) is also taken. The tissue is examined under a microscope.

TREATMENT

The treatment for basal cell carcinoma depends on the type, size, location, and number of tumors. Possible treatments include:

  • Mohs surgery. This is a procedure done by a skin doctor (dermatologist or Mohs surgeon) in his or her office. The cancerous cells are removed layer by layer. This treatment has a high cure rate.

  • Surgical removal of the tumor.

  • Freezing the tumor with liquid nitrogen (cryosurgery).

  • Plastic surgery to remove the tumor, in the case of large tumors.

  • 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.

  • Chemical treatments, such as imiquimod cream and interferon injections. This may be used to remove superficial tumors with minimal scarring.

  • Electrodesiccation and curettage. This involves alternately scraping and burning the tumor, using an electric current to control bleeding.

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.

PREVENTION

  • Avoid the sun between 10:00 a.m. and 4:00 pm when it is the strongest.

  • Use a sunscreen or sunblock with a sun protection factor of 30 or greater.

  • Apply sunscreen at least 30 minutes before exposure to the sun.

  • Reapply sunscreen every 2 to 4 hours while you are outside, after swimming, and after excessive sweating.

  • Always wear protective hats, clothing, and sunglasses with ultraviolet protection.

  • Avoid tanning beds.

HOME CARE INSTRUCTIONS

  • Avoid unprotected sun exposure.

  • Follow your caregiver's instructions for self-exams. Look for new spots or changes in your skin.

  • Keep all follow-up appointments as directed by your caregiver.

SEEK MEDICAL CARE IF:

  • You notice any new spots or changes in your skin.

  • You have had a basal cell carcinoma tumor removed and you notice a new growth in the same location.