Basal cell carcinoma, the most common skin cancer, originates in certain cells of the outer layer of the skin (epidermis).
Usually, a small, shiny bump appears on the skin and enlarges slowly.
The bumps may break open and form a scab, sometimes with bleeding, or become flat, resembling a scar.
This cancer can often be identified by sight, but doctors usually do a biopsy.
The cancer is usually removed, but sometimes people may be given chemotherapy drugs applied to the skin, immunotherapy, or, occasionally, radiation therapy or medications taken by mouth.
Basal cells are in the lowest layer of the epidermis (the outer layer of the skin). Although basal cell carcinoma may not develop from the basal cells, the disease is so named because the cancer cells look like basal cells under a microscope.
Basal cell carcinoma is the most common type of skin cancer. Approximately 2 million people develop this type of cancer in the United States each year.
Basal cell carcinoma is most common among people who have light skin and a history of sun exposure. It is very rare among people with dark skin.
Basal cell carcinoma usually develops on skin surfaces that are exposed to sunlight, commonly on the head or neck, and may develop in a type of birthmark that often appears on the scalp (nevus sebaceus). Basal cell carcinoma also may develop in people who have certain hereditary disorders, such as xeroderma pigmentosum, Gorlin syndrome, and Bazex syndrome.
The tumors enlarge very slowly, sometimes so slowly that they go unnoticed as new growths. However, the growth rate varies greatly from tumor to tumor, with some growing as much as ½ inch (about 1 centimeter) in a year.
Basal cell carcinomas rarely spread (metastasize) to other parts of the body. Instead, they invade and slowly destroy surrounding tissues. When basal cell carcinomas grow near the eyes, ears, mouth, bone, or brain, the consequences of spread can be serious and can lead to death. Yet, for most people, the tumors simply grow slowly into the skin.
Symptoms of Basal Cell Carcinoma
There are several types of basal cell carcinomas.
The nodular type of basal cell carcinoma usually begins as small, shiny, firm, almost clear to pink in color, raised growth. After a few months or years, visible dilated blood vessels (telangiectases) may appear on the surface, and the center may break open and form a scab. The border of the cancer is sometimes thickened and pearly white. The cancer may alternately bleed and form a scab and heal, leading a person to falsely think that it is a sore rather than a cancer.
Other types of basal cell carcinomas vary greatly in appearance. For example, the superficial type appears as flat, thin, red or pink patches, and the morpheaform type appears as thicker flesh-colored or light red patches that look somewhat like scars.
In this basal cell carcinoma, a red bump (nodule) begins to break open in the middle.
Image provided by Thomas Habif, MD.
In this basal cell carcinoma, dilated blood vessels (telangiectases) appear on the surface.
© Springer Science+Business Media
This basal cell carcinoma is a light red patch that looks somewhat like a scar.
© Springer Science+Business Media
In this basal cell carcinoma, a red bump (nodule) begins to break open in the middle.
Image provided by Thomas Habif, MD.
In this basal cell carcinoma, dilated blood vessels (telangiectases) appear on the surface.
© Springer Science+Business Media
This basal cell carcinoma is a light red patch that looks somewhat like a scar.
© Springer Science+Business Media
Diagnosis of Basal Cell Carcinoma
Biopsy
Doctors often can recognize a basal cell carcinoma simply by looking at it, but a biopsy is the standard procedure for confirming the diagnosis. During this procedure, doctors remove a piece of the tumor and examine it under a microscope.
Treatment of Basal Cell Carcinoma
Removal of the tumor (many different methods)
Basal cell carcinomas should be treated by a specialist.
Doctors may remove the cancer in the office by scraping and burning it with an electric needle (a procedure called curettage and electrodesiccation) or by cutting it out. Doctors may destroy the cancer by using extreme cold (cryosurgery).
Certain chemotherapy drugs may be applied to the skin. Photodynamic therapy (see Using Lasers to Treat Skin Problems), in which chemicals and a laser are applied to the skin, also may be used. Occasionally, radiation therapy is used.
A technique called Mohs microscopically controlled surgery may be required for some basal cell carcinomas that are large or regrow or occur in certain areas, such as around the nose and eyes.
vismodegib or sonidegib may be given a type of immunotherapy
Mohs Microscopically Controlled Surgery
Because skin cancer cells often have spread beyond the edges of the visible patch on the skin, dermatologists sometimes use a special surgical technique to make sure they remove all of the cancer. In this technique, called Mohs microscopically controlled surgery or Mohs micrographic surgery, dermatologists first remove the visible tumor and then begin cutting away the edges of the wound bit by bit. During surgery, the dermatologist examine pieces of tissue to look for cancer cells. Tissue removal from the area continues until the samples no longer contain cancer cells. This procedure enables dermatologists to limit the amount of tissue removed and thus is especially useful for removing cancers near such delicate sites as the eye. After removing all of the cancer, dermatologists decide how best to replace the skin that has been cut away. They may bring the edges of the remaining skin together with sutures or use a skin graft or skin flap. Or they may place a dressing on top of the wound and let the skin heal on its own. Mohs surgery reduces recurrence rates for skin cancers. This surgery is useful for basal cell and squamous cell cancers but is less often used for melanoma. |
Prognosis for Basal Cell Carcinoma
Treatment of basal cell carcinoma is nearly always successful, and the cancer is rarely fatal. However, almost 25% of people who have had 1 basal cell carcinoma develop a new basal cell cancer within 5 years of the first one. Thus, anyone with one basal cell carcinoma should have a yearly skin examination.
Prevention of Basal Cell Carcinoma
Because basal cell carcinoma is often caused by sun exposure, people can help prevent this cancer by doing the following, starting in early childhood:
Avoiding the sun: For example, seeking shade, minimizing outdoor activities between 10 AM and 4 PM (when the sun’s rays are strongest), and avoiding sunbathing and the use of tanning beds
Wearing protective clothing: For example, long-sleeved shirts, pants, and broad-brimmed hats
Using sunscreen: At least sun protection factor (SPF) 30 with UVA and UVB protection used as directed and reapplied every 2 hours and after swimming or sweating but not used to prolong sun exposure
In addition, any skin change that lasts for more than a few weeks should be evaluated by a doctor.
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
American Cancer Society: Basal and Squamous Cell Skin Cancer: Information about skin cancers , including detection, prevention, treatment options, and other resources
The Skin Cancer Foundation: Basal Cell Carcinoma Overview: Information about basal cell carcinoma, including detection, prevention, treatment options, and other resources
