In this tutorial, dermatologist Eric Stewart, MD, discusses the diagnosis and treatment options for basal cell carcinoma.
*Most common form of skin cancer
*Consists of bumps or growths which can be pearly or waxy, white, light pink, flesh-colored, or brown, sometimes slightly raised. Commonly, BCC will scab or bleed intermittently
*Frequently occurs in sun-damaged skin
*Does not usually metastasize. These are locally destructive cancers
Basal cell carcinoma (BCC) is the most common form of skin cancer. It usually presents in areas of the skin exposed to sun, including the face, neck, head, chest and upper back, though it can appear anywhere. There are several subtypes, including nodular, infiltrating, morpheic, and superficial.
In nodular BCC, the cancer presents itself as pearly, skin-colored or pink bumps, with tiny blood vessels often appearing on their surface. As the lesion grows, it may ulcerate or bleed with minor trauma. Infiltrating lesions often appear scar-like or depressed. They may often be shiny and have sores or scabs on their surface. Superficial BCC presents itself as pink or red scaly skin, often dry appearing. Lesions will slowly grow and the border of the lesion may become raised. This can be mistaken as a chronic rash such as ringworm or just dryness. This subtype is generally found on the trunk, arms, and legs. While BCC can affect any age or ethnic group, it most commonly appears in elderly fair complected caucasians. Chronic sun exposure is virtually always noted as a causative factor. There are also syndromes they convey a markedly elevated risk of BCC, such as nevoid Basal cell carcinoma Syndrome and Xeroderma Pigmentosa.
Differential Diagnosis (Other conditions with similar appearance)
*Diagnosis based on skin appearance
*Skin biopsy performed to confirm diagnosis and rule out other conditions
*Biopsy results indicate which treatment course is appropriate
BCC is generally diagnosed based on appearance, then further classified by sub-type. Health care professionals will then perform a biopsy to confirm diagnosis and plot out treatment course.
*Self-examination and evaluation by a dermatologist is key in identifying lesions early
*Surgical removal is the most commonly employed treatment
While self-examination is recommended to identify lesions, they must be treated by health care professionals. Once diagnosis is confirmed via biopsy, treatment will be depend on several factors. These may include size and location of the cancer, as well as the general health of the patient.
In the case of nodular BCC, treatment options include electrodessication and curettage, surgical excision, Mohs Micrographic surgery, and radiation treatment of the affected area. Radiation is usually only used in cases where the affected person isn't a good candidate for surgery due to other health problems.
With infiltrating BCC or morpheic BCC, treatment is more limited due to the aggressive and invasive nature of the disease. Mohs Micrographic surgery is usually the treatment of choice in this situation.
Aggressive treatments are generally not required for instances of superficial BCC, as it is slow-growing and thin. In addition to conventional treatments such as cryosurgery, electrodessication and radiation treatment, topical options such as Imiquimod (which encourages the immune system to attack the BCC), Photodynamic therapy, and laser treatments can be used to combat the condition.