This is the most commonly diagnosed skin cancer in the US every year; over three million a year! About 80 percent of non-melanoma (squamous cell and basal cell) skin cancers will be a basal cell carcinoma. As expected, those with fair skin and lots of cumulative sun damage are at higher risk. Vacations at the beach, sunburns when a teenager, tanning beds, and walking the dog without sunscreen can contribute to the development of basal cell skin cancer. Just think of all the times you are in the sun without sunscreen. Those times are part of the cumulative UV exposure that can lead to BCC. If you were to develop a skin cancer in your lifetime this is the one you want. The risk of spreading is very low.
Both young and old are at risk for basal cell skin cancer. Although we typically diagnosis this in the older population it is not unheard of to treat someone in their 20s for this. Sunburns, fair skin, and the tanning bed fad may be at fault for the younger generation developing these. Also, there are a lot of medications that make people more sensitive to sunlight. Blood pressure medications, antibiotics, and even acne treatments can make the skin more sensitive to UV light.
Just like squamous cell skin cancer, those that are immunosuppressed or have had long term radiation therapy are at higher risk for BCC, regardless of sun exposure.
There are several type of basal cell skin cancer, but we will focus on the two most common.
Nodular is the most common form of BCC accounting for about 50-60 percent. These can occur anywhere on the body that has had excess sun exposure. They tend to look like pearly dome shaped bumps and bleed easily. Nodular BCCs tend to ulcerate in the middle.
Superficial BCC can also occur anywhere on the body. Unlikely the “pearly papule” of a nodular BCC these tend to be flatter and shinier or even sometimes scaly. Also, they don’t tend to bleed like the nodular variant.
There are other types of BCC called morpheaform, micronodular, and infiltrative. These three tend to be more aggressive so some treatment options that exist for a superficial or nodular basal cell would not be appropriate for these types.
Treatment for BCC is relatively straight forward. The same options that are available for squamous cell skin cancer are available for basal cell skin cancer. There are several treatment options for BCC based on location of the skin cancer (nose vs forearm) and type (superficial vs nodular). Treatment could include excision, Mohs micrographic surgery, electrosurgery (ED&C, electrodesiccation and curettage), radiation therapy, and topical therapies such as fluorouracil (Efudex). Photodynamic therapy (PDT) or “Blue Light” is also an option for superficial basal cell skin cancer with good cure rates.
The best treatment is not the same for every person and every type of basal cell skin cancer. After diagnosis of a BCC we will discuss with each patient the risks and benefits of each recommended treatment option.
Once the skin cancer is removed or otherwise treated it is extremely important to have good follow up. Like all cancer, skin cancer can recur in the same treated area or develop in a new area. We recommend a total body skin exam every six months for two years after the diagnosis of a basal cell skin cancer. If no other skin cancers are found during that time period we then recommend yearly total body skin examinations. Possibly more important is the need to look over your body once a month at home. Trust your instincts. If a spot does not heal, bleeds, or somehow is different from your other moles you should come in for an office visit sooner.