Basal cell carcinoma (BCC) is the most common type of nonmelanoma skin cancer, and nonmelanoma skin cancer represents about half of all cancers diagnosed in this country. In fact, BCC affects over one million people in the United States each year. Although BCC has the highest frequency of all cancers, it is also the easiest to treat and the least likely to spread to other areas of the body. It most frequently occurs on the head and neck, and is thus linked to areas of the body that are chronically exposed to the sun. With that said, other areas of the body can also be affected, including the trunk and lower extremities.
In general, this cancer tends to affect the elderly, which is consistent with several decades of chronic sun exposure as a major risk factor. Older folks have been exposed to the sun’s rays for a longer period of time as compared to young adults. This does not mean that young adults and children are immune to BCC development–it can still occur, but is much rarer, in younger populations. As stated before, the primary risk factor for the development of BCC is long-term UV radiation without protection, but other risk factors have been implicated such as burns, radiation exposure, and arsenic intoxication.
BCC most often affects people with fair skin, light hair, and blue, green, or gray eyes. It classically looks like a fleshy bump, nodule, or red patch. In fact, if left untreated, the lesion will often begin to repeatedly bleed and crust over. Please note that these last two statements do no justify the variable appearance of BCC. Other warning signs include an open sore, a growth with an elevated border and central indentation, a bump or nodule, and a scar-like area.
Despite the fact that BCC is the least likely of nonmelanoma skin cancers to spread, it can cause fairly aggressive local destruction if left untreated for a long period of time. It is not uncommon for this local invasion to affect nearby nerves and bone.
In addition, BCCs have a high recurrence rate; if you’ve had one diagnosed, there’s a good chance of developing another within 5 years. In other words, basal cell carcinoma begets basal cell carcinoma, and this should emphasize the importance of regular follow-up visits to a dermatologist.
DON’T BECOME A STATISTIC!
It’s all about skin protection. The majority of BCC cases are caused by overexposure to sunlight. This is why sun avoidance, especially during peak sunlight hours (10A.M. – 3P.M.)is the best way to limit the risk of developing this form of skin cancer. Other mechanical protectants to consider include sunglasses, broad-brimmed hats, and protective, tightly woven clothing.
On top of mechanical protection, the one best protective measure you can take is the use of sunscreen. A broad-spectrum sunscreen should be applied liberally to all sun-exposed skin (including the lips) on a daily basis (even cloudy days!) and reapplied every 90 minutes during outdoor activities. Sunscreens should block both UVA and UVB rays and be rated SPF 15 or higher. Also, avoid tanning parlors and home tanning lights of any kind. The only safe tan comes from a bottle! In other words, self-tanning creams and sprays are okay.
And for the moms reading this article–long-term sun damage prevention is key. This means applying sunscreen to your children! Over 50% of the sun damage middle-aged adults complain about most likely occurred as a result of bad sunburns during their childhood!
SO WHAT’S THE TREATMENT?
A biopsy is needed in order to confirm a diagnosis of BCC. A biopsy involves removing a portion of tissue, which is then examined under the microscope by a dermatopathologist (a doctor who specializes in the microscopic appearance of skin). If confirmed, then treatment is required.
In general, there are several options for treatment and your dermatologist’s choice of therapy will be based on a number of factors. These influential factors include the tumor’s size, its location, depth of penetration, and type of basal cell carcinoma. Other factors to consider include you (the patient’s age) and your overall general health status.
Current treatment options include topical therapy, freezing, excisional surgery, electrosurgery, radiation therapy, laser surgery, and Mohs surgery (microscopically controlled surgery). Your dermatologist will discuss with you which treatment option is best suited for your particular clinical picture. An entirely separate article can be written about the different types of treatment options available. Look for this article to also include a run-down of the different types of BCC…it’s coming soon!