Basal Cell Carcinoma
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.
Although this cancer can often be identified by sight, doctors usually do a biopsy.
The cancer is usually removed, but sometimes people may be given chemotherapy drugs applied to the skin or, occasionally, radiation therapy or drug therapy.
(See also Overview of Skin Cancer.)
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. More than 4 million people develop this type of cancer in the United States each year. It is more common among fair-skinned people with a history of sun exposure and is very rare among dark-skinned people. Basal cell carcinoma usually develops on skin surfaces that are exposed to sunlight, commonly on the head or neck.
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.
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.
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 is nearly always successful, and the cancer is rarely fatal. However, almost 25% of people with a history of 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.
Because basal cell carcinoma is often caused by sun exposure, people can help prevent this cancer by doing the following:
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.
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.
People whose cancer has spread to nearby tissues or spread to other parts of the body (metastasized) and who are not candidates for surgery or radiation therapy may be given the drug vismodegib or sonidegib taken by mouth.
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