Basal Cell Carcinoma

What is basal cell carcinoma?

Basal cell carcinoma (BCC) is the most common type of cancer in the United States.  BCC is a cancer of the skin caused by ultraviolet (UV) light exposure.  BCC begins in the deepest layer of the epidermis of the skin: the basal layer. BCC typically occurs in areas that are exposed to the sun, such as the head, face, and neck, but it can occur in any area of the body.

BCC is a slow-growing cancer that rarely metastasizes.  Even so, BCC can be very damaging. If left untreated, BCC will continue to grow and will invade and destroy the surrounding skin and tissues beneath the skin.

The major risk factor for BCC is UV light exposure, whether from the sun or tanning beds.  Although anyone can develop BCC, people with certain physical characteristics (such as light or freckled skin, light eyes or hair, or difficulty getting a tan) are at increased risk.  Other risk factors include taking immunosuppressant medications, overexposure to X-rays, having a close relative who had a BCC growth, or previously having had a BCC growth.

What does BCC look like?

Generally, a BCC growth looks like a pink or pearly white lesion or sore.  BCC lesions commonly bleed easily, crust over, and heal poorly.  There may be tiny blood vessels on the lesion (called ‘telangiectasias’), or the lesion may have a center that appears depressed (like a pie that deflated in the middle).

Some BCC subtypes have special characteristics. For example, BCC can also appear as any of the following:

• A dome-shaped, nodular lesion with the same pearly white/pink color as described above.  Growths of this type of lesion are frequently irregular (i.e., some parts of the lesion grow larger than others).  This type of lesion may also have areas of black or brown pigment.
• A flat growth that is round- or oval-shaped, with crusty red scales.   This subtype may be mistaken for eczema or psoriasis.
• A lesion that looks like a scar, is pale whitish-yellow, and feels waxy to the touch.

The one and only way to diagnose any type of skin cancer is to biopsy the skin.  Skin biopsy is a simple procedure in which part of the lesion is removed and examined under a microscope to detect any cancerous cells.

Treatment for BCC

The method of treatment for BCC depends on many factors, including the subtype and location of the BCC growth. Methods of treatment include the following:

• Cryotherapy: Liquid nitrogen is used to freeze and kill the cancerous cells.
• Curettage: Dr. Rokhsar uses a tool to scoop out the cancerous growth, then applies an electrical current to the area to ensure destruction of any remaining cancerous cells.
  

• Excision: The doctor cuts out the lesion and some normal skin around the lesion, then examines the removed tissue to see if the normal skin around the lesion is free of cancerous cells.  If the doctor finds abnormal cells, the procedure is repeated until the normal skin is free of cancerous cells under the microscope.  The excision method is less desirable for BCCs on the face.
  

• Mohs micrographic surgery: Mohs is similar to the excision method in that the lesion is removed and examined under a microscope to ensure complete removal of the cancerous growth.  However, as the name “micrographic” implies, during Mohs treatment, the doctor removes the growth in thin layers.  The removed skin is “mapped” and processed in such a way that 100% of the lesion can be examined for abnormal cells.  This method allows leaving as much normal skin as possible intact. Physicians licensed to perform Mohs surgery have had 1 year of extra training.
  

• Photodynamic therapy: The doctor applies a chemical to the skin and shines light on the area to destroy the cancer cells.
• Radiation:  Radiation treatment can be used for lesions in areas that would be difficult to treat surgically (for example, the eyelids).
• Nonsurgical therapy: Imiquimod (Aldara™) or 5-flourouracil are creams that are applied directly to the BCC growth for removal.  Non-surgical treatments can be used if BCC is recognized in the ear.

Dr. Rokhsar is a trained Mohs and cosmetic surgeon. As a fellowship-trained dermatologist surgeon, he specializes in Mohs Micrographic surgery which is the most precise way to remove skin cancer. Fellowship-trained doctors gain a significant amount of intensive training after they complete their bachelor’s degree, medical school requirements, residential training and dermatology training. The additional training results in a level of expertise and knowledge beyond most dermatologists.