Basal Cell Carcinoma

Basal Cell Carcinoma is the most common form of cancer worldwide. In the vast majority of cases, it is thought to be caused by repeated exposure, over many years, to the harmful ultraviolet rays of the sun. It is becoming more common, perhaps because people may be spending mote time outdoors. Some believe that the decrease in the ozone layer is allowing more ultraviolet radiation from the sun to reach the earth’s surface. In general, Basal cell carcinoma does not spread to distant sites through the blood stream or through lymph nodes. It grows by infiltrating the surrounding area of skin and underlying structures, and can be destructive over time. Basal cell cancer should be treated promptly by your dermatologist with dermatologic surgical techniques.

What does basal cell cancer look like?

Basal Cell cancer most often appears on sun exposed areas such as the face, scalp, ears, chest, back and legs. These tumors can have several different forms. The most common appearance of basal cell cancer is that of a small dome-shaped bump that has a pearly white color. Blood vessels may be seen on the surface. Basal cell cancer can also appear as a pimple-like growth that heals, only to come back again and again. A less common form, called morpheaform, looks like a smooth white or yellowish waxy scar. A very common sign of basal cell cancer is a sore that bleeds and heals up, only to recur again.

I think I have a basal cell cancer. What should I do next?

If you have a sore that doesn’t heal, you should make an appointment with your dermatologist for evaluation. After the dermatologist examines the growth, he or she will decide whether or not to perform a biopsy. A biopsy is a simple procedure done in the office under local anesthesia. The dermatologist will first inject a small amount of anesthesia similar to the type used by your dentist. After the area is numb, the dermatologist will remove a small sample of the growth or use a small-cookie cutter device to do a “punch” biopsy. A bandage will then be placed on the wound and you will receive instructions on how to care for the wound. The area will heal over five to seven days. There are several different kinds of basal cell cancer. The biopsy results will indicate whether or not you have a basal cell cancer and what kind of basal cell cancer it is. In some cases, if the basal cell cancer is very thin and present only on the surface of the skin, your dermatologist may choose to perform the biopsy and treat the skin cancer at the same time.

The biopsy shows that I have a basal cell cancer. What is the next step?

Your dermatologist will discuss with you the various dermatologic surgical options should your growth prove to be a basal cell cancer. Your dermatologist may use a method called electrodesiccation and curettage. In this procedure the surface of the skin caner is gently burned or “cauterized” with an electric needle. When this is done there is often no need for further treatment. Simple surgical excision, in which the skin cancer is cut out and the skin is sewn together will often be recommended. In this case, the specimen is sent away to a lab after the procedure and examined to determine that all of the skin cancer has been removed. In certain situations, your dermatologist may refer you for a specialized technique called Mohs Micrographic Surgery.

I have been referred for Mohs Micrographic surgery. What does this mean?

Mohs Microhraphic surgery was named after Dr.Frederick Mohs, a surgeon who invented the technique of examining the removed tissue in a very precise way prior to suturing the wound closed. It is recommended when it is imperitive to attain the highest cure rate, and/or to spare as much normal skin as possible. With Mohs surgery, the entire perimeter and undersurface of the removed tissue are examined while the patient waits, in order to ensure removal prior to reconstruction. Because 100% of the margin gets examined, the Mohs surgeon can minimize the amount of tissue removed, and maximize conservation of healthy/normal tissue.

Mohs micrographic surgery is performed by specially trained dermatologic surgeons who specialize in the removal of skin cancer, and in post operative reconstruction. The skin cancer is removed under local anesthesia in an office setting and microscopic sections are prepared on slides while you wait. Your Mohs surgeon examines the slides to determine if the cancer cells have been removed. If not, additional layers are taken until the cancer is completely excised. The advantage of this technique is that a minimum amount of tissue is removed and all the edges of the specimen are carefully studied. Mohs surgery results in the highest cure rate and in maximal tissue conservation, thus optimizing the cosmetic outcome.

Mohs micrographic surgery is indicated for tumors that are:
      • Located on cosmetically sensitive areas (face)
      • Located on structures where tissue conservation is imperative (eyes, ears, nose, lips)
      • Aggressive in their growth characteristics
      • Persistent or recurrent despite previous treatment
      • Large in size

Regardless of the technique used, will I be scarred?

Because the vast majority of skin cancers occur on the face, many patients are understandably concerned about the cosmetic outcome. If the skin cancer is small, conservative methods usually produce an excellent cosmetic result. If the skin cancer requires more specialized treatment such as Mohs surgery, reconstructive options are available that, in most cases, result in an excellent cosmetic outcome.

If basal cell cancer does not travel in the blood stream to other organs like other cancers why should I bother treating it?

Some people wonder whether it is worth treating basal cell cancer at all since it doesn’t metastasize or travel in the bloodstream to other organs. It is important to remember that basal cell cancer is in fact a cancer, and will continue to grow locally unless treated. Basal cell cancer does not spontaneously go away on its own. In addition, if the skin cancer is located near important organs such as the eyes, ears, and nose or is growing near a nerve, serious problems can arise if the skin cancer is neglected.

I have already had one basal cell cancer. Am I at risk for getting another?

If you have already had one basal cell cancer studies have shown that you are at 40 % risk of getting a second basal cell caner within five years. It is important to follow closely with you dermatologist and be alert to any non-healing sores that develop on your skin.

I have had basal cell cancer. I am at risk of developing other skin cancers, such as melanoma?

Individuals, who have had multiple basal cell caners or other skin cancers such as squamous cell, are at an increased risk for melanoma. It is important to have a full body skin examination at lest once a year to check for abnormal moles which could be precursors to melanoma or melanoma itself. It is also important to know that basal cell cancer does not turn into melanoma.

Is there anything I can do to prevent basal cell cancer?

Because basal cell cancer is caused by ultraviolet radiation from the sun in the vast majority of cases, proper sun protection can prevent the development of further basal cell cancers. Because 85% of lifetime sun exposure is acquired in childhood by age 18, careful sun protection in children may effectively prevent basal cell cancer later in life. Follow these simple steps from your dermatologist and dermatologic surgeon.
    1. Apply sunscreen with a sun protection factor of 15 or greater while outdoors.
    2. Wear a broad-rimmed hat and sun protective clothing.
    3. Avoid the sun between 10:00a.m and 4:00 p.m.
  Many people wonder how often they have to reapply sunscreen. In general, if you are active outdoors, it is quite reasonable to apply sunscreen every 1 ½ hours. As long as you practice good sun protection habits and enjoy the sun in moderate amounts you should be able to minimize the chances of developing basal cell cancer.

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