Basal cell carcinoma

Answer 1

Definition

Basal cell carcinoma is a slow-growing form of skin cancer.

See also:

• Squamous cell skin cancer
• Melanoma

Alternative Names

Rodent ulcer; Skin cancer - basal cell; Cancer - skin - basal cell

Causes, incidence, and risk factors

Skin cancer is divided into two major groups: nonmelanoma and melanoma. Basal cell carcinoma is a type of nonmelanoma skin cancer, and is the most common form of cancer in the United States. According to the American Cancer Society, 75% of all skin cancers are basal cell carcinomas.

Basal cell carcinoma starts in the top layer of the skin called the epidermis. It grows slowly and is painless. A new skin growth that bleeds easily or does not heal well may suggest basal cell carcinoma. The majority of these cancers occur on areas of skin that are regularly exposed to sunlight or other ultraviolet radiation. They may also appear on the scalp. Basal cell skin cancer used to be more common in people over age 40, but is now often diagnosed in younger people.

Your risk for basal cell skin cancer is higher if you have:

• Light-colored skin
• Blue or green eyes
• Blond or red hair
• Overexposure to x-rays or other forms of radiation

Basal cell skin cancer almost never spreads. But, if left untreated, it may grow into surrounding areas and nearby tissues and bone.

Symptoms

Basal cell carcinoma may look only slightly different than normal skin. The cancer may appear as skin bump or growth that is:

• Pearly or waxy
• White or light pink
• Flesh-colored or brown

In some cases the skin may be just slightly raised or even flat.

You may have:

• A skin sore that bleeds easily
• A sore that does not heal
• Oozing or crusting spots in a sore
• Appearance of a scar-like sore without having injured the area
• Irregular blood vessels in or around the spot
• A sore with a depressed (sunken) area in the middle

Signs and tests

Your doctor will check your skin and look at the size, shape, color, and texture of any suspicious areas.

If skin cancer is a possibility, a piece of skin will be removed from the area and examined under a microscope. This is called a skin biopsy. This must be done to confirm the diagnosis of basal cell carcinoma or other skin cancers. There are many types of skin biopsies. The exact procedure depends on the location of the suspected skin cancer.

Treatment

Treatment varies depending on the size, depth, and location of the basal cell cancer. It will be removed using one of the following procedures:

• Excision cuts the tumor out and uses stitches to place the skin back together.
• Curettage and electrodesiccation scrapes away the cancer and uses electricity to kill any remaining cancer cells.
• Surgery, including Mohs surgery, in which skin is cut out and immediately looked at under a microscope to check for cancer. The process is repeated until the skin sample is free of cancer.
• Cryosurgeryfreezes and kills the cancer cells.
• Radiation may be used if the cancer has spread to organs or lymph nodes or for tumors that can't be treated with surgery.
• Skin creams with the medications imiquimod or 5-fluorouracil may be used to treat superficial basal cell carcinoma.

Expectations (prognosis)

The rate of basal cell skin cancer returning is about 1% with Mohs surgery, and up to 10% for other forms of treatment. Smaller basal cell carcinomas are less likely to come back than larger ones. Basal cell carcinoma rarely spreads to other parts of the body.

You should follow-up with your doctor as recommended and regularly examine your skin once a month, using a mirror to check hard-to-see places. Call your doctor if you notice any suspicious skin changes.

Complications

Untreated, basal cell cancer can spread to nearby tissues or structures, causing damage. This is most worrisome around the nose, eyes, and ears.

Calling your health care provider

Call your health care provider if you notice any changes in the color, size, texture, or appearance of any area of skin. You should also call if an existing spot becomes painful or swollen, or if it starts to bleed or itch.

Prevention

The best way to prevent skin cancer is to reduce your exposure to sunlight. Ultraviolet light is most intense at midday, so try to avoid sun exposure during these hours. Protect the skin by wearing hats, long-sleeved shirts, long skirts, or pants.

Always use sunscreen:

• Apply high-quality sunscreens with SPF (sun protection factor) ratings of at least 15.
• Look for sunscreens that block both UVA and UVB light.
• Apply sunscreen at least 30 minutes before going outside, and reapply it frequently.
• Use sunscreen in winter, too.

Examine the skinregularly for development of suspicious growths or changes in:

• Color
• Size
• Texture
• Appearance

Also note if an existing skin sore bleeds, itches, is red and swollen (inflamed), or is painful.

References

Habif TP. Clinical Dermatology. 4th ed. St. Louis, Mo: Mosby; 2004:724-735.

Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG. Clinical Oncology. 3rd ed. Orlando, Fl: Churchill Livingstone; 2004:449-452.

Noble J. Textbook of Primary Care Medicine. 3rd ed. St. Louis, Mo: Mosby; 2001:772-773.

Neville JA, Welch E, Leffell DJ. Management of nonmelanoma skin cancer in 2007. Nat Clin Pract Oncol.2007;4(8):462-469.

Eigentler TK, Kamin A, Weide BM, et al. A phase III, randomized, open label study to evaluate the safety and efficacy of imiquimod 5% cream applied thrice weekly for 8 and 12 weeks in the treatment of low-risk nodular basal cell carcinoma. J Am Acad Dermatol. 2007;57(4):616-621.

Answer 2

Definition

Basal cell carcinoma is a slow-growing form of skin cancer.

Skin cancer falls into two major groups: Nonmelanoma and melanoma. Basal cell carcinoma is a type of nonmelanoma skin cancer.

See also:

• Squamous cell skin cancer
• Melanoma

Alternative Names

Basal cell skin cancer; Rodent ulcer; Skin cancer - basal cell; Cancer - skin - basal cell; Nonmelanoma skin cancer; Basal cell NMSC

Causes, incidence, and risk factors

Basal cell carcinoma, or basal cell skin cancer, is the most common form of cancer in the United States. Most skin cancers are basal cell cancer.

Basal cell carcinoma starts in the top layer of the skin called the epidermis. Most basal cell cancers occur on skin that is regularly exposed to sunlight or other ultraviolet radiation. This includes the top of your head, or scalp.

Basal cell skin cancer is most common in people over age 40. However, it occurs in younger people, too.

You are more likely to get basal cell skin cancer if you have:

• Light-colored or freckled skin
• Blue, green, or grey eyes
• Blond or red hair
• Overexposure to x-rays or other forms of radiation
• Many moles
• Close relatives who have or had skin cancer
• Many severe sunburns early in life
• Long-term daily sun exposure (such as the sun exposure people who work outside receive)

Symptoms

Basal cell skin cancer grows slowly and is usually painless. It may not look that different from youur normal skin. You may have a skin bump or growth that is:

• Pearly or waxy
• White or light pink
• Flesh-colored or brown

In some cases the skin may be just slightly raised or even flat.

You may have:

• A skin sore that bleeds easily
• A sore that does not heal
• Oozing or crusting spots in a sore
• A scar-like sore without having injured the area
• Irregular blood vessels in or around the spot
• A sore with a depressed (sunken) area in the middle

Signs and tests

Your doctor will check your skin and look at the size, shape, color, and texture of any suspicious areas.

If your doctor thinks you might have skin cancer, a piece of skin will be removed and sent to a lab for examination under a microscope. This is called a skin biopsy. There are different types of skin biopsies.

A skin biopsy must be done to confirm basal cell skin cancer or other skin cancers.

Treatment

Treatment depends on the size, depth, and location of the skin cancer, and your overall health.

Treatment may involve:

• Excision: Cutting out the skin cancer and stitching the skin together
• Curettage and electrodesiccation: Scraping away cancer cells and using electricity to kill any that remain
• Cryosurgery: Freezing the cancer cells, which kills them
• Medication: Skin creams containing imiquimod or 5-fluorouracil for superficial (not very deep) basal cell cancer
• Johns surgery: Removing a layer of skin and looking at it immediately under a microscope, then removing many layers of skin until there are no signs of the cancer; Usually used for skin cancers on the nose, ears, and other areas of the face.
• Photodynamic therapy: Treatment using light

Radiation may be used if a basal cell cancer cannot be treated with surgery.

Expectations (prognosis)

How well a patient does depends on many things, including how quickly the cancer was diagnosed. Most of these cancers are cured when treated early.

Some basal cell cancers may return. Smaller ones are less likely to come back. Basal cell carcinoma almost never spreads to other parts of the body.

If you have had skin cancer, you should have regular check-ups so that a doctor can examine your skin. You should also examine your skin once a month. Use a hand mirror to check hard-to-see places. Call your doctor if you notice anything unusual.

Complications

Basal cell skin cancer almost never spreads. But, if left untreated, it may grow into surrounding areas and nearby tissues and bone. This is most worrisome around the nose, eyes, and ears.

Calling your health care provider

Call your health care provider if you notice any changes in your skin. You should also call if an existing spot becomes painful or swollen, or if it starts to bleed or itch.

Prevention

The best way to prevent skin cancer is to reduce your exposure to sunlight. Ultraviolet light is most intense between 10 a.m. and 4 p.m., so try to avoid sun exposure during these hours. Protect the skin by wearing hats, long-sleeved shirts, long skirts, or pants.

Always use sunscreen:

• Apply high-quality sunscreens with sun protection factor (SPF) ratings of at least 15, even when you are only going outdoors for a short time.
• Apply a large amount of sunscreen on all exposed areas, including ears and feet.
• Look for sunscreens that block both UVA and UVB light.
• Use a waterproof formula.
• Apply sunscreen at least 30 minutes before going outside, and reapply it frequently, especially after swimming.
• Use sunscreen in winter, too. Protect yourself even on cloudy days.

Other important facts to help you avoid too much sun exposure:

• Avoid surfaces that reflect light more, such as water, sand, concrete, and white-painted areas.
• The dangers are greater closer to the start of summer.
• Skin burns faster at higher altitudes.
• Avoid sun lamps, tanning beds, and tanning salons.

Examine the skinregularly for unusual growths or skin changes.

References

Basal cell and squamous cell cancers. NCCN Medical Practice Guidelines and Oncology.V.1.2009. Accessed July 15, 2009.

Neville JA, Welch E, Leffell DJ. Management of nonmelanoma skin cancer in 2007. Nat Clin Pract Oncol.2007;4(8):462-469.

Eigentler TK, Kamin A, Weide BM, et al. A phase III, randomized, open label study to evaluate the safety and efficacy of imiquimod 5% cream applied thrice weekly for 8 and 12 weeks in the treatment of low-risk nodular basal cell carcinoma. J Am Acad Dermatol. 2007;57(4):616-621.

Hexsel CL, Bangert SD, Hebert AA, et al. Current sunscreen issues. 2007 Food and Drug Administration sunscreen labelling recommendations and combination sunscreen/insect repellant products. J Am Acad Dermatol. 2008;59:316-323.

Lautenschlager S, Wulf HC, Pittelkow MR. Photoprotection. The Lancet [early online publication]. May 3, 2007.

Ridky TW. Nonmelanoma skin cancer. J Am Acad Dermatol. 2007;57:484-501.

Wood GS, Gunkel J, Stewart D, et al. Nonmelanoma skin cancers: basal and squamous cell carcinomas. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, eds. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa: Churchill Livingstone;2008:chap 74.

Reviewed By

Review Date: 07/26/2011

Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.