Basal Cell Carcinomas
Basal Cell Carcinomas are abnormal growths or lesions derived from the basal layer of the epidermis (the outermost layer of the skin). Often, BCCs look like open sores, red patches/growths, shiny bumps or scars. The leading cause of BCCs is cumulative sun exposure. Basal cell carcinomas are the most common forms of skin cancer – the Skin Cancer Foundation reports that more than 4 million cases of basal cell carcinoma are diagnosed in the U.S. each year.
BCCs are easily treated when identified in their earliest stages. Some of the most common signals and symptoms are:
An open sore that bleeds, oozes, or crusts and remains open for a few weeks. The sore may heal and then return, this is a common early sign of BCC.
A reddish patch or irritated area – typically on the face, chest, shoulders, arms or legs. Sometimes the patch will develop a crust, and it may itch, however often there is no discomfort associated.
A shiny bump or nodule that is pearly or clear and is often pink, red, or white. The bump can also be tan, black, or brown, especially in dark-haired people, and can be confused with a normal mole.
A scar-like area that is white or yellow and often has jagged borders – the skin itself may appear shiny and taut. This is a signal of a more invasive BCC that has developed beyond the epidermis.
After the BCC is confirmed by biopsy, there are many effective treatment options, most of which can be performed in our office.
Curettage and Electrodessication - this technique is usually recommended for small superficial BCCs on the body. The affected skin will be scraped off with a curette, next the tumor site is burned with an electrocautery needle and repeated 2-3 times. When performed properly, this non-invasive method has a cure rate of 94% overall for all types of BCC.
Mohs Micrographic Surgery – Mohs surgery has the highest cure rate (99% or better) and can be done in our office for non-melanoma skin cancers (link to landing page about the Mohs Surgery under “Surgical” section) by Dr. Mraz Robinson who is a fellowship trained Mohs physician. This procedure is generally recommended for aesthetically sensitive areas, functional or tight areas of skin, recurrent lesions, or large (>2cm) skin cancers. The procedure first removes a thin layer of the affected tissue, and then while the patient waits the tissue is examined under a microscope. If cancer is present in the tissue being examined, the procedure is repeated until the last excised layer is cancer-free. The defect is then repaired with plastic surgery techniques.
Excision Surgery – using a scalpel, the physician removes the entire growth along with a surrounding border of skin. The skin is closed with sutures, and the tissue is sent to an outside laboratory to verify that all cancerous cells have been removed. A repeat excision may be necessary if margins are positive by pathology.
Radiation – for tumors that are difficult to manage surgically due to size and/or placement, superficial radiotherapy can be used. During radiation, x-ray beams are directed through the skin at the tumor, with no need for cutting nor anesthesia. Typically multiple sessions per week are required over 12 weeks.
Cryosurgery – with cryosurgery the cancerous tissue is destroyed by freezing with liquid nitrogen. The growth will then blister or become crusted and then fall off within a few weeks. This is only used for very superficial small BCCs and is generally not advised due to higher recurrence rates.
Photodynamic Therapy (PDT) – PDT is sometimes used for superficial cases of BCC. The affected area will be medicated with a topical acid and then activated by a red or blue light.
Topical chemotherapy agents like Imiquimod or 5-fluorouracil are applied to the tumor five to seven times for up to 6 weeks or longer. It causes a brisk inflammatory response that attacks the superficial cancerous cells; thus, this treatment is reserved for superficial lesions only.
Oral medications may be used for some cases of advanced BCC. These medications work to block the “hedgehog” signaling pathway. Neither medication can be used by women who are pregnant or plan to be pregnant due to side effects.
Vismodegib (Eviredge™) was approved by the FDA in 2012 for rare cases of metastatic BCC or locally advanced or multiple lesions
Sonidegib (Odomzo®) was approved by the FDA in 2015 for patients with locally advanced BCCs whose tumors returned following surgery or radiation therapy