Basal cell carcinoma is the most common form of cancer worldwide. In the vast majority of cases, it is thought to be caused by exposure to the harmful ultraviolet rays of the sun. It is becoming more common, perhaps because people may be spending more 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. Basal cell carcinoma does not usually metastasize or travel in the bloodstream; rather it infiltrates the surrounding area destroying tissue. For this reason, basal cell carcinoma should be treated promptly by your dermatologist with dermatologic surgical techniques.
What does basal cell carcinoma look like?
Basal cell carcinoma most often appears on sun-exposed areas such as the face, scalp, ears, chest, arms, back, and legs. These tumors can have several different forms. The most common appearance of basal cell carcinoma is that of a small dome-shaped bump that has a pearly white color. Blood vessels may be seen on the surface. Basal cell carcinoma 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 or that looks like a lesion described above, you should make an appointment with your dermatologist or with Treasure Coast Dermatology 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.
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 carcinoma. Your dermatologist may perform a simple surgical excision, in which the skin cancer is cut out and the skin is sewn together using dermatologic cosmetic surgical techniques. In this case, the specimen is examined under the microscope after the procedure to determine that all the skin cancer has been removed. Other treatment methods, such as cryosurgery, radiation therapy, and laser surgery may be used in specific circumstances. In certain situations your dermatologist may opt to treat the basal cell cancer with a specialized technique called Mohs micrographic surgery. At Treasure Coast Dermatology all of our dermatologists are trained in this specialized method. In this method the skin cancer is removed under local anesthesia in the office and microscopic sections are prepared on slides while you wait. The Mohs surgeon examines the slides to determine if most of 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. This method has a high cure rate, but is not required for all skin cancers. In general, most dermatologists agree that recurrent skin cancers, that is skin cancers that were previously treated and have come back, incompletely removed skin cancers, large skin cancers, and skin cancers in cosmetically important areas, may benefit from the Mohs technique. After the skin cancer has been removed using this method, it may allow to heal naturally or reconstructive surgery using a skin flap or skin graft may be performed.
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, results in an excellent cosmetic outcome.
Am I at risk for getting another?
If you have already had one basal cell cancer studies have shown that you are at a 40% risk of getting a second basal cell cancer within 5 years. It is important to follow closely with your dermatologist and be alert to any non-healing sores that develop on your skin.
Am I at risk of developing other skin cancers, such as melanoma?
Individuals who have had multiple basal cell cancers 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 least 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 may help to prevent the development of further basal cell cancers. Follow these simple steps from your dermatologist and dermatologic surgeon:
1. Apply sunscreen with a sun protection factor of 30 or greater while outdoors.
2. While outdoors, reapply sun screen every 1 1/2 hours.
3. Wear a broad-brimmed hat and sun protective clothing.
4. Avoid the sun between 10:00 a.m. and 4:00 p.m.