Skin Cancer- Basal Cell Carcinoma

Introduction

Basal cell carcinoma is the most common type of skin cancer.  It occurs when the basal cells in the skin grow abnormally and out of control.  Exposure from ultraviolet (UV) radiation from the sun is the most frequent cause of basal cell carcinoma.

There are several types of basal cell carcinomas and it has many different appearances.  Basal cell carcinoma is a very slow growing type of non-melanoma skin cancer.  It rarely spreads to other parts of the body. 

This type of skin cancer needs to be treated and has a high cure rate.  If left untreated, basal cell carcinomas can become quite large, cause disfigurement, and in rare cases, spread to other parts of the body and cause death.

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Anatomy

Your skin covers your body and protects it from the environment.  Your skin is composed of three major layers, the epidermis, dermis, and subcutaneous tissue.  The epidermis is the outermost layer of your skin.  It protects your inner skin layers.  The epidermis is made up of protein containing cells called keratinocytes, also referred to as squamous cells.  The keratinocytes form at the bottom layer of the epidermis and move upward to the outer layer.  They eventually wear off and are replaced by the next layer of cells.  The epidermis also contains melanocytes.  This type of cell contains color pigments called melanin.  The lowest layer of the epidermis is composed of basal cells.
 
The dermis is your second layer of skin.  It is made up of connective tissue and provides structure.  It is composed of collagen and various elements that give your skin strength and elasticity.  The dermis contains hair cells, sweat glands, and sebaceous glands that secrete oils to hydrate the skin.  Subcutaneous tissue composes your inner most layer of skin. 
 
Subcutaneous tissue contains fat cells.  The fat cells insulate your body and make your skin appear plump and full.  Below the subcutaneous tissue are fat tissues, your muscles, and bones.
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Causes

Cancer occurs when cells grow abnormally and out of control, instead of dividing in an orderly manner.  Basal cell carcinoma is caused by cancerous changes in the basal skin cells.  The majority of basal cell carcinomas are caused by exposure to UV radiation from the sun.
 
There are several different kinds of basal cell carcinomas.  Basal cell carcinoma changes the way the skin looks on the surface.  Basal cell carcinoma can have several different appearances.
 
Basal cell carcinoma is a slow growing skin tumor.  It usually does not spread to distant parts of the body or into the blood stream.  Basal cell carcinoma does spread on the skin and can become quite large over time.  If left untreated, it can spread to the muscles, nerves, bones, brain, and in rare cases, cause death.
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Symptoms

Basal cell carcinoma usually appears on areas of the skin that received frequent sun exposure, such as the face, ear, neck, chest, back, or scalp.  All basal cell carcinomas result from cancerous changes that take place in the skin.  Basal cell carcinoma has a variety of appearances.
 
Some types of basal cell carcinomas may begin as a dome-shaped lump or bump.  The bump may be pearly white in color and contain blood vessels.  Some basal cell carcinomas look more like a pimple that comes and goes, but never really goes away.  Other basal cell carcinomas appear flat or slightly raised.  They may be pink, red, clear, skin colored, brown, blue, shiny, or waxy.  They can look like an old scar or a sore that does not heal, but appear in an area where an injury has not taken place.  Some basal cell carcinomas may bleed, ooze, or crust.
 
Basal cell carcinomas are a slow growing type of skin cancer.  Basal cell skin cancer tends to invade and spread across skin tissue.  They may grow very large and cause disfigurement if untreated.  Basal cell carcinoma rarely spreads to distant organs.  In rare cases, it may spread to muscles, bones, nerve tissue, the brain, and cause death. 
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Diagnosis

You should contact your doctor if you notice a change in the color, texture, or appearance of your skin or if you have a sore that does not heal.  Your doctor can diagnose basal cell carcinoma by examining the growth and performing a biopsy of the suspected area.  A biopsy is a simple procedure that takes tissue for examination.  There are a few types of biopsy methods. 
 
After numbing your skin, your doctor may perform a shave, punch, incisional, or excisional biopsy.  A shave biopsy removes the top layers of the skin.  A punch biopsy uses a round punch to cut through all of the layers of skin to remove a tissue plug.  An incisional biopsy removes a part of the tumor, and an excisional biopsy removes all of the tumor.  In some cases, the incisions will be stitched. 
 
The tissue samples are sent to a laboratory for examination.  Request to have your tissue sample examined by a dermapathologist.  A dermapathologist is a pathologist with special training in skin disorders.  The dermapathologist will determine if your tissue sample contains basal cell carcinoma and the type of basal cell carcinoma.  Your doctor’s office will contact you with the results when they receive them. 
 
Skin cancer is classified based on how far it has spread, although it is not common for basal cell carcinoma to spread to other parts of the body.  Stages are classified as 0-4, with 4 being a more serious cancer. There is more than one type of staging system, so make sure that you and your doctor are referring to the same one.
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Treatment

Basal cell carcinoma is a very treatable type of cancer.  In some cases, a biopsy can remove all of the cancerous tissue.  If you need treatment, your doctor will discuss your options with you.  In many cases, basal cell carcinoma can be completely cured with fairly minor procedures.  The goal of treatment is to remove all of the cancer cells.
 
There are several treatments for basal cell carcinoma.  The treatment that you receive depends on the size, location, and extent of your cancer.  Most treatments can take place in your doctor’s office using a local anesthesia.
 
Electrodesiccation and curettage is a procedure that removes the surface layer of skin cancer and gently burns (“cauterizes”) its base to destroy any remaining cells.  A simple excision is a method that cuts out the tumor and some healthy cells around it.  The incision is stitched back together.  Cryosurgery is a treatment method that uses liquid nitrogen to freeze and kill cancer cells. 
 
A specialized technique, Mohs micrographically controlled surgery, is used to treat large skin cancers or skin cancers that have come back.  For Mohs surgery, the doctor removes a layer of skin containing the basal carcinoma cells and examines it under a microscope right away.  The process is repeated until the skin samples are found to be free of cancer cells.  The advantages of Mohs surgery are that only the minimum amount of tissue necessary is removed and the specimens are carefully examined.  Mohs surgery is associated with a high cure rate for basal cell carcinoma.
 
Skin grafting and reconstructive surgery may be necessary after the removal of large basal cell carcinomas.  Scarring after skin cancer removal is common.  Cosmetic surgery techniques can improve the appearance of scars.  Some people choose to cover their scars with make-up.  Researchers are studying medicated lotions as a treatment option to surgery to reduce scars and disfigurement.
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Prevention

You should perform a full body skin and mole inspection monthly.  It may be helpful to use a mirror or have someone else look at areas of your skin that are difficult for you to see.  Promptly report any suspicious moles or areas of skin to your doctor.  It is important to have your doctor perform regularly scheduled full body skin and mole checks.  You should make and attend all of your follow up appointments.
 
You may be able to prevent skin cancer by limiting the amount of time that you are exposed to the sun.  Anyone that is exposed to the sun should wear a sunblock that blocks both UV A and B sunrays.  A sunscreen is a different product.  Sunscreens allow you to spend a longer amount of time in the sun without burning than you could if you were not wearing sunscreen.
 
Most doctors recommend a sunblock that blocks both UV A and B rays and a sunscreen with a sun protection factor (SPF) of at least 15.  An SPF of 15 provides protection from burning for 150 minutes.  Sunscreen should be reapplied every 1 ½ hours or so depending on your activity level.
 
Sunscreens may reduce your risk of getting skin cancer, but it is not a guarantee.  If you are in the sun for a long time, even with sunscreen, you are at risk for developing skin cancer.  Sunscreen may reduce your risk of developing some skin cancer and precancerous conditions, but researchers have not proven that sunscreen prevents basal cell carcinoma.
 
It is important to discard old sunblock and sunscreen.  Their effectiveness is reduced over time.  You should apply sunblock and sunscreen even in the winter.  Remember to apply it to all of your skin that is exposed including your hands, ears, lips, lower legs, the backs of your knees, and the tops of your feet.
 
It is beneficial to avoid being in the sun between the hours of 10 AM and 4 PM, when the sun’s rays are the strongest.  A good way to remember this is that if your shadow is shorter than you are tall, it is not a good time to be out in the sun.  You can still be outside, but seek shade.
 
If you must spend time in the sun, it is smart to wear hats with wide brims and tightly woven fabrics that are especially made to block the sun.  Some clothing is rated for its SPF factor. Your doctor is happy to refer you to such clothing suppliers. 
 
Wear sunglasses that block UV A and B sunrays.  The label may also read “UV absorption to 400 nm,” which means the same thing.  Wrap-around styled sunglasses protect your eyes and your eye area.  Sun-related cancers can occur inside of the eye.  Wear sunglasses and make sure that your eye doctor checks for cancer at each of your eye exams.
 
You should avoid sun tanning outside and sun tanning lamps or booths.  Tanning beds and lamps give off harmful UV rays and can cause sunburns.  An alternative is to use self-tanning products or spray on coloring products.  Teach your children about protecting their skin in the sun.  This is important because many skin cancers result from sunburns that occur before age 18.  Make sure that your children learn to apply and reapply sunblock and sunscreen when they are playing outdoors.
 
You should stop smoking and avoid cancer causing chemicals.  If your job requires exposure to cancer causing agents, follow all safety instructions associated with the chemical’s use.  Wear protective masks and gear as instructed.
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Am I at Risk

Risk factors may increase your likelihood of developing basal cell carcinoma, although some people that experience this skin cancer may not have any risk factors.  People with all of the risk factors may never develop basal cell carcinoma; however, the likelihood increases with the more risk factors you have.  You should tell your doctor about your risk factors and discuss your concerns.


Risk factors for basal cell carcinoma:

_____ People with light colored skin (Caucasians), blue eyes, green eyes, gray eyes, blond hair, or red hair have an increased risk for developing skin cancer.  However, people with darker complexions and dark hair may get skin cancer as well, but they have a lower risk.
_____ People that spend a lot of time in the sun, such as construction workers, farmers, fishermen, lifeguards, sunbathers, and outdoor sport enthusiasts have an increased risk for skin cancer.
_____ Receiving multiple severe sunburns in childhood or as a teenager is a big risk factor for developing skin cancer.
_____ People that have had basal cell carcinoma are at risk for another basal cell carcinoma and other types of skin cancer.
_____ Cigarette smoking can contribute to skin cancer.  The tar in cigarettes is a known cancer causing agent.
_____ Exposure to cancer causing chemical agents, such as tars, oils, and arsenic (found in some herbicides) is associated with an increased risk for basal cell carcinoma.
_____ Chronically injured skin is a risk factor for basal cell carcinoma.
_____ People with suppressed immune systems, such as organ transplant recipients or people that have AIDS, have an increased risk for basal cell carcinoma.
_____ Not wearing a sunblock for UV rays A and B while in the sun increases the risk of skin cancer.
_____ Your risk for basal cell carcinoma increases with age.  Most cases develop after the age of 40, but it certainly can develop in younger people.
_____ People that sunburn easily are at a higher risk for developing skin cancer. 
_____ People with multiple moles have a higher risk of developing skin cancer.
_____ People with freckled skin have a higher risk of developing skin cancer.
_____ Artificial tanning lights used in tanning booths, beds, and lamps have harmful UV rays and increase the risk of skin cancer.
_____ Some people may have a genetic predisposition to basal cell carcinoma.
_____ Overexposure to X-rays or other forms of radiation increases the risk of skin cancer.
_____   People with basal cell nevus syndrome have the potential for many basal cell carcinomas.  This is a rare syndrome that people are born with.
_____ People with rare genetic disorders, such as nevoid carcinoma syndrome, xeroderma pigmentosum, or Bazex syndrome, have an increased risk for developing basal cell carcinoma.

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Complications

Untreated basal cell carcinoma can become large and disfiguring if they are at places of concern, such as the face, nose, and ears.  Radiation or chemotherapy treatments may be necessary if your cancer has spread to other sites.  Untreated basal cell carcinoma can spread, in rare instances, to the muscles, nerves, bones, and brain.  In rare cases, it can result in death.  People with one basal cell carcinoma are at risk for recurrence and the development of future skin cancers.
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Advancements

Researchers have advanced the formulas in sunscreen and sunblock to offer better protection.  Many cosmetics offer sun protection.  New products are being developed since the damaging effects of UVA rays have been discovered fairly recently.  Further, researchers are investigating alternatives to lotions, such as pills that offer protection from the sun.

Scientists have learned the mechanisms by which UV light harms DNA and causes normal cells to become cancerous.  They hope to use this knowledge to find ways to treat skin cancer.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.