Basal Cell Carcinoma (BCC)
What is Basal Cell Carcinoma (BCC)?
Basal cell carcinoma is the most common type of skin cancer, affecting 50-60,000 Canadians a year. This is a NON-MELANOMA skin cancer, that is NOT LIFE THREATENING. It is localized to the superficial layers of the skin and almost never spreads to other areas of the body. However, it can invade the surrounding tissue and cause significant deformities if left untreated. It develops in the bottom layer of the epidermis and is almost always associated with ultraviolet sun damage. The most common areas it develops on is the face, ears, scalp, chest or back.
Basal Cell Carcinoma FAQs
What does it look like?
- Persistent non-healing sore that bleeds, oozes or crusts
- A shiny pink, white or red bump that is pearly or translucent
- A pink growth with slightly elevated and rolled borders
- A bump with visible blood vessels (telangiectasia’s) on the surface of the skin
- A scar like area that is white, yellow or waxy with poorly defined borders
- A reddish, irritated patch on the back, shoulders, chest, arms or legs
images from: www.canadianskincancerfoundation.com
How it is diagnosed?
If your doctor suspects that the lesion could be a skin cancer, he will proceed with a biopsy to confirm the diagnosis. This is necessary to determine the sub-type and choose the appropriate treatment plan. A local anesthetic will be administered through a small needle and two different types of biopsies could be
- Shave Biopsy – for smaller lesions, a flat blade is used to remove the bulk of the lesion. A Co2 Laser may be used to cauterize the base so that no sutures are required.
- Punch Biopsy – for larger or deeper lesions, a small circular blade is used to cut a portion of the tissue out. The opening will be closed with a few sutures that will need to be removed
- Excisional Biopsy – in some cases, the entire lesion will be removed with the biopsy. An incision will be made in an elliptical (eye shape fashion) with a narrow margin of normal skin around the lesion. The opening will be closed with sutures that will need to be removed in 7-14 days depending on the location.
What will the biopsy results tell us?
Biopsy results take approximately 2-3 weeks to be processed. Regardless of your results, we will contact you with your final results. At this point, the pathologist will have determined which sub-type of BCC it is. This will help us determine the most appropriate treatment.
There are three main sub-types of BCC: superficial, nodular and infiltrative.
Depending on the sub-type of basal cell, several treatment options may be recommended.
Superficial Basal Cell (SBCC)
– localized in the very superficial portions of the skin. Most common on the torso or extremities:
- Topical Imiquimoid (Aldara 5%) or (Zyclara 3.75%)
- This is an immune-stimulating medication that when applied to the site stimulates your body to repair the damaged tissues
- A small amount of cream is applied 5 nights/week x 6 weeks
- Some local irritation and crusting is expected during the treatment process
- Co2 Laser Ablation
- Under local anesthetic in the office, the laser systematically removes the skin cancer as well as a margin of healthy skin.
- No sutures are required, but because there is a larger defect, it often takes 2-4 weeks to completely heal. Lower legs may take even 6-8 weeks to completely heal
Nodular or Infiltrative BCC
– most common on the face & scalp, often with deeper invasion that is not visible on the surface of the skin.
- Wide Excision in our office
- An elliptical shape of tissue is used to remove the skin cancer as well as a margin of healthy tissue. Both internal (absorbable) and external sutures are usually required.
- The surgical specimen is sent to the lab to be analyzed. Results will be obtained in approximately 2-3 weeks. Our goal is to obtain “clear margins”, confirming that the cancer has been removed with an adequate margin of healthy skin.
- MOHS Surgery – This is recommended for skin cancers that are located on high risk areas such as the face, scalp and ears where there is little excess skin and there is a higher risk of spreading.
- MOHS surgery is the most effective method to remove the entire skin cancer while sparing as much tissue as possible.
- Once the area has been frozen with a local anesthetic the visibly apparent skin cancer is removed. While you remain in the office, the tissue is examined under a microscope.
- If cancer cells are still present, additional skin will be removed and analyzed again. This process will be repeated until no cancer cells remain.
- Once no skin cancer cells are present, the tissue is sutured together. Some larger defects may require a skin graft for closure.
- This process gives the advantage of knowing that the tumor has been completely excised without having to wait 2-3 weeks for biopsy results.
Skin Cancer Treatment Follow-Up
With any of the above treatment methods, the cure rate for BCC is >95%. However, although the risk of a previously diagnosed BCC recurring is quite low, the chance of developing another BCC on a different part of the body is quite high. This can be attributed to skin type, genetics, sun exposure, etc. As the incidence of BCC is very high and the risk associated with it is very low, you will normally be followed in our office for one year following your successful treatment. At this time, unless you have developed additional skin cancers, you will be returned to your family doctor for regular skin surveillance. If you develop any new or suspicious lesions that are sore and never heal, have your doctor assess them and refer you back to our office if he feels you need additional treatment.
For more information you can visit the following websites: