Basal Cell Carcinoma

Did you know that basal cell carcinoma (BCC) is not only the most common form of skin cancer, but the most frequently diagnosed kind of all cancers? In fact, over four million cases of BCC will be diagnosed this year, in the US alone. Because this skin cancer is typically slow-growing, outcomes are generally very good. Though it is rarely a life-threatening form of skin cancer, it is still important to understand the causes and risk factors of developing BCC, as the earlier the diagnosis, the better the outcome.

 

What exactly is a basal cell carcinoma?

A BCC is a skin cancer that occurs from damage to a kind of skin cell, called a basal cell, located on the outermost layer of the skin (called the epidermis). When damage is done to these basal cells, DNA changes occur, which can result in abnormal cell growth and division, and a cancerous growth (BCC) is formed on the skin. Typically, ultraviolet (UV) radiation (sunlight) is the major cause for developing this kind of skin cancer. And don’t let the clouds of Seattle fool you – Washington state is among the top ten states for highest skin cancer incidence, according to the CDC.

 

What are the risk factors for developing a BCC?

Though anyone can develop BCC, some people are at higher risk. These factors increase your risk of developing BCC:

  • Fair skin
  • UV exposure
    • Includes use of tanning beds or spending time in the sun
    • Includes anyone with a job (including previous jobs) working outdoors, or anyone with outdoor hobbies
  • Previous history of skin cancer, including squamous cell carcinoma or melanoma
  • Age over 50
  • Male gender
  • Chronic infections / skin inflammation / skin trauma (burns, scars, etc)

 

What does a BCC look like?

BCC can present in many different ways. There are different subtypes of BCC, and each present with different features. Typically, BCC occurs on sun-exposed areas, like the face, shoulders, back, arms, and legs, though it can appear anywhere on the body. Alert your dermatology provider at Pacific Dermatology & Cosmetic Center should you notice any of the following:

  • A pink or red patch of skin that may be itchy, crusty, or sore / painful, or may cause no discomfort at all
  • A pimple-like “sore” that does not heal, and may bleed, or may heal and then recur
  • A flesh-toned, pink, or red bump on the skin that may be shiny, may have “rolled borders,” and may have very tiny blood vessels that develop over time
  • A white / yellow / waxy patch of skin that looks “taut” with poorly defined borders, and may mimic a scar

Though the above outlines the more common presentations of BCC, remember that BCC can present differently than these descriptions. In fact, it can present as common skin conditions like eczema or psoriasis. In people with darker skin, BCCs tend to be darker in color.

 

How is BCC treated?

We offer many treatment options here at Pacific Dermatology & Cosmetic Center for BCC. Dr. Reichel and her team will choose the appropriate treatment depending on the subtype, size, and location of the BCC. Some of the treatments options for BCC include:

Excisional Surgery: This treatment method is commonly used for a few different types of BCC. Dr. Reichel or one of her highly trained staff members will remove the BCC with a scalpel, after you have been fully and completely numbed. A small amount of healthy tissue (called a “margin”) will also be excised, to ensure complete removal. That tissue is sent to a laboratory where a dermatopathologist (a dermatologist who specializes in diagnosing disorders of the skin under a microscope) will make sure that all of the BCC has been removed.

Mohs Micrographic Surgery (commonly referred to as “Mohs”): This treatment option is similar to an excisional surgery, with some key differences. Mohs surgery is performed as an outpatient procedure in the surgical suite of Pacific Dermatology & Cosmetic Center, and is performed during a single visit, in stages. Dr. Reichel will excise the BCC along with a small margin of tissue around and beneath the BCC, and will then assess that tissue under the microscope while you wait in our very comfortable & private surgical waiting room. These steps will be repeated until all of the cancerous tissue has been removed, and only healthy tissue remains. Mohs is commonly referred to as the “Gold Standard” because it has the highest cure rate at about 99%, while preserving the most amount of healthy tissue possible, minimizing potential scarring. It is often the treatment of choice for larger BCCs, or BCCs on sensitive areas, including the face, scalp, hands, feet, and genitals.

Electrodessication & Curettage (ED&C): This procedure is an option for superficial or small BCCs, and is performed by Dr. Reichel or one of her highly trained staff. You will first be numbed completely with a local numbing agent to ensure complete comfort. Then, your provider will scrape the BCC with a sharp metal tool called a curette, and will burn the cancerous tissue with an instrument called electrocautery, or a hyfrecator. This will be repeated until all of the cancerous tissue is destroyed.

Cryosurgery: This treatment option is utilized for small, superficial BCCs. Liquid nitrogen is sprayed on the BCC using a cryogen tank. The area treated will get red, and may get blistered and scab over, eventually falling off and leaving healthy skin to arise. This procedure is quick and has great outcomes, with cure rates between 85-90%.

Topical Medications: There are topical prescription creams / gels that are approved for the treatment of superficial BCCs. These include 5-fluorouracil (“5-FU”) and Imiquimod. These creams are applied directly to the BCC for the recommended amount of time that your provider at Pacific Dermatology recommends. This is a good option for superficial BCCs, as cure rate is roughly 80-90%, and there is minimal scarring.

 

What to know after a BCC diagnosis:

Once you have developed one BCC, you are at higher risk for developing another. In fact, it is not uncommon for someone to be diagnosed with numerous BCCs throughout their lifetime. Though uncommon, BCC can sometimes grow back after treatment (this is called “recurrent BCC”).  It is important to have regular check-ups at Pacific Dermatology & Cosmetic Center, as well as doing your own monthly at-home skin check. Alert your dermatology provider at Pacific Dermatology & Cosmetic Center should you be concerned about any new or changing growths.

The best protection against developing BCC is photoprotection – simply using sunscreen appropriately will drastically decrease your risk of developing this skin cancer. Let us help you explore our large selection of medical-grade sunscreen we have here at Pacific Dermatology & Cosmetic Center – we have sunscreens for all skin types and skin concerns, from sensitive skin to acne-prone skin to skin prone to hyperpigmentation.

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Thank you for choosing Pacific Dermatology & Cosmetic Center, we look forward to providing you with the very best skin care.

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