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Basal Cell Carcinoma
What is basal cell carcinoma?
Basal cell carcinoma is a slow-growing type of non-melanoma skin cancer. It is the most common type of cancer in the U.S., but it is very, very unusual to cause death, since it grows very slowly. It usually affects fair-skinned people, but it occurs in any race.
What are the possible causes and risk factors for basal cell carcinoma?
Fair skin, red hair, sunburns, X-ray treatments, a family member with basal cell carcinoma, a poor immune system, or use of immunosuppressing medicines as in organ-transplant patients.
How does basal cell carcinoma look and feel like?
Basal cell carcinoma may look like a pearly, skin-colored bump, scar-like, or red patch anywhere on the skin, but mostly on the head and neck. It usually does not have any abnormal feelings to it, but sometimes it may bleed and cause an open sore (ulcer), or crust on the skin.
I think I have a basal cell carcinoma, what should I do?
You should see your health care provider who will hear your story and examine the spot. Usually a good physical exam with touching the spot, and looking at it with special instrument called a dermatoscope (a handheld instrument that looks similar to battery lamp, but with special system of polarized lenses and LED light that enables your health care provider to take deeper look into the skin. It is usually used by dermatologists) will be enough to decide if a biopsy is needed.
A skin biopsy is a cutting a small sample of the changing skin off to be looked under microscope. There are two types of biopsies, both performed under the local anesthesia and both taking about 5 -10 minutes to perform – a shave biopsy and a punch biopsy.
Shave biopsy is the most common type since it is usually preferred both by patients and by their health care providers, since it does not require placement of stitches and is faster. Your health care provider will numb the skin with small amount of fast acting local anesthetic and then use a razor blade or a more sophisticated instrument called a Dermablade (our favorite), which is actually a razor blade with handles that enable your healthcare provider to have a better control over the depth of the biopsy. Afterwards, the bleeding is stopped by using special liquid called aluminum chloride (which is, by the way, the active ingredient in many anti-sweating deodorants). Then plain Vaseline or a double antibiotic ointment and bandage are placed on the biopsy wound.
Punch biopsy is also a very fast procedure, where your health care provider will numb the skin with small amount of fast acting local anesthetic and then sterilize the skin using special cleansing swabs soaked with povidone-iodine, or chlorhexidine gluconate, put sterile drape over the area, and then use a pen-like cylindrical instrument called a punch, which looks like a very small cookie-cutter that would produce small cylindrical specimen with diameter of about 4 mm and depth of about 5-8 mm. We usually close the wound and stop the bleeding by placing a nylon stitch that should be removed in 1-2 weeks. Then plain Vaseline or a double antibiotic ointment and bandage are placed on the biopsy wound.
The results of the skin biopsy are usually available within 1-2 weeks. We always call our patients with all the results. Please, never agree to a policy of “no news is good news”, since results may be misplaced with possible bad outcome to your health.
I have just been diagnosed with basal cell carcinoma, what now?
Your health care provider should make a treatment plan depending on the biopsy results, the size of the cancer and its location on your skin. There are several treatment options depending on the microscopic type of basal cell carcinoma, its overall size and its location on your skin:
- 5% fluorouracil cream (brand name Efudex) for a superficial type of basal cell carcinoma.
- 5% imiquimod cream (brand name Aldara), also for a superficial type of basal cell carcinoma.
- Freezing the cancer off using liquid nitrogen (medical name is cryotherapy). It is usually used for a superficial basal cell carcinomas.
- Curettage (i.e. scraping the cancer off with a sharp instrument called curette) followed by electrodesiccation, or aluminum chloride soaks. It is usually used for a superficial basal cell carcinomas and certain nodular basal cell carcinomas on non-hair bearing skin.
- Photodynamic therapy (PDT) – the area of the cancer is painted with special liquid that will make cancerous cells more sensitive to a special light. The most commonly used device in the U.S. is Blu-U, which uses blue light. It is usually used for a superficial type of basal cell carcinoma.
- Excision, which is cutting the cancerous skin off with a scalpel together with the rim of a normal looking skin around the cancer to ensure its complete removal.
- Mohs surgery (named after its inventor Dr. Frederic E. Mohs) is a microscopically controlled excision of the cancer in order to achieve the complete removal of the cancer, but with the smallest possible wound and scar. It is used for cancers on cosmetically sensitive areas (nose, ears, eyelids etc.), for certain types of more aggressive basal cell carcinomas and for those that have come back after the previous treatment.
- X-ray therapy. It is used for selected basal cell carcinomas when patients are not good candidates for the options mentioned above, or when the patient declines the other options.
I had my treatments, but what now?
You should have regular skin exams by your board certified dermatologist, or your health care provider (e.g. in 3 months after the treatment then every 6 months for 2 years, then a little bit less often depending on the findings).
How can I prevent basal cell carcinoma?
The best would be to stay away from sun, or at least seek shade between 10 a.m. and 2 p.m., wear lightweight, loose-fitting long-sleeved shirts, pants, a wide-brimmed hat and sunglasses. In good old times ladies wore gloves and carried parasols as well. Also avoid use of any indoor tanning devices. Second step would be to generously apply a broad-spectrum sunscreen with a SPF (Sun Protection Factor) of at least 30. Our family favorite is Banana Boat Kids SPF 50 (with titanium dioxide and zinc oxide), which is, by the way, one of the cheapest sunscreens.
Also, avoid any tanning, since tan is a sign of skin’s struggle with a genetic damage caused by the ultraviolet radiation. Not everyone who tans will get skin cancer, but everyone will age much faster. Therefore, if you want to preserve your youthful look, please consider the information above. We also like to point one fact to our patients – The Sun is a humongous nuclear reactor in the sky, and there is only an empty space between you and that nuclear reactor. When you think like that, it is a bit easier to follow the above recommendations. Worth of mentioning is an iconic Slip-Slop-Slap sun protection campaign in Australia during the 1980s.
It stands for:
Slip on a shirt,
Slop on the 30+ sunscreen,
Slap on a hat!