Skin Diseases

When to Remove Basal Cell Carcinoma: EssentialĀ Guidelines

By: Dr. Farhat Naz

Dr. Beenish Janjua

Introduction, Causes, Symptoms, Diagnosis, Treatment, Prognosis

We admitted a male patient 62 years of age with complaints of anorexia and generalized weakness. During the examination, we found a lesion about 3-4 cm in size on the right side of the nose. It extended underneath the right eye and was suggestive of Basal Cell Carcinoma. According to the patient, the lesion had been there for the last 4 years. It gradually increased in size but did not cause symptoms of much concern, except for cosmetic disfigurement. What would be the best treatment choice for this patient?

Basal Cell Carcinoma on medial aspect of right eye and right side of nose.http://www.healthinfobasic.com

What is Basal cell carcinoma?

Basal cell carcinoma is slow growing benign skin cancer which is fairly common. This cancer originates in basal cells of the skin. The cancer has many forms. It typically starts as a small bump on the skin. It then becomes indurated in the middle with rolled margins. It mostly develops on sun exposed areas of skin like Head and Neck.

How common is Basal Cell Carcinoma?

BCC is most common among all skin cancers, it is particularly more common in white population compared to dark skinned. In the United States, the incidence of BCC is increasing by more than 10% per year. The lifetime risk of developing BCC is 30%.

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What causes Basal Cell Carcinoma?

Basal cell carcinoma is typically caused by excessive exposure to UV radiations, mostly through sunlight. Chronic risk factors for getting basal cell carcinoma include:

  • Radiation therapy
  • Chronic exposure to sunlight
  • Fair skin
  • Old age
  • Immuno supressant drugs
  • exposure to arsenic
  • Precancerous lesion Actinic Keratosis
  • Family or personal history of skin cancer

What are most common types of skin cancers?

There are 3 most common skin cancers:

  • Basal cell carcinoma
  • Squamous cell carcinoma
  • Melanoma

What are the symptoms of Basal Cell Carcinoma?

The carcinoma typically is on sun exposed area of skin and can show the following symptoms:

  • Scaly flat patch
  • Black or brown shiny bump with rolled margins and central induration
  • A scar like waxy lesion
  • Blue, black or brown lesion

How the diagnosis of BCC is confirmed? How long should it take to biopsy skin cancer?

The diagnosis will be confirmed through skin Biopsy. Ideally, the biopsy should be done within one week for suspected Melanoma. It should be within one month for suspected squamous cell carcinoma. For suspected basal cell carcinoma, it should be within 3 months.

How Basal cell carcinoma is treated?

Electrosurgery

Mohs Surgery: The ideal treatment for Basal cell carcinoma is through surgery. Mohs surgery has cure rate of >95%.

Radiation therapy: Low dose X-ray beams are used to destroy tumor, may need many sessions to cure.

Photodynamic therapy: A medicine is applied to the lesion topically or injected into the tumor. This makes the tumor sensitive to light. Then a blue light is applied and absorbed to kill cancer cells. The patient should strictly avoid sunlight during the treatment period as it can cause severe burns.

Chemotherapy: Mostly topical chemotherapy drugs are used in basal cell carcinoma.

Immunotherapy: In February 2021, FDA approved immunotherapy drug Cemiplimab for certain forms of Basal Cell Carcinoma.

Cryosurgery can cure cancer. Liquid nitrogen is applied to the cancerous lesion, causing freezing. This is followed by the death of cancer cells, which later slough off.

Laser surgery: Laser light is applied to tumor which either vaporizes the tumor cells or kills the tumor through heat. https://www.skincancer.org/skin-cancer-information/basal-cell-carcinoma/ bcc-treatment-options/

What is Mohs surgery and how it is performed?

Mohs is special micrographic surgical technique where tumor is removed in layers and examined under Microscope. The surgeon continues to remove skin layers till all the tumor cells are removed. The advantage of Mohs is that it causes minimal damage to normal tissue. It ensures that all the cancerous tissue is removed, leaving minimal chance of recurrence. https://youtu.be/aCV1UZ0Yj-o

What is the prognosis of Basal Cell carcinoma?

The prognosis of Basal cell carcinoma is very good and 5 years life expectancy after diagnosis is 100%.

What happens if Basal Cell Carcinoma is left un-treated?

Leaving BCC untreated cause cosmetic disfigurement and being locally invasive tumor can cause destruction of skin, soft tissues and bones. Delay in treatment makes the removal of treatment difficult and there are higher chances of recurrence after removal.