BASAL CELL CARCINOMA - BCC

BCC stands for basal cell carcinoma. This is a "nonmelanoma" skin cancer, not as serious as melanomas, but far more common. More than one million new non-melanoma skin cancers are diagnosed each year in the United States. BCCs are by far the most common, accounting for about 80 percent of the non-melaanoma skin cancers.

BCCs arise in the epidermis, the uppermost layer of the skin, and when detected and treated at an early stage, they are almost invariably cured. Metastasis, meaning a spread beyond the skin, is rare for BCCs. Nonetheless, it must be recognized as a risk. Although non-melanomas were formerly a disease of older people, they are now on the increase in the young.

THE MOST COMMON SKIN CANCER

Basal cell carcinoma is the most common form of skin cancer, affecting about 800,000 Americans each year. In fact, it is the most common of all cancers. 1 out of every 2 new cancers is a skin cancer, and the vast majority are basal cell carcinomas, often referred to by the abbreviation, BCC. These cancers arise from epithelial cells which resemble basal-cells, those cells that reside in the bottom layer of the epidermis (outer skin layer). Until recently, those most often affected were older people, particularly men who had worked outdoors. Although the number of new cases increase sharply each year, in the last few decades the average age of patients who newly develop this skin cancer steadily decreased. More women are getting BCC's than in the past; nonetheless, men still outnumber them greatly.

The Major Cause of BCC

Chronic exposure to sunlight is the cause of almost all basal cell carcinomas, which occur most frequently on exposed parts of the body - the face, ears, neck, scalp, shoulders, and back. Rarely, however, tumors develop on non-exposed areas. In a few cases, contact with arsenic, exposure to radiation, and complications of burns, scars, vaccinations, or even tattoos are contributing factors.

Who Gets It

Anyone with a history of frequent sun exposure can develop basal cell carcinoma, often referred to as BCC. But people who have fair skin, light hair, and blue, green, or gray eyes are at highest risk. Those whose occupations require long hours outdoors or who spend extensive leisure time in the sun are in particular jeopardy. Dark-skinned individuals are far less likely than fair-skinned to develop skin cancer. More than two-thirds of the skin cancers that they do develop, however, are squamous cell carcinomas, usually arising on the sites of preexisting inflammatory skin conditions or burn injuries.

TYPES OF TREATMENT

After a physician's examination, a biopsy will be performed to confirm the diagnosis of squamous cell carcinoma. This involves removing a piece of the affected tissue and examining it under a microscope. If tumor cells are present, treatment (usually surgery) is required. Fortunately, there are several effective ways to eradicate squamous cell carcinoma. The choice of treatment is based on the type, size, location, and depth of penetration of the tumor, as well as the patient's age and general state of health. Treatment can almost always be performed on an outpatient basis in a physician's office or at a clinic. A local anesthetic is used during most procedures. Pain or discomfort is usually minimal with most techniques, and there is rarely much pain afterwards.

Excisional Surgery

The physician uses a scalpel to remove the entire growth and a surrounding border of what happens to be normal skin as a "safety margin." The incision is then closed with sutures. The removed tissue is sent to the laboratory, where it is examined microscopically to ensure that all the malignant cells have been removed.

Curettage and Electrodesiccation (Electrosurgery)

The physician scrapes the cancerous tissue away from the skin with a sharp, ring-shaped instrument called a curette, then uses an electric needle to burn the scraped area and a margin of normal skin around it. This two-step procedure may be repeated several times, a deeper layer of tissue being scraped and burned each time, until the physician determines that no tumor cells remain.

Cryosurgery

The physician uses liquid nitrogen to destroy tumor tissue by freezing. No cutting is involved in this bloodless procedure, which may be repeated several times at the same visit to ensure total destruction of malignant cells. Easy to administer, cryosurgery is favored for patients with bleeding disorders or intolerance to anesthesia. Redness, swelling, blistering, and crusting can occur following this treatment.

Mohs Micrographic Surgery (microscopically controlled surgery)

The surgeon successively removes very thin layers of the tumor. Each layer is examined immediately under a microscope. Removal and microscopic examination are repeated until the site is tumor-free. Mohs micrographic surgery saves the greatest amount of healthy tissue and reduces the rate of local recurrence. It is most often used on tumors that have recurred and on those in locations that are difficult to treat (for example, the nose, ears, and around the eyes).

Radiation

A radiation therapist directs X-ray beams at the tumor. Total tumor destruction generally requires a series of treatments, usually several times a week for one to four weeks. Radiation therapy is ideal for certain elderly patients or for individuals whose overall health is poor.

Laser Surgery

The laser beam is used either to excise the tumor, much as a scalpel does, or to destroy it by vaporization, in a procedure similar to electrodesiccation. The major advantage of this relatively new surgical technique is that it seals blood vessels as it cuts, making it useful for patients with bleeding disorders.


If you have any questions about Babar K. Rao, MD, FAAD, or any questions about our dermatology or dermatopathology (skin cancer) procedures please feel free to contact Board Certified Dermatologist, Board Certified Dermatopathologist, Babar K. Rao, MD, FAAD at his Manhattan, New York, Newbrunswick, New Jersey, or Fresno, California offices.