melanocytes and melanin admixed with the tumor cells, which is more common in
the superficial, micronodular, or follicular variants.
What is Basal Cell Cancer?
Basal cell carcinoma, the most frequent type of skin cancer, affects nearly one in five Americans. Although it hardly ever spreads to other parts of the body, it can cause considerable damage and health issues to the area where it starts if not identified and treated properly.
macule or patch, which may contain telangiectasia. They have a predilection for
the shoulders, chest, or back, and multiple lesions may be present.
What Causes Basal Cell Cancer?
Basal cell carcinoma, a type of skin cancer, typically develops on areas of the skin that have been damaged by the sun. This includes regions like the head, neck, and torso. Generally, this condition takes a long time to develop – anywhere between 10 to 40 years after exposure to ultraviolet (UV) light, and there are no known early signs or precursors for it.
People with lighter skin tones and eye colors have a higher chance of getting these skin tumors. Furthermore, as people are now living longer, and more individuals are using drugs that suppress the immune system, the number of individuals affected by basal cell carcinoma has been increasing.
Risk Factors and Frequency for Basal Cell Cancer
Basal cell carcinoma is the most common type of skin cancer, affecting nearly 20% of individuals in the United States during their lifetime. It is estimated that the US sees over four million new cases of this cancer each year, accounting for a large 80% of all non-melanoma skin cancers. In recent years, there has been an almost 10% annual increase in diagnosed cases across all age groups. It is thought that this increased occurrence might be due to greater exposure to both natural and artificial ultraviolet light, particularly among younger individuals and females.
- Basal cell carcinoma is the most common type of skin cancer, with a lifetime risk of nearly 20% in the United States.
- More than four million new cases are diagnosed each year, making up 80% of all non-melanoma skin cancers.
- The number of diagnosed cases has been increasing by almost 10% annually across all age groups.
- The rise of basal cell carcinoma cases is thought to be associated with increased exposure to both natural and artificial ultraviolet light.
- This skin cancer is nowadays being more commonly seen in younger individuals and females.
Signs and Symptoms of Basal Cell Cancer
Basal cell carcinoma, which is a type of skin cancer, comes in three main forms: superficial, nodular, and infiltrative. Each type has different characteristics and can appear in different parts of the body.
- Nodular basal cell carcinoma is the most frequent kind. It appears as a pink, shiny bump with visible blood vessels, often on the head and neck. This slow-growing bump often ulcerates (forms a sore) and bleeds, which can resemble a shaving cut.
- Superficial basal cell carcinoma presents as a thin, pink patch, bump, or a flat and discolored area of skin. It has a pink, shiny border and is often found on the chest, back, or limbs.
- Infiltrative basal cell carcinomas which consists of infiltrative, micronodular, and morpheaform types, have various presentations. Morpheaform basal cell carcinoma looks like a firm, scar-like patch and can be mistaken for a new scar without a known injury. Both infiltrative and micronodular types are similar to the nodular type and appear as pink, shiny bumps with visible blood vessels.
Testing for Basal Cell Cancer
Basal cell carcinoma is a type of skin cancer that may be suspected if you have a new, pink, shiny bump on your head, neck, or trunk. These bumps often form sores and can bleed. By asking about your health history, your doctor can rule out other conditions that appear quickly, like acne bumps. Patients usually report the bump has been there for weeks or months and doesn’t heal properly, or bleeds off and on.
To confirm if it is basal cell carcinoma, your doctor usually orders a biopsy. This involves taking a small piece of the suspected bump to look at under a microscope. There are three main types of basal cell carcinoma, each looking different under a microscope. Nodular basal cell carcinoma shows up as large, blue patches of cells with cells neatly arranged along the edges. There can often be gaps between the cells and the connective tissue. It also has a unique mix of fibrous and gel-like tissue.
Superficial basal cell carcinoma, on the other hand, appears as a neat border of blue cells sprouting from the skin’s surface. In cases of the infiltrating type, the cancer cells are seen as small blue clusters squeezing between the connective tissue.
The morpheaform subtype has a hard, scar-like tissue, which shows up as a rigid texture under the microscope. This matches the scar-like appearance of the patch on the skin.
Treatment Options for Basal Cell Cancer
For the removal of basal cell carcinoma, the most prevalent type of skin cancer, the most proven method is known as surgical excision. A specialized type of this, called Mohs micrographic surgery (MMS), boasts the highest cure rate, with only 2.5% of patients experiencing a return of the cancer within five years. It is especially effective for basal cell carcinoma that is deeply rooted, recurring, or poorly defined, particularly in areas where preserving as much skin as possible is crucial. For cases that are not suitable for MMS, a standard surgical excision leaving a 4-mm border around the tumor is advised. This method has a slightly higher rate of recurrence, with 4.1% of patients experiencing a return of the cancer within five years.
A common procedure for nodular or superficial basal cell carcinoma is curettage with electrodesiccation which is often employed at the biopsy stage when there is strong clinical suspicion of cancer. This treatment, however, has a 5-year recurrence rate of 7.7%.
There are chemotherapy creams available and approved by the FDA for the treatment of superficial basal cell carcinoma – imiquimod 5% cream and 5-fluorouracil 5% cream. Imiquimod cream stimulates an immune response, while 5-fluorouracil cream inhibits the formation of a crucial substance for DNA replication. Both creams are typically applied over several weeks. An advantage of these creams over surgery is that they can be used on areas of the body where cosmetic appearance is a concern, as they are less likely to cause scarring.
In 2012, the FDA approved Vismodegib, a drug specifically for the treatment of advanced or metastatic basal cell carcinoma. It inhibits a particular pathway related to unregulated cell growth, thus helping control cancerous growths.
Radiation therapy is another treatment option for cases where surgery might not be possible or preferred. It can be used as an additional treatment in high-risk postoperative situations, or to alleviate symptoms such as pain, ulceration, or bleeding when curative treatment isn’t achievable.
What else can Basal Cell Cancer be?
When looking at skin conditions, doctors have several illnesses that they might have to consider, these can include:
- Dermatitis (skin inflammation causing redness and itching)
- Desmoplastic Trichoepithelioma (a rare, benign skin tumor)
- Ringworm (a type of skin fungal infection)
- Intradermal Nevus (a common mole within the skin)
- Lichenoid Benign Keratosis (a harmless skin lesion mostly found in elderly people)
- Eczema (an itchy inflammation of the skin)
- Fibroepithelioma of Pinkus (a benign form of skin cancer)
- Actinic Keratosis (rough, scaly patches on the skin caused by sun exposure)
- Sebaceous Hyperplasia (oily bumps on the skin due to enlarged sebaceous glands)
- Keratoacanthoma (a fast-growing, benign skin tumor)
- Nevi Malignant Melanoma (a serious and potentially life-threatening skin cancer)
- Seborrhoeic Keratosis (brown, black or light coloured growths on the skin)
- Metastatic malignancies (types of cancer that have spread from where they started)
- Cutaneous T-cell Lymphoma (a type of non-Hodgkin lymphoma, specifically impacting skin cells)
- Bowen Disease (an early form of skin cancer)
Identifying the correct underlying ailment is crucial for effective treatment. The physician would typically consider all these conditions, among others, before settling on an accurate diagnosis.
What to expect with Basal Cell Cancer
The outlook for people with basal cell cancer is generally very positive, showing a 100% survival rate in cases where the cancer hasn’t spread to other parts of the body. However, if the basal cell cancer isn’t treated and gets worse, it can result in substantial health consequences, including noticeable changes to the person’s appearance.
Possible Complications When Diagnosed with Basal Cell Cancer
The possible complications of basal cell carcinoma can include:
- Recurrence of the cancer
- Spread of the cancer to other parts of the body (metastasis)
- A higher chance of developing other types of skin cancer
Preventing Basal Cell Cancer
The best way to tackle Basal Cell Carcinoma (BCC) and other skin cancers is to prevent them from happening in the first place. This is especially crucial for people who’ve had skin cancer before, even if the treatment was successful. To do this, avoid being out in direct sunlight, especially during the middle of the day. Wear clothes that cover your skin when you’re outside, and always use a broad-spectrum sunscreen.
