Basal Cell Carcinoma

Overview

Basal cell carcinoma is a type of skin cancer that originates in the basal cells, which are skin cells responsible for producing new skin cells as old ones die off. It typically appears as a slightly transparent bump on the skin, often found in sun-exposed areas such as the head and neck. Long-term exposure to ultraviolet (UV) radiation from sunlight is considered a primary cause of basal cell carcinoma. Sores that don't heal and unusual growths on the skin are common symptoms. In rare cases, genetic diseases like nevoid basal cell carcinoma syndrome (Gorlin-Goltz syndrome) and xeroderma pigmentosum can contribute to the risk. Complications can include a higher likelihood of recurrence, the development of other skin cancers, and, in some cases, the spread of cancer beyond the skin. Preventative measures include limiting sun exposure and using sunscreen. If you notice changes in your skin, such as new growths or recurring sores, consult your health care provider.

Understanding the disease

Symptoms

The symptoms of basal cell carcinoma include a slightly transparent bump on the skin or a growth or sore that won't heal. These changes in the skin (lesions) usually have one of the following characteristics:

Risk Factors

The risk factors for developing basal cell carcinoma include:

1. Chronic sun exposure
2. Radiation therapy, particularly for acne or skin conditions
3. Fair skin, freckling, or easy burning
4. Increasing age
5. Personal or family history of skin cancer
6. Immune-suppressing drugs
7. Exposure to arsenic, either through contaminated well water or certain occupations
8. Inherited syndromes that cause skin cancer, such as nevoid basal cell carcinoma syndrome (Gorlin-Goltz syndrome) and xeroderma pigmentosum. Remember to consult a healthcare provider if you observe any changes in the appearance of your skin, such as new growths, changes in existing growths, or recurring sores.

Development

Basal cell carcinoma develops when one of the basal cells in the skin undergoes a mutation in its DNA. This mutation causes the basal cell to multiply rapidly and continue growing when it would normally die, leading to the formation of an abnormal mass of cells called a cancerous tumor. The lesion that appears on the skin is the result of the accumulation of these abnormal cells. Ultraviolet (UV) radiation from sunlight and commercial tanning lamps and beds is thought to be a significant contributing factor to the development of basal cell carcinoma, as it can damage the DNA in skin cells. However, other factors can also increase the risk of basal cell carcinoma, such as inherited syndromes that cause skin cancer, chronic sun exposure, radiation therapy, fair skin, and increasing age.

Assessment and Diagnosis

Triage

You should see a doctor if you observe changes in the appearance of your skin, such as a new growth, a change in a previous growth, or a recurring sore that has not healed for several weeks, as these could be signs of basal cell carcinoma. It is essential to seek medical attention to ensure an accurate diagnosis and appropriate treatment plan.

Diagnosis

Diagnosing basal cell carcinoma involves a combination of medical history, physical examination, and testing. Your doctor will conduct a general physical exam, ask questions about your medical history, changes in your skin, or any other signs or symptoms you've experienced. They may also examine the rest of your body for other lesions. In some cases, a skin biopsy may be performed to remove a small sample of a lesion for testing in a laboratory, which can confirm the presence of skin cancer and determine the type.

Management and Treatment

Complications

Complications of basal cell carcinoma can include a risk of recurrence, an increased risk of other types of skin cancer, and cancer that spreads beyond the skin. Very rarely, basal cell carcinoma can spread (metastasize) to nearby lymph nodes and other areas of the body, such as the bones and lungs.

Prevention

Basal cell carcinoma can be prevented to some extent by following certain measures. To reduce your risk of basal cell carcinoma, you can:

1. Avoid the sun during peak hours: Limit sun exposure, especially between 10 a.m. and 4 p.m. when UV rays are strongest. Schedule outdoor activities for other times of the day.
2. Use sunscreen: Apply a broad-spectrum sunscreen with an SPF of at least 30, even on cloudy days. Reapply every two hours, or more often if you're swimming or sweating.
3. Wear protective clothing: Cover your skin with long-sleeved shirts, long pants, and a broad-brimmed hat. Opt for tightly woven fabric and dark colors that offer more protection.
4. Wear sunglasses: Choose sunglasses that block both UVA and UVB rays.
5. Limit sun exposure: Reduce exposure to the sun, especially if you have fair skin, freckle or burn easily, or have a history of severe sunburns.
6. Avoid commercial tanning beds: Exposure to artificial UV light from tanning beds can significantly increase the risk of basal cell carcinoma.
7. Be aware of your skin: Regularly monitor your skin for unusual growths or changes and consult a dermatologist if you notice anything concerning. Remember, while these measures can help reduce the risk of basal cell carcinoma, it's essential to be vigilant about monitoring your skin and seeking medical advice if you notice any suspicious changes.

Home Remedies

It's important to consult a dermatologist or healthcare professional for proper diagnosis and treatment of basal cell carcinoma. Preventative measures such as avoiding sun exposure, wearing protective clothing and using sunscreen can help reduce the risk of developing basal cell carcinoma.

Treatment

Treatments for basal cell carcinoma include:

1. Surgical excision: The most common treatment for basal cell carcinoma is surgical removal. The cancerous tissue is cut out, along with some surrounding healthy tissue, to ensure complete removal. This can be done with a local anesthetic and may be followed by skin reconstruction.
2. Curettage and electrodesiccation (C&E): In this procedure, the doctor scrapes away the cancerous tissue with a curette, then uses heat (electrodesiccation) to control bleeding and kill any remaining cancerous cells.
3. Cryotherapy: This involves freezing the cancerous tissue with liquid nitrogen. As the tissue thaws, the frozen cancer cells die and the dead tissue sloughs off.
4. Mohs surgery: This is a specialized surgical technique used for basal cell carcinomas that are challenging to treat or have recurred. The surgeon removes the cancerous tissue layer by layer, examining each layer under a microscope until no cancerous cells are found.
5. Topical treatments: For very superficial basal cell carcinomas, topical treatments may be used, such as imiquimod or 5-fluorouracil (5-FU). These medications help the immune system recognize and attack the cancer cells.
6. Radiation therapy: In some cases, radiation therapy may be used to treat basal cell carcinoma. This can involve external beam radiation or brachytherapy, where a radioactive source is placed directly into the cancerous tissue. It's important to consult a dermatologist or other medical professional to determine the most appropriate treatment for your specific case of basal cell carcinoma.

Preparing for medical consultation

To prepare for an appointment for basal cell carcinoma, you should:

1. Create a list of questions to ask your doctor about your condition, such as whether you have skin cancer, what type, whether it has spread, and what treatment approach is recommended.
2. Write down your medical history, including other conditions you've been treated for and any personal history of exposure to excessive ultraviolet (UV) light.
3. Note any immediate family members who have had skin cancer.
4. Make a list of your medications and natural remedies, including prescription and over-the-counter medications, vitamins, supplements, and herbal remedies.
5. Be aware of any pre-appointment restrictions and follow any instructions provided by your healthcare provider.
6. Write down any symptoms you are experiencing, including those that may seem unrelated to the reason for your appointment.
7. Prepare a list of key personal information, such as major stresses or recent life changes. Remember to bring a family member or friend to the appointment for support, as skin cancer diagnosis can be overwhelming. Following these steps can help you make the most of your time with your doctor and ensure that you have all the necessary information to address your concerns.