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Basal Cell Carcinoma
BCCs are abnormal, uncontrolled growths or lesions that arise in the skin’s basal cells, which line the deepest layer of the epidermis (the outermost layer of the skin). BCCs often look like open sores, red patches, pink growths, shiny bumps, or scars and are usually caused by a combination of cumulative and intense, occasional sun exposure. BCC almost never spreads (metastasizes) beyond the original tumor site. Only in exceedingly rare cases can it spread to other parts of the body and become life-threatening. It shouldn’t be taken lightly, though: it can be disfiguring if not treated promptly.
A biopsy is a small sampling of the skin tissue. The area is numbed with local anesthetic and then a small piece of tissue is removed. Depending on the type of biopsy taken, sometimes sutures are required. Once proven by biopsy to be a Basal Cell Carcinoma, there are several treatment options, depending on the specific type of Basal Cell Carcinoma.
Using a scalpel, the physician removes the entire growth along with a surrounding border of apparently normal skin as a safety margin. The skin around the surgical site is closed with stitches, and the tissue specimen is sent to the laboratory to verify that all cancerous cells have been removed. Cure rates are generally above 95 percent in most body areas, similar to those of curettage and electrodesiccation. A repeat excision may be necessary on a subsequent occasion if evidence of skin cancer is found in the specimen.
X-ray beams are directed through the skin at the tumor, with no need for cutting or anesthesia. Total destruction usually requires several treatments over a few weeks, or sometimes daily for one month. This is ideal for tumors hard to manage surgically and for elderly patients or others in poor health. Cure rates are around 90 percent. Although radiation limits damage to adjacent tissue, it can involve long-term cosmetic problems and radiation risks.
PDT is FDA-approved for the treatment of superficial or nodular BCC, with cure rates ranging from 70 to 90 percent. A light-sensitizing agent, topical 5-aminolevulinic acid (5-ALA), is applied to the lesion in the physician’s office. Subsequently, the medicated area is activated by a strong blue light; theoretically, this will selectively destroy BCCs while causing minimal damage to surrounding normal tissue. Some redness, pain, and swelling can result. Patients must strictly avoid sunlight for at least 48 hours, or UV exposure may further activate the medication, causing severe sunburn.
A physician trained in Mohs micrographic surgery removes a thin layer of tissue containing the tumor. While the patient waits, frozen sections of this excised layer are mapped in detail and examined under a microscope, generally in an on-site laboratory. If cancer is present in any area of the excised tissue, the procedure is repeated only on the body area where those cancer cells were identified (the tissue mapping allows the Mohs surgeon to pinpoint this area of the body), until the last excised layer viewed microscopically is cancer-free. This technique can save the greatest amount of healthy tissue and has the highest cure rate, 99 percent or better. It is often used for large tumors in cosmetically important areas, and those that have recurred, are poorly demarcated (hard to pinpoint), or are in critical areas.
- Imiquimod: FDA-approved only for superficial BCCs, with cure rates generally between 80 and 90 percent. The cream is rubbed gently into the tumor five times a week for up to six weeks or longer. The first in a new class of drugs that work by stimulating the immune system, it causes the body to produce interferon, a chemical that attacks cancer.
- 5-Fluorouracil (5-FU): a chemotherapy drug approved to treat internal cancers, also has been FDA-approved for superficial BCCs, with similar cure rates to imiquimod. The liquid or cream is gently rubbed into the tumor twice a day for three to six weeks. Side effects are variable, and some patients do not experience any discomfort, but redness, irritation, and inflammation usually occur.