What is Basal Cell Cancer?

Basal Cell Cancer is the most common type of cancer worldwide. About 1 million cases of Basal Cell Cancer are estimated to occur annually in the United States in 2005. Thankfully, this form of skin cancer is readily curable. Basal Cell cancer occurs as a result of the combination of chronic sun exposure and genetic susceptibility. Those patients with blue eyes and freckles, who easily burn and have a history of blistering sunburns are more likely to develop this type of skin cancer. What is troublesome about Basal Cell Cancer is that often patients are unaware of any symptoms. For this reason, it is important that self skin examinations are performed every few months and that a comprehensive skin exam is performed by your dermatologist on a yearly basis. If you are diagnosed with this type of cancer, close follow up by your doctor is essential as there is a 20-40% chance of your developing a second similar cancer within within five years.

Basal Cell Carcinoma- the most common of the skin cancers, is characterized by a non-healing ulcer or papule with a "rolled border" and prominent blood vessels.

Fig. 1

How do I recognize Basal Cell Cancer?

Basal Cell Cancer can present in a multitude of ways. Often a nonhealing lesion can be the earliest sign of a newly formed tumor. Bleeding, pain, tingling, and itching can also be very early symptoms. Tumors can either appear as an inconspicuous red bump with a central dimple or depression or a simple benign flat red region on the skin. When an ulcer or crust is present, bleeding is often a common complaint.

If a non-healing lesion such as those described above occurs on your skin, it is advisable to have your dermatologist assess the area as soon as possible, especially if you have had extensive sun exposure or a personal or family history.

Basal Cell Carcinoma-Nodular variant is the most common subtype

Fig. 2

Does Basal Cell Cancer spread internally? Am I in danger?

This question is often asked and can be divided into two parts. First, the good news. This type of cancer does not usually metastasize or spread to other organs. The second aspect of this question, however, recognizes that these tumors can become a destructive force. Basal Cell cancer, if left untreated, can become invasive and grow deep into the skin and underneath structures. This process can result in a disfiguring appearance and even the destruction of a sensory organ such as the ear, eye or nose. Therefore, especially on the on the head and neck areas, these cancers need to be treated early and aggressively.

Scar-Like (Morpheaform) Basal Cell Carcinoma-very destructive

Fig. 3

  What are the options for treatment of Basal Cell Cancer?

The mainstay therapy for Basal Cell cancer is surgery. Newer treatments involving chemotherapy with medications that have a boosting effect on your immune system such as Imiquimod (Aldara ^™) (See Below) are proving to be promising for certain less invasive basal cell cancers. The mainstay procedure, however, is still surgical excision or electrically destroying the tumor (EDC or Laser procedures)  which yields a cure rate of about 95%. These latter techniques are performed under local anesthesia and recovery time is minimal. In certain instances, where the cancer is close to a sensory organ such as the nose or eye, a tissue sparing technique called Mohs Surgery may be employed. This type of surgery involves the evaluation of multiple frozen specimens to make sure that these important areas are free from residual cancer. It has abou a 99% cure rate and is used for tumors in the head and neck region primarily.Finally, some doctors treat basal cell cancers with injectable medications such as interferon or Bleomycin but these treatments are still in the experimental stage.

NEW TREATMENTS FOR BASAL CELL CANCER

For early and limited basal cell cancer, Imiquimod (Aldara^™) cream can be used to eliminate the cancer. This saves patients from surgery and leads to an excellent cosmetic result. For more information about Aldara ^™ nonsurgical treatments, please inquire about this at your next appointment.
 

Fig 4. Basal Cell Cancer-under the microscope