Basal cell skin cancer, also known as basal cell carcinoma, is usually very curable, but it can cause disfigurement and complications if left untreated. In the majority of cases, basal cell carcinoma is very treatable.
It is unusual for basal cell carcinoma to be fatal. About 2,000 people in the United States die each year from basal and squamous skin cancers. In most cases, people who die from these types of skin cancer tend to be older, immunocompromised, or have been diagnosed at a very late stage.
What is basal cell carcinoma?
Basal cell carcinoma is the most common form of skin cancer, with about 80% of skin cancers developing from basal cells. The epidermis (the top layer of the skin) has three types of cells. The cells in the bottom layer of the epidermis are basal cells.
Basal cells divide continuously to form new cells. These cells replace squamous cells, pushing old cells to the surface of the skin, where they die and slough off. Cancer that starts in this basal/basal layer of skin cells is called basal cell carcinoma.
Basal cell carcinoma is often triggered by damage from ultraviolet (UV) radiation. This is most commonly caused by sun exposure or tanning beds. UV radiation can damage basal cells, causing them to change and grow uncontrollably.
Basal cell carcinoma can look different from person to person. It can present as an open sore, scaly patch, shiny bump, irritated red patch, pink growth, waxy scar-like growth, or a central depression. They can sometimes ooze, scab, or bleed
Since it can vary in appearance, it’s essential that your healthcare provider check for any new growths, lesions, lumps, bumps, or changes in your skin.
Types of basal cell carcinoma
There are several types of basal cell carcinoma, including:
- Nodular basal cell carcinomaAbout 60-80% of all basal cell carcinomas presenting on the face or head are nodular. This is the most common subtype, and it is also known as nodular carcinoma. It manifests as a shiny, smooth nodule. It may have a central depression, with rolled edges and blood vessels often seen on its surface.
- Superficial spread of basal cell carcinoma: Most commonly seen on the upper body, back, and shoulders, this type is more common in younger people. It presents as shallow, scaly, irregular patches that are pink or similar in color to the skin. Almost all superficially spreading basal cell carcinomas are secondary to sun damage.
- Sclerosing basal cell carcinoma (also called morphological basal cell or infiltrative basal cell skin cancer): This type can be difficult to diagnose. Most commonly seen on the face, it can look like a small, waxy white scar that expands over time. It can be more dangerous or disfiguring because it is not usually recognized as a skin cancer until it has grown.
- Pigmented basal cell carcinoma: Most commonly occurs in people with darker skin tones, especially Asians. Pigmentation can be found in different basal cell carcinoma subtypes and it may appear dark green, dark brown, or black.
It is possible that you may have several types of basal cell carcinoma at the same time. If you have one, it increases your risk of getting another. Basal cell carcinoma rarely spreads to other parts of the body.
Skin Oncologist Discussion Guide
Get our printable guide to your next healthcare provider appointment to help you ask the right questions.
Basal cell carcinoma stage
In most cases, basal cell carcinoma does not need to be staged because it rarely spreads. Staging may only apply if your cancer is very large or has spread. It determines the severity of the cancer and how it is treated.
The TNM system is most often used to stage cancer:
- BILLIONumor: Consider the size of the tumor and if the tumor has infiltrated other nearby structures, such as bone.
- WOMENode: Describes cancer that has spread to the lymph nodes.
- USAetastases: Determines whether cancer has spread to distant body parts.
The stages are numbered and classified as follows:
- Phase 0: Cancer is found only in the original tumor on the skin. It is only in the epidermis and has not yet spread to the dermis. Stage 0 is also known as Bowen’s disease or carcinoma in place.
- State 1: The tumor is 2 cm (cm) wide or smaller. It may have spread into the dermis, but not beyond the skin. The tumor has no more than two high-risk features.
- Phase 2: The tumor is larger than 2 cm and may have spread from the epidermis into the dermis. It can also have high-risk features, such as dural invasion (the cancer has spread into the space around the nerve). Stage 2 tumors can also be any size with two or more high-risk features.
- Stage 3Cancer: Cancer has spread to areas beneath the skin, such as into muscle, bone, cartilage, or lymph nodes, but only near the original tumor. It has not spread to distant organs.
- Stage 4: The tumor can be any size and may have spread to nearby lymph nodes. It has spread to distant organs such as the brain or lungs, or has invaded bone, or has invaded the dura mater into the base of the skull.
High risk features
These features are identified as high risk:
- Thicker than 2 millimeters (mm)
- Growth in the dermis
- Perineal invasion has occurred
- The main location is hairy lips or ears
- The cancer sample appears poorly differentiated or undifferentiated (unlike well-developed basal cells) under the microscope.
Classification is a way of describing a cancer based on its cellular appearance under a microscope.
- Grade 1: Low level. Most cells look like normal cells.
- Level 2: Cells have the characteristics of normal cells.
- Grade 3: High-class. The cells look very abnormal.
If left untreated, basal cell carcinoma can spread over skin tissue and, in some cases, can lead to disfigurement. Although rare, it can spread and metastasize to other parts of the body, such as the bones and lungs.
Other complications of basal skin cancer include:
- Risk of relapse
- Increased risk of developing other types of skin cancer
Can basal cell carcinoma be cured?
In the majority of cases, basal cell skin cancer can be cured. Survival rates are excellent; However, the exact statistics are still unknown. Unlike other cancers, basal cell and squamous cell skin cancers are not tracked by cancer registries, so statistics are not available.
In some cases, basal skin cancer can recur. The risk of recurrence seems to be related to the type of treatment used to treat the cancer.
Research has shown that the risk of recurrence is:
- Just over 10% after surgical removal
- Less than 8% after electrode measurement and curettage
- About 7.5% after cryotherapy
- Less than 1% after Mohs . microsurgery
Treatment options vary depending on the subtype, stage, and location of the underlying skin cancer.
Medications used include:
- Chemotherapy: Anti-cancer drugs injected into a vein or injected in the mouth
- Targeted therapy: Drugs that specifically target proteins present in cancer cells
- Immunotherapy: Drugs that encourage your own immune system to identify and kill cancer cells more effectively
Topical treatments include:
- Cryotherapy: Liquid nitrogen is used to freeze and kill cells.
- Laser surgery: Laser light is focused through a beam to vaporize the cancer cells.
- Photodynamic therapy: Skin medicines. The skin is then exposed to a special light-emitting device for a few minutes to a few hours.
- Chemical peels: A chemical is applied to the skin. destroys tumor cells in a matter of days.
- In situ chemotherapy: Anti-cancer chemotherapy drugs are applied directly to the skin.
- Immune response modifier: They are designed to boost the body’s immune response against cancer. This can cause it to shrink and disappear.
Surgical methods include:
- Scrape and electrode: Basal cell carcinoma is removed from the skin using a technique called curettage. The electrode then uses heat to kill any remaining cancer cells.
- Mohs . microsurgery: A very thin layer of skin, including the tumor, is removed. The sample is then examined under a microscope. If cancer cells remain, another layer is removed and examined. This procedure is repeated until no more cancer cells are visible under the microscope.
- Wide cutout: Basal cell skin cancer is surgically removed along with an area of normal-looking skin around it.
Radiation therapy for skin cancer uses high-energy rays or particles to kill cancer cells.
You can reduce your risk of developing basal cell carcinoma by taking these precautions:
- Avoid the midday sun when it’s strongest
- When out in the sun, find shade to limit UV exposure
- Wear broad-spectrum sunscreen year-round — remember it doesn’t have to be sunny for UV rays to damage your skin
- Take extra precautions around water, snow, and sand. UV rays can reflect these rays, increasing the chance of sunburn
- Wear protective clothing.
- Wear protective sunglasses.
- Avoid tanning beds.
- Make sure children are protected from the sun.
- Check your skin regularly and report changes to your healthcare provider.
Get to know your skin and check it regularly
Notice changes like:
- Moles that change shape, color, size, bleed, or develop an irregular border
- A new spot on the skin that changes in size, shape or color
- Ulcers that do not heal
- New bumps, lumps or spots that don’t go away
- Glossy, waxy or scar-like lesions
- New patches of dark skin have appeared
- Rough, red, scaly patches of skin
If you notice any changes in your skin, seek advice from a medical professional. Basal cell carcinoma is very treatable when detected early.
A very good word
Basal cell carcinoma can appear differently from person to person. This is why it is important to check your skin regularly and report any changes to your healthcare provider. Skin cancers can be treated if caught early, but they can spread, disfigure, or metastasize if left untreated.
Basal cell skin cancer has an excellent survival rate when it is treated early. Regular skin checks will help you catch changes early.
The best way to reduce your risk of developing basal cell skin cancer is prevention. Protect yourself from harmful UV rays with sunscreen, sunglasses and clothing as much as possible.
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