Basal cell carcinoma

Basal cell skin cancer is the most common form of skin cancer. Approximately 80 percent of all skin cancers are basal cell carcinomas (BCC), meaning they occur in the skin’s basal cell layer, according to the American Cancer Society.

The other two main types of skin cancer are squamous cell cancer and melanoma. While BCC isn’t as deadly as melanoma, all types of skin cancer should be properly diagnosed and treated by a doctor.

Your skin’s uppermost layer is called the epidermis, and the bottom layer of the epidermis is the basal cell layer. If your skin cancer starts in the basal cell layer, it’s a basal cell carcinoma.

Basal cell skin cancers tend to grow slowly and rarely spread, but this doesn’t mean you should ignore them. Untreated basal cell cancer can invade the bone or other tissues under the skin. It can also recur. If you’ve had basal cell skin cancer in the past, it may come back in the same place or elsewhere on your body.

Exposure to the sun’s ultraviolet rays is the top risk factor for all types of skin cancer, including basal cell carcinoma. Basal cell skin cancers occur on parts of the body that are exposed to sun including the neck, scalp, chest, shoulders and back. If you had sunburns as a child, you’re at greater risk for basal cell skin cancers.

Exposure to other sources of ultraviolet radiation such as through indoor tanning also increases your risk. The UV rays damage the genetic material within the basal skin cancer cells, setting the stage for cancer.

This form of skin cancer is more common in people older than 50, but it can strike younger people with a history of extensive sun exposure, too.

In addition to history of exposure to the sun or other UV radiation, you’re at higher risk for developing basal cell skin cancer if you have:

• Light or freckled skin
• Blue, green or gray-colored eyes
• Red or blonde hair
• Multiple moles
• A family history of skin cancer
• A challenged immune system from medicines, including those meant to suppress the immune system after an organ transplant
• Other skin diseases such as nevoid basal cell carcinoma syndrome, a hereditary condition characterized by multiple basal cell skin cancers
• A history of photodynamic therapy, which uses special drugs along with a light source to kill cancer cells
• A history of smoking

The best way to reduce your risk for basal cell or any type of skin cancer is to:

• Apply broad-spectrum sunscreen with an SPF of 30 or higher, making sure to cover all exposed areas and reapply it frequently.
• Avoid the sun when it’s strongest.
• Wear wide-brimmed hats and long sleeves or long pants when out under the sun's rays.
• Wear sunglasses that block UV light, which can prevent damage to the thin skin around your eyes.
• Skip indoor tanning.
• Schedule yearly skin cancer checks with a dermatologist.
• Conduct monthly self-checks for skin changes.

When diagnosing basal cell carcinoma, symptoms may include:

• An open sore that won’t heal, but may bleed, ooze or crust
• A shiny or pearly pink, red, or flesh-colored bump
• A raised, rolled edge and a crusted indentation in the center
• A white, waxy or yellow scar-like area

Knowing what to look for can help you stay one step ahead of basal cell skin cancers.

If you’re concerned about a mark on your skin, schedule a visit with your dermatologist. It’s always better to be safe than sorry. Your doctor will examine the spot and if he or she is concerned, a biopsy is the next step. This involves taking a sample of the lesion and sending it off to a lab for analysis. The process can take around a week or more to get results.

Treatment plans for basal cell carcinoma is based on its size, depth and where it’s located.

Your surgeon may opt to excise the cancer, which means cut it out and stitch the remaining skin back together. Another basal skin cell carcinoma treatment method, curettage and electrodesiccation, involves scraping away cancer cells and using electricity to kill any that remain.

Mohs surgery is a skin cancer treatment that removes a mole layer by layer. Your surgeon looks at each layer under a microscope and continues to remove more layers until there is no evidence of the cancer. This tends to be preferred if the basal skin cell carcinoma is on the nose, ears and other areas of the face.

Treatments other than surgery may also be options, including:

• Cryosurgery to freeze and kill the cancer cells
• Medicated skin creams
• Photodynamic therapy
• Radiation therapy, which uses X-rays to kill cancer cells. This is an option when basal cell cancer can’t be removed surgically.

If basal cell cancer has spread to other parts of your body, options may include newer biologic therapies. Both Erivedge® (vismodegib) and Odomzo® (sonidegib) block a key signaling pathway that encourages basal cell skin cancers to grow and spread.