Basal cell carcinoma is a very slow developing type of skin cancer. The American Cancer Society reports that approximately three quarters of all skin cancers diagnosed are basal or squamous cell, which is a total of 2.2 million cases annually. Of these, basal cell carcinomas are the most common.1 It is found in all ethnic groups, age groups and in all geographic locations in the world. There are some risk factors that may contribute to the development of basal cell carcinoma and there are preventative measures that can be used to minimize the risk of developing this type of skin cancer. For people diagnosed with basal cell carcinoma the risk of the cancer spreading to other areas of the skin or to internal organs is minimal and much less likely than with a faster developing melanoma.
Development of Basal Cell Carcinoma
Basal cell skin cancer forms in the lower layers of the epidermis, the skin, and gets its name from the naturally occurring skin basal cells. These cells exist at the deepest layer of the skin to produce new skin cells known as keratinocytes. As the basal cells divide to produce new keratinocytes they push to the surface where the cells eventually are shed from the skin’s surface. In this way the basal layer of the epidermis is constantly generating new skin to replace the top cells that are old and no longer functioning.
Basal cell carcinoma is most commonly found on areas of the body that receive significant sun exposure. This is most commonly the neck and the head, but may be also found on the arms, back and legs. The cells divide abnormally to create tissue that pushes out, creating small lumps just under the skin’s surface. If not treated they can continue to grow slowly and, under the right conditions, can even move into bone and surrounding tissue.2
Appearance
The appearance of basal cell carcinoma is not the same as that of melanoma and typically it is not associated with moles. It often starts out as a slightly more red or brown to tanned looking irregularly shaped patch of skin. In addition the skin may actually be white or even a light pink in color. It all depends on your skin tone and the number of cells that are involved in the cancerous tissue.
Many people note that the skin is raised in a bump like protrusion that may appear to be waxy or almost a pearly color initially. Small blood vessels may be evident in the skin and there may be a scar like area that forms around the bump or elsewhere on the skin without any previous injury to that specific skin surface. This is usually flat with the surface of the skin.
Other symptoms that may indicate basal cell skin cancer include a bleeding sore that doesn’t heal, sores that are very slow to heal given their size and significance, crusting, oozing or scabbing over then opening of sores or a shrunken in area to the sore, typically in the middle.3 Occasionally people may experience some pain when the area of the bump or sore is touched, but most patients will not have problems with pain.
Risk Factors
In general sun exposure without sunscreen and suitable protection is the leading cause of the development of skin cancer. Tanning in tanning beds or exposure to specific types of chemicals and carcinogens is also linked to the development of basal cell carcinomas. These types of skin cancers can develop anywhere on the body since the exposure is not just confined to the arms, back, chest and legs, the common areas exposed in direct sunlight. There are also other factors that can occur at the same time as sun exposure that increases risks to particular groups of individuals. People that have the following risk factors are much more likely to develop basal cell carcinoma than people without:4
- Blond or red hair
- Very light colored skin
- Extensive freckling
- Blue, grey or green eyes
- History of burning quickly rather than tanning
Age also is considered a risk factor as most people are diagnosed with basal cell carcinoma over the age of 40. It is important to keep in mind that the sun exposure occurs over long periods of time, not related to a specific sun exposure incident immediately before the skin change.
Treatment
Treatment of basal cell carcinoma can vary based on the size, depth and location of the specific tissue. For many people a simple removal surgery that is performed in a doctor’s office is all that is required. With larger skin areas minor surgery may be required and stitches used after the procedure. Cryosurgery uses a freezing technique and liquid nitrogen, similar to the process used to remove warts on the skin. Electrodessication uses a laser type process to target and kill the cancerous cells. This can be used for small to medium sized cancerous areas and it usually a day surgery procedure performed in an office.
Larger basal cell carcinomas may require Mohs surgery which allows doctors to examine the tissue after removal to ensure all cancerous cells have been eliminated form the skin. Mohs surgery is often used in areas where there is a concern that the cancer may have spread to surrounding tissue.5
Basal cell carcinoma can be very effectively treated and removed, usually with minimal risk or complications. However, it can appear in the same area of the body or in another, so self skin exams and regular doctor skin exams are highly recommended once a diagnosis and treatment has occurred.
References
1 Skin Cancer: Basal and Squamous Cell. (n.d.). Retrieved from American Cancer Society: www.cancer.org/Cancer/SkinCancer-BasalandSquamousCell/DetailedGuide/skin-cancer-basal-and-squamous-cell-key-statistics
2 Basal Cell Carcinoma. (n.d.). Retrieved from Mayo Clinic: www.mayoclinic.com/health/basal-cell-carcinoma/DS00925/DSECTION=causes
3 Skin Cancer:Signs and Symptoms. (n.d.). Retrieved from American Acadmey of Dermatology: www.aad.org/skin-conditions/dermatology-a-to-z/skin-cancer/signs-symptoms/skin-cancer-signs-and-symptoms
4 Basal Cell Carcinoma. (n.d.). Retrieved from PubMed Health: www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001827/
5 The Mohs Procedure. (n.d.). Retrieved from American College of Mohs Surgery: www.skincancermohssurgery.org/mohs-surgery/mohs-procedure.php
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