The Most Frequently Occurring Form of Skin Cancer
Basil Cell Carcinomas 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. Usually caused by a
combination of cumulative UV exposure and intense, occasional UV exposure, BCC can be
highly disfiguring if allowed to grow, but almost never spreads (metastastasizes) beyond the
original tumor site. Only in exceedingly rare cases can BCC spread to other parts of the body and
There are an estimated 2.8 million cases of BCC diagnosed in the US each year. In fact, it is the
most frequently occurring form of all cancers. More than one out of every three new cancers are
skin cancers, and the vast majority are BCCs. It shouldn’t be taken lightly: this skin cancer can
be disfiguring if not treated promptly. Are you at risk? We have the information you need about
the prevention, detection, and treatment of basal cell carcinoma
Treatment for Basil Cell Carcinoma
After the physician’s examination, the diagnosis of BCC is confirmed with a biopsy. In this
procedure, the skin is first numbed with local anesthesia. A piece of tissue is then removed and
sent to be examined under a microscope in the laboratory to seek a definitive diagnosis. If tumor
cells are present, treatment is required. Fortunately, there are several effective methods for
eradicating BCC. Choice of treatment is based on the type, size, location, and depth of
penetration of the tumor, the patient’s age and general health, and the likely cosmetic outcome of
Treatment can almost always be performed on an outpatient basis in the physician’s office or at a
clinic. With the various surgical techniques, a local anesthetic is commonly used. Pain or
discomfort during the procedure is minimal, and pain afterwards is rare.
Mohs Micrographic Surgery
Using local anesthesia, the physician removes the tumor with a very thin layer of tissue around it.
The layer is immediately checked under a microscope thoroughly. If tumor is still present in the
depths or peripheries of this surrounding tissue, the procedure is repeated until the last layer
examined under the microscope is tumor-free. This technique saves the greatest amount of
healthy tissue and has the highest cure rate, generally 98 percent or better. It is frequently used
for tumors that have recurred, are poorly demarcated, or are in critical areas around the eyes,
nose, lips, and ears. After removal of the skin cancer, the wound may be allowed to heal
naturally or be reconstructed using plastic surgery methods.
After numbing the area with local anesthesia, the physician uses a scalpel to remove the entire
growth along with a surrounding border of normal skin as a safety margin. The skin around the
surgical site is then closed with a number of stitches, and the excised tissue is sent to the
laboratory for microscopic examination to verify that all the malignant cells have been removed.
The effectiveness of the technique does not match that of Mohs, but produces cure rates around
Curettage and Electrodesiccation
Using local anesthesia, the physician scrapes off the cancerous growth with a curette (a sharp,
ring-shaped instrument). The heat produced by an electrocautery needle destroys residual tumor
and controls bleeding. This technique may be repeated twice or more to ensure that all cancer
cells are eliminated. It can produce cure rates approaching those of surgical excision, but may
not be as useful for aggressive BCCs or those in high-risk or difficult sites.
X–ray beams are directed at the tumor, with no need for cutting or anesthesia. Total destruction
generally requires several treatments per week for a few weeks. Radiation may be used for
tumors that are hard to manage surgically and for elderly patients or others who are in poor
health. Cure rates are around 90 percent, but the technique can involve long-term cosmetic
problems and radiation risks, as well as multiple visits. No anesthesia is necessary.
Tumor tissue is destroyed by freezing with liquid nitrogen, without the need for cutting or
anesthesia. The procedure may be repeated at the same session to ensure total destruction of
malignant cells. The growth becomes crusted and scabbed, and usually falls off within weeks.
Cryosurgery is effective for the most common tumors and is the treatment of choice for patients
with bleeding disorders or an intolerance to anesthesia. This method is used less commonly
today, and has a lower cure rate than the surgical techniques–approximately 85-90 percent
depending on the physician’s expertise.
Photodynamic Therapy (PDT)
PDT can be useful when patients have multiple BCCs. A photosensitizing agent such as Topical
5-aminolevulinic acid (5-ALA) is applied to the tumors at the physician’s office. It is taken up by
the abnormal cells. The next day, the patient returns, and those medicated areas are activated by
a strong light. This treatment selectively destroys BCCs while causing minimal damage to
surrounding normal tissue. PDT is FDA approved for treatment of superficial and nodular BCCs.
Cure rates can vary considerably, ranging from 70 to 90 percent. Patients become photosensitive
for 48 hours after the treatment and must stay out of the sun.
The skin’s outer layer and variable amounts of deeper skin are removed using a carbon dioxide
or erbium YAG laser. Lasers give the doctor good control over the depth of tissue removed, and
are sometimes used as a secondary therapy when other techniques are unsuccessful. Laser
treatment has recurrence rates similar to those of PDT. It is not FDA-approved for BCC.
is FDA-approved only for superficial BCCs, with cure rates generally between 80
and 90 percent. The 5% cream is rubbed gently into the tumor five times a week for up to six
weeks or longer. It is the first in a new class of drugs that work by stimulating the immune
also has been FDA-approved for superficial BCCs, with similar cure
rates to imiquimod. The 5% liquid or ointment is gently rubbed into the tumor twice a day for
Trials with more invasive BCCs are under way for both imiquimod and 5-FU. Side effects are
variable, and some patients do not experience any discomfort, but redness, irritation, and
New Medicine for Advanced Basal Cell Carcinoma
In extraordinarily rare cases of metastatic BCC or locally advanced BCC, this cancer can become
dangerous, sometimes even life-threatening. ErivedgeTM (vismodegib), the first medicine ever
for advanced BCC, is an oral drug approved by the FDA in early 2012 only for very limited
circumstances where the nature of the cancer precludes other treatment options (such as surgery
or radiation). Due to a risk of birth defects, vismodegib should not be used by women who are
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