Basal Cell Carcinoma (BCC)

Overview

What is basal cell carcinoma (BCC)?

BCC is a type of skin cancer that may form in the basal cells of the skin. These cells are the ones that make new cells to replace the cells that die.

How common is basal cell carcinoma (BCC)?

It is the most common type of cancer in human beings. The number of new cases just in the United States is estimated to exceed 4 million each year.

Who is affected by basal cell carcinoma (BCC)?

Basal cell carcinoma affects slightly more men than women. It occurs more often in older people. People with fair skin and light eyes are more likely to get BCC. It is 19 times more common in whites than blacks, but people of color may still be affected. People who have had BCC once are at higher risk for developing another lesion.

Symptoms and Causes

What causes basal cell carcinoma (BCC)?

Exposure to the ultraviolet rays in sunlight is a main cause. BCC is often found on the areas of the body reached by the sun, such as the face, hands and neck. Exposure to radiation and/or arsenic may also be a cause. It is possible that you might inherit a tendency for basal cell carcinomas.

What are the symptoms of basal cell carcinoma (BCC)?

  • Lumps or nodules on the skin that look shiny or that have visible blood vessels. The lumps can get bigger over time.
  • Areas on the skin that look like scars
  • Itchy patches
  • Areas of red or patchy skin that look like eczema
  • Sores that look crusty, have a depression in the middle, or bleed often

Diagnosis and Tests

How will a doctor diagnose basal cell carcinoma (BCC)?

Many doctors might be able to tell immediately by looking whether or not a spot is BCC. However, the doctor will do a biopsy to be sure. This means that the doctor will remove a piece of the lump or skin area so that it can be checked under a microscope.

Management and Treatment

What are the treatments for basal cell carcinoma (BCC)?

BCC is treated by removing it. The choice of treatment depends on many things, including patient health and age, the location of the tumor, and the extent and type of the cancer. Treatment may occur in many ways:

  • Scratching off with a curette, an instrument that may end in a ring or a spoon, and then burning with a special electric needle. This method is called electrodessication and curettage.
  • Surgical removal
    • Mohs surgery: This is a specialized technique. The doctor first removes the visible cancer and then begins cutting around the edges. The tissues are examined during the surgery until no more cancer cells are found in tissues around the wound. If necessary, a skin graft or flap might be applied to help the wound heal.
    • Excisional surgery: The growth and a bit of surrounding skin is removed with a scalpel.
  • Freezing (cryotherapy or cryosurgery)
  • Applying chemotherapy medication to the skin
  • Using lasers
  • Using blue light and a light-sensitive agent applied to the skin (photodynamic therapy or PDT)
  • Using radiation (rare)

If the BCC has advanced locally or spread (metastasized) to another location, which is very rare for BCC, the FDA has approved two medicines: vismodegib (Eviredge™) and sonidegib (Odomzo®). These drugs are of a class called hedgehog inhibitors.

What are the complications/side effects of the treatments for basal cell carcinoma (BCC)?

Most of the complications related to BCC treatments other than the hedgehog inhibitors are cosmetic, such as scarring or redness.

People who use sonidegib or vismodegib should make sure to use effective birth control to avoid pregnancy due to the risk of birth defects. In addition, sonidegib has other potential risks, including problems with nerves and muscles.

Prevention

How can you prevent basal cell carcinoma (BCC)?

Being safe in the sun is the best way to prevent BCC and other skin cancers. Here are some tips:

  • Avoid being in the sun from 10 am to 4 pm.
  • Avoid tanning beds.
  • Use a broad spectrum sunscreen with an SPF of 15 or higher each day. If you will be outside for longer periods of time, use a broad spectrum sunscreen that is water-resistant and has an SPF of 30 or higher. Put the sunscreen on 30 minutes before going outside. Put sunscreen on again every two hours, or more frequently if you have been swimming or sweating a lot.
  • Use protective clothing that has built-in sun protection, which is measured in UPF. Also, use broad-brimmed hats and sunglasses.
  • Do your own skin self-exam about once per month and see a dermatologist about one time per year for a professional skin exam.
  • Have any skin changes examined as soon as possible by a healthcare provider.

Outlook / Prognosis

What is the prognosis/outlook for patients who have basal cell carcinoma (BCC)?

The outlook for people with BCC is very good. Almost every case of BCC can be cured, especially when it is discovered early and treated right away.

Living With

When should I see a healthcare provider about basal cell carcinoma (BCC)?

It is important to contact a healthcare provider any time you have a skin problem that does not resolve. This means developing any new or larger mole, lump or sore, or new symptoms such as pain or itchiness. If you have had BCC or another type of skin cancer, you will probably be given a recommended schedule of needed appointments. You should follow up on these appointments as directed.

Resources

Where can I learn more about skin cancer?

National Cancer Institute - Cancer Information Service
1,800.4.CANCER (422.6237)
www.cancer.gov

American Academy of Dermatology
1.888.462.DERM (3376)
www.aad.org

Last reviewed by a Cleveland Clinic medical professional on 07/05/2019.

References

  • Skin Cancer Foundation. Accessed 7/5/2019.Basal cell carcinoma (BCC). (https://www.skincancer.org/skin-cancer-information/basal-cell-carcinoma)
  • American Academy of Dermatology. Accessed 7/5/2019.Basal cell carcinoma. (https://www.aad.org/public/diseases/skin-cancer/basal-cell-carcinoma)
  • National Cancer Institute. Accessed 7/5/2019.Skin Cancer Treatment (PDQ®)—Patient Version. (https://www.cancer.gov/types/skin/patient/skin-treatment-pdq)
  • Krishna SM, Garrett AB, Forman SB. Basal Cell Carcinoma. In: Kelly A, Taylor SC, Lim HW, Serrano A. eds. Taylor and Kelly's Dermatology for Skin of Color, 2e New York, NY: McGraw-Hill.
  • Tang JY, Epstein, Jr. EH, Oro AE. Basal Cell Carcinoma and Basal Cell Nevus Syndrome. In: Kang S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, McMichael AJ, Orringer JS. eds. Fitzpatrick's Dermatology, 9e New York, NY: McGraw-Hill.
  • Merck Manual Consumer Version. Accessed 7/5/2019.Basal cell carcinoma. (https://www.merckmanuals.com/home/skin-disorders/skin-cancers/basal-cell-carcinoma)

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