Basal Cell Carcinoma (BCC)

What Is Basal Cell Carcinoma?

Basal cell carcinoma (BCC) is a type of skin cancer that starts in the basal cells. The deepest layer of the outer skin (epidermis). It is the most common cancer in the world, with millions of new cases diagnosed each year. BCC grows slowly and almost never spreads to other parts of the body (metastasis is extremely rare, less than 0.1%). However, if left untreated, it can grow deep into the skin, destroy nearby tissue, and become very difficult to remove. Early treatment offers the best outcome.

Risk Factors

Several factors increase a person's chance of developing BCC:

• Cumulative sun exposure over a lifetime. UV radiation is the primary cause
• History of sunburns, especially blistering sunburns in childhood or adolescence
• Fair skin, light hair, and light-colored eyes
• Personal or family history of skin cancer
• Use of tanning beds or sunlamps
• Weakened immune system (from medications after organ transplant, HIV, or cancer treatment)
• Exposure to arsenic, certain industrial chemicals, or prior radiation therapy
• Genetic conditions such as Gorlin syndrome (basal cell nevus syndrome)
• Living at high altitude or in regions with intense, year-round sunlight

How Does BCC Look?

BCC can look many different ways depending on its subtype and location. Common appearances include:

• A shiny or pearly bump with visible small blood vessels (telangiectasias). Most classic sign
• A flat, scar-like lesion that is white or yellow with waxy edges
• A pink or red patch of skin that may look like a rash or eczema
• A sore that bleeds, heals, then keeps coming back
• A slightly raised, translucent growth with a rolled border
• A dark (pigmented) lesion that may resemble a mole. Rare but occurs
• BCCs are most common on sun-exposed areas: nose, ears, cheeks, scalp, forehead, and neck

BCC Subtypes

There are several subtypes of BCC. The subtype affects how the tumor grows and which treatment is best.

Treatment Options

The right treatment depends on the BCC's subtype, size, location, and your overall health. Your dermatologist will discuss which option is best for you.

• Mohs Micrographic Surgery. Highest cure rate (up to 99%); best for H-zone (face, ears, nose), recurrent BCCs, and aggressive subtypes. The entire surgical margin is examined in real time.
• Standard Excision. Removes the tumor with a margin of normal skin; tissue is sent to a lab. Cure rates are slightly lower than Mohs because only a portion of the margin is examined.
• Electrodessication and Curettage (ED&C). Scraping and burning the tumor; suitable for small, low-risk superficial or nodular BCCs on the trunk or extremities. Not appropriate for the face.
• Cryotherapy. Freezing with liquid nitrogen; used for very small, superficial BCCs. Lower cure rate than surgery.
• Topical Therapy (imiquimod, 5-fluorouracil). Creams applied to the skin; appropriate only for superficial BCCs in low-risk locations. Not suitable for nodular or aggressive subtypes.
• Radiation Therapy. Used when surgery is not possible; also useful for elderly patients or those with medical conditions that prevent surgery.
• Targeted Therapy (vismodegib, sonidegib). Oral pills for locally advanced or metastatic BCC; reserved for cases where surgery is not feasible.

Prognosis and Future Risk

With early treatment, the prognosis for BCC is excellent. However, having one BCC significantly increases your risk of developing another one:

• Approximately 50% of patients who have had one BCC will develop a new BCC within 5 years
• The new cancer may appear in a completely different location. Not necessarily near the original site
• Annual (or more frequent) full-body skin exams by a dermatologist are strongly recommended
• Self-examination of the skin monthly helps catch new or changing spots early
• BCCs rarely spread to lymph nodes or other organs. Mortality from BCC is very uncommon

Prevention

While not all BCCs can be prevented, consistent sun protection significantly lowers your risk:

•  Apply broad-spectrum SPF 30 or higher sunscreen every day, even on cloudy days. Reapply every 2 hours outdoors
•  Wear protective clothing: wide-brimmed hat (at least 3-inch brim), UV-blocking sunglasses, and long sleeves
•  Seek shade especially between 10 AM and 4 PM when UV radiation is strongest
•  Never use tanning beds or sunlamps. Indoor tanning increases BCC risk significantly
•  Perform a monthly self-skin exam: check all skin surfaces including the scalp, ears, and between the toes
•  See a dermatologist at least once a year for a professional full-body skin exam
•  If you are immunosuppressed (transplant patient, on biologics), discuss a more frequent screening schedule with your doctor