What is It?
Basal cell carcinoma is the most common form of skin cancer, affecting nearly 1 million Americans each year. In fact, it is the most common of all cancers. Traditionally, elderly males with outdoor exposure were most affected. People now are developing basal cell carcinomas at earlier ages and women are now equally affected.
What causes it?
Chronic exposure to sunlight is the cause 95% of the time. Parts of the body exposed to the sun are most involved; the face, ears, neck, scalp, shoulders, and back. Rarely do tumors develop on non-exposed skin surfaces. In a few cases, contact with arsenic, exposure to radiation, complications from burns, scars, or vaccinations are contributing factors.
Who gets it?
While anyone with excessive sun exposure is at risk, people with fair skin, light hair, and blue/green eyes are more apt to develop the tumor. Outdoor occupations and leisure activities increase susceptibility. Skin cancers occur more often in people living in sunny areas like Texas, Arizona, and California than in areas receiving less sunshine, such as New England.
What to look for?
Basal cell carcinoma sometimes resembles non-cancerous skin conditions such as psoriasis or eczema — only a trained physician can decide for sure. It is recommended to examine your body regularly, as often as once a month, if you are at high risk. Be sure to include the scalp, back of ears, and neck as well as other hard-to-see areas. (A full-length mirror and hand-held mirror can be very helpful.)
The five warning signs of basal cell carcinoma are:
1) An open sore that bleeds or crusts for 3 or more weeks
2) A reddish patch or irritation which does not resolve
3) A smooth growth with an elevated, rolled border and an indentation in the center (tiny blood vessels may develop in surface of lesion).
4) A shiny bump or nodule which is pearly or translucent
5) A scar-like area with poorly defined borders and taut, shiny skin (although a less frequent sign, it can indicate an aggressive tumor).
If you observe any one of these warning signs or other changes in your skin, or unusual growth, consult your physician immediately.
Treatment
After the physician’s exam, the diagnosis is confirmed with a biopsy — a small piece of tissue removed and examined in the laboratory under a microscope. If tumor cells are present, treatment – usually surgery– is required. Treatment can almost always be performed on an outpatient basis in the physician’s office or clinic. A local anesthetic is used; pain/discomfort during and after the procedure is minimal. Because all surgery involves cutting the skin, scarring is inevitable. When small skin cancers are removed, the result is usually cosmetically acceptable. Larger tumors may require more complex reconstruction involving a skin graft or flap.
Types of Treatment
Excisional surgery — growth is cut out and wound closed with stitches
Electrosurgery — (cuttage and electrodesiccation) growth is scraped away and burned.
Cryosurgery — growth is destroyed by freezing with liquid nitrogen. This is the treatment of choice for patients who have bleeding problems or anesthetic allergies.
Radiation therapy — X-ray beams are directed at the malignant cells.
Moh’s surgery — (microscopically controlled surgery) very thin layers of the growth are removed, checking each layer under a microscope until the site is tumor-free.
Laser surgery — laser beam is used to either excise or vaporize the tumor.
Enter Geram — investigational genetically engineered product of the human immune system which may be of value in some basal cell carcinomas.
Prevention
The skin-damaging effects of sunlight are permanent and build up slowly over time. Ordinary sun exposure and sunbathing produce gradual skin damage even if sunburn is avoided. As many as 10, 20, or more years can pass between the time of sun exposure and the time skin shows signs of sun damage. You can prevent further skin injury by using sun-protective measures.
With the passage of time, skin-cancer patients are likely to develop additional skin cancers. If you notice a new growth, or a sore that doesn’t heal or recurs, be sure to have it examined by a physician.