Basal Cell Carcinoma

Basal cell carcinoma is the most common form of skin cancer. It begins in the basal cells, which are at the bottom of the outer skin layer (epidermis). Basal cell carcinoma can often be cured. It rarely spreads to other areas of the body (metastasizes). It may come back at the same location (recur), but it can be treated again if this happens.

Basal cell carcinoma occurs most often on parts of the body that are frequently exposed to the sun, such as:

Parts of the head, including the scalp or face.
Ears.
Neck.
Arms or legs.
Backs of the hands.

What are the causes?

This condition is usually caused by exposure to ultraviolet (UV) light. UV light may come from the sun or from tanning beds. Other causes include:

Exposure to arsenic, a highly poisonous metal.
Exposure to high-energy X-rays (radiation).
Exposure to toxic tars and oils.
Certain genetic conditions, such as a condition that makes a person sensitive to sunlight.

What increases the risk?

You are more likely to develop this condition if:

You are older than 40 years of age.
You have:
- Fair skin (light complexion), blond or red hair, or blue, green, or gray eye color.
- Childhood freckling.
- Had repeated sunburns or sun exposure over long periods of time, especially during childhood.
- A weakened body defense system (immune system).
- Been exposed to certain chemicals, such as tar, soot, and arsenic.
- Chronic inflammatory conditions or infections.
- A family or personal history of basal cell carcinoma.
You use tanning beds.

What are the signs or symptoms?

The main symptom of this condition is a growth or lesion on the skin.

The shape and color of the growth or lesion may vary. The main types include:
- An open sore that may remain open for three weeks or longer. The sore may bleed or crust. This type of lesion can be an early sign of basal cell carcinoma. Basal cell carcinoma often shows up as a sore that does not heal.
- A reddish area that may crust, itch, or cause discomfort. This may occur on areas that are exposed to the sun. These patches might be easier to feel than to see.
- A shiny or clear bump that is red, white, or pink. In people who have dark hair, the bump is often tan, black, or brown. These bumps can look like moles.
- A pink growth with a raised border. The growth will have a crusted and indented area in the center. Small blood vessels may appear on the surface of the growth as it gets bigger.
- A scar-like area that looks like shiny, stretched skin. The area may be white, yellow, or waxy. It often has irregular borders. This may be a sign of more aggressive basal cell carcinoma.

How is this diagnosed?

This condition may be diagnosed with:

A physical exam.
Removal of a tissue sample to be examined under a microscope (biopsy).

How is this treated?

Treatment for this condition involves removing the cancerous tissue. The method that is used for this depends on the type, size, location, and number of tumors. Possible treatments include:

Surgery, such as:
- Mohs surgery. In this procedure, the cancerous skin cells are removed layer by layer until all of the tumor has been removed.
- Surgical removal (excision) of the tumor. This involves removing the entire tumor and a small amount of normal skin that surrounds it.
- Cryosurgery. This involves freezing the tumor with liquid nitrogen.
- Plastic surgery. The tumor is removed, and healthy skin from another part of the body is used to cover the wound. This may be done for large tumors that are in areas where it is not possible to stretch the nearby skin to sew the edges of the wound together.
Therapies or treatments, such as:
- Radiation. This may be used for tumors on the face.
- Photodynamic therapy. A chemical cream is applied to the skin, and light exposure is used to activate the chemical.
- Electrodesiccation and curettage. This involves alternately scraping and burning the tumor while using an electric current to control bleeding.
- Chemical treatments, such as imiquimod cream and interferon injections. These may be used to remove superficial tumors with minimal scarring.

Follow these instructions at home:

Avoid direct exposure to the sun.
Do self-exams as told by your health care provider. Look for new spots or changes in your skin.
Keep all follow-up visits. This is important.

How is this prevented?

Avoid the sun when it is the strongest. This is usually between 10 a.m. and 4 p.m.
When you are out in the sun, use a sunscreen that has a sun protection factor (SPF) of at least 30.
Apply sunscreen at least 30 minutes before exposure to the sun.
Reapply sunscreen every 2–4 hours while you are outside. Also reapply it after swimming and after excessive sweating.
Always wear hats, protective clothing, and UV-blocking sunglasses when you are outdoors.
Do not use tanning beds.

Contact a health care provider if:

You notice any new spots or any changes in your skin.
You have had a basal cell carcinoma tumor removed, and you notice a new growth in the same location.

Get help right away if:

You have a spot that is sore and does not heal.
You have a spot that bleeds easily.

Summary

Basal cell carcinoma is the most common form of skin cancer. It begins in the bottom of the outer skin layer (epidermis). Basal cell carcinoma can almost always be cured.
This condition is usually caused by exposure to ultraviolet (UV) light. It mostly affects the face, scalp, neck, ears, arms, legs, or backs of the hands.
The main symptom of this condition is a growth or lesion on the skin that can vary in shape and color.
You can prevent this cancer by avoiding direct exposure to the sun, applying sunscreen of at least 30 SPF, and wearing protective clothing.
Apply sunscreen 30 minutes before you go out into the sun, and reapply every 2–4 hours while you are outside.