Basal Cell Carcinoma: The Most Common Form of Skin Cancer. By Jacob Anderson, B.S, Anais Hacobian, B.S and Dr. David Robles MD, PhD

What is Basal Cell Carcinoma?

 
Basal Cell Carcinoma (BCC) is the most common type of skin cancer and is often seen in areas of the body which are most prone to sun exposure. Basal Cell Carcinoma is formed through mutations in the skin cells, which comprise the bottom layer of epidermis (basal cells). This layer is responsible for skin cell production. 

Basal Cell Carcinoma falls into the category of non-melanoma skin cancers. It is more common and less aggressive than squamous cell carcinoma and melanoma. The cancer is localized and metastasis is exceedingly rare. Basal cell carcinoma is known for its pearly white, dome-shaped, reddish crusting characteristics, but there may also be some blood vessels at the surface along with an ulceration appearance.

Basal cell carcinoma can sometimes be pigmented and look dark, thus mimicking melanoma. Pigmented basal cell carcinomas occur  much more frequently in those with darker skin types, like Asians and Hispanics.

Demographics & Risk Factors

UV radiation
Frequent and prolonged exposure to sun, including tanning beds increase the risk of development of BCC. The risk is greater for individuals who live in sunny or high altitude locations, which both expose you to more UV radiation and increase the probability of receiving sun burns.

Past Family or Personal History
If a family member has a history of skin cancer, genetically, that may increase your risk of developing skin cancer. In addition, if you have a history of skin cancer, this can also increase the probability of redeveloping the same or different type of non-melanoma skin cancer by 30-50% along with an increased risk of developing melanoma.

Fair skin
Ethnic groups that are more susceptible to developing BCC are ones that fall under Caucasian and individuals who are fair skinned, freckled, easily burned, red headed and have light colored eyes. This is due to the fact that individuals with these hereditary characteristics are more prone to getting sun damage, which may develop into skin cancer overtime.
Increased age
Basal cell carcinoma takes years or even decades to develop. For this reason, BCC is most commonly detected in older adults starting in the 50s (see Aging Skin). However, cases have been detected in younger individuals in their 20s and 30s, and are becoming more identified.

Immune suppressing drugs
Prolonged use of immunosuppressive drugs, for example, those used to prevent organ transplant rejection or certain medications to treat rheumatologic conditions, increase the susceptibility of developing skin cancer. This is because your immune system normally works to ward off precancerous or cancerous cells in the skin.

How is it treated?

Basal cell carcinoma (BCC) can be treated effectively and completely. There are various treatment options for BCC, with each option being dependent on the size, location and/or type of the carcinoma. A common treatment option for small BCC lesions is “electrodesiccation and curettage”. In this procedure, a dermatologist will scrape off the lesion with a curette (a sharp surgical instrument). After scraping or shaving the lesion, the area with remaining cancer cells is cauterized (a heated instrument that burns the skin) until no cancer cells remain. 
Another option is surgical excision with a scalpel by a qualified skin surgeon.The procedure will be done with a “safety margin”, which means adjacent tissue will be removed as well, to ensure the cancer is completely removed. After excision, the removed skin will be sent to pathology to examine for residual cancer cells. An effective procedure will yield “clear margins.” For superficial BCC’s, cryosurgery, which is the freezing of the lesion with liquid nitrogen may be performed. 

Sometimes superficial BCC’s may be treated with topical imiquimod (Aldara) cream. Furthermore, BCCs in cosmetically sensitive areas (e.g around the eyes, nose, lips or ears) may be treated with a more advanced technique known as MOHS surgery.

 
How to prevent BCC?

As previously mentioned BCC is most commonly caused by UV exposure and occurs in areas of the skin with the most sun exposure. Thus, staying in the shade, avoiding peak sun hours, not using tanning beds and wearing sunscreen can help prevent the development of BCC (see 10 Things You Can Do to Lower Your Risk of Skin Cancer). 
Other risk factors, such as increasing age, family or personal history, a weakened immune system and fair skin can lead to the development of BCC. Therefore, following up with a dermatologist for skin checks are of utmost importance and can help prevent the development of BCC.