Basal cell carcinoma (BCC) shows up on the skin in different ways.

If you see any of the following on your skin, you should immediately make an appointment to see a dermatologist:

• Dome-shaped skin growth with visible blood vessels. These growths are often pearly, shiny and pink or flesh-colored but they may also have flecks of brown or black. BCC may have a sunken center like a crater, ooze, and crust over or bleed easily. Some describe BCC as a pimple that won’t heal.
• Shiny pink or red, slightly scaly patch, especially on the chest or back. It grows slowly and may be mistaken for a patch of eczema.
• Waxy, hard, pale-white or yellow growth that looks like a scar.
• Although rare, BCC may be painful or itchy. Usually, the only sign of BCC is a growth on the skin.

The cause of BCC is well known- ultraviolet (UV) rays from the sun or tanning beds.  When UV rays hit our skin, these rays damage the DNA in the cells of our skin. The body tries to repair this damage. However, when the rays repeatedly hit our skin, the body cannot repair all the damage and skin cancer develops. Skin cancer usually develops after years of sun exposure. Around 50 years of age, the risk of developing skin cancer increases significantly. People younger than 50 years of age also get BCC. Many of these people are women who use indoor tanning beds.

If you have had one BCC, your risk for developing a second one increases by about 40%.

Anyone can get this common skin cancer, but some people have a greater risk.

People with a greater risk of getting BCC have one or more of the following physical features or risk factors:

• Fair or freckled skin
• Blue, green or gray eyes
• Natural blond or red hair
• Inability to tan
• Spent a lot of time outdoors for work or recreation, without using sunscreen or covering up with clothing
• Frequently used tanning beds
• Have a weakened immune system. This includes taking medicines after receiving an organ transplant, having lymphoma/leukemia or human immunodeficiency virus (HIV/AIDS)
• Overexposure or long-term exposure to x-rays
• Born with a rare genetic condition that makes one more likely to develop skin cancers, including BCC, early in life.

The only way to diagnose any type of skin cancer including basal cell carcinoma (BCC), is with a skin biopsy. Your dermatologist can perform this procedure during an office visit.

A skin biopsy should not cause anxiety. To perform a skin biopsy, your dermatologist will numb the suspected growth then remove part of it with a scalpel, punch or razor blade. Your dermatologist will send this to a laboratory to be looked at under a microscope. The findings will be communicated in a biopsy report.

If the biopsy report states that you have a BCC, your dermatologist will consider many factors to determine which treatment is best for you.

There are several ways to treat BCC:

• Excision: This is a surgical procedure that your dermatologist can often perform during an office visit. It involves numbing the area to be treated and cutting out any remaining tumor. Like the skin biopsy, this removed skin is examined under a microscope to ensure that the entire tumor has been removed.
• Electrodessication and curettage: Once the area to be treated is numbed, this treatment involves scraping away the tumor followed by applying electricity to destroy any remaining cancer cells.
• Mohs micrographic surgery: Named for the doctor who developed this surgery, Mohs (pronounced moes) is a surgery performed by a specialist to remove certain skin cancers. It offers the highest cure rate for difficult-to-treat BCC. Your dermatologist will tell you if Mohs is right for you.  With Mohs surgery, the surgeon will cut out the tumor plus a small amount of normal-looking skin surrounding the tumor. While you wait, the Mohs surgeon uses a microscope to determine if there are leftover cancer cells. If cancer cells remain, the surgeon will continue to remove small amounts of skin and look at them under the microscope. This continues until the surgeon no longer sees cancer cells.
• Cryosurgery: This treatment uses liquid nitrogen to freeze cancer cells, causing them to die.
• Radiation: This treatment is reserved for patients with BCC who are not able to have surgery or when surgery may not be the best choice. A patient may need 15-30 treatments.
• Photodynamic therapy (PDT): This treatment uses light to remove early skin cancers. A solution is applied to make skin cancer cells more sensitive to light. After a few hours, the treated skin is exposed to blue light. The light activates the solution and kills the skin cancer cells.
• Prescription creams: Creams that contain a drug, such as imiquimod or 5-fluorouracil, can be used to treat early BCC. The medicated cream is applied at home as directed by the dermatologist.
• Oral medication: While extremely rare, there are reports of BCC spreading to other parts of the body. In these cases, the dermatologist may prescribe vismodegib or sonidegib. This medication may also be prescribed for patients with advanced BCC that cannot be cut out or treated with radiation.

If you have been diagnosed with BCC, your prognosis is excellent. Most BCC are cured with one of the above prescribed treatments, especially when found early.  It is possible for a BCC to recur but these are almost always cured with additional treatment.

• American Cancer Society, Cancer Facts and Figures 2012. p. 21-22.
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