Basal cell carcinoma

Alternative names
Rodent ulcer; Skin cancer - basal cell; Cancer - skin - basal cell

Definition
Basal cell carcinoma is a slow-growing skin tumor involving cancerous changes in basal skin cells.

Causes, incidence, and risk factors

Basal cell carcinoma is the most common form of cancer in the US. It accounts for about 75% of all skin cancers. The incidence of skin cancer has increased greatly in recent years, due in part to greater exposure to UV radiation from the sun. In 1990, 600,000 Americans were diagnosed with either basal cell cancer or squamous cell cancer, up from 400,000 in 1980.

Basal cells are normal skin cells. They may develop cancerous changes, causing a lump or bump that is painless. A new skin growth that ulcerates, bleeds easily, or does not heal well may indicate development of basal cell skin cancer. This type of skin cancer has a high cure rate, but neglect can allow the cancer to enlarge, causing possible disability or, in rare cases, death.

More than 90% of basal cell carcinomas occur on areas of skin that are regularly exposed to sunlight or other ultraviolet radiation. They may also occur on the scalp. The onset most commonly occurs after age 40.

Other risks include a genetic predisposition - basal cell carcinomas are more common in those who have light-colored skin, blue or green eyes, and blond or red hair - and overexposure to x-rays or other forms of radiation.

This cancer usually remains local and almost never spreads to distant parts of the body, but it may continue to grow and invade nearby tissues and structures, including the nerves, bones, and brain. The tumor may be very small in the beginning, growing to 1 or 2 centimeters in diameter after several years of growth.

Symptoms

     
  • A skin lesion, growth, or bump located on the face, ear, neck, chest, back, or scalp       o Pearly or waxy appearance       o White or light pink, flesh-colored, or brown       o Flat or slightly raised  
  • Visible blood vessels in the lesion or adjacent skin  
  • Appearance of a scarlike lesion without a history of injury to the skin in that area  
  • A sore that will not heal

Signs and tests
A biopsy of a suspicious skin lesion is needed to confirm the diagnosis of basal cell carcinoma.

Treatment
Treatment varies depending on the size, depth, and location of the cancer.

The carcinoma is removed using one of these procedures:

     
  • Scraping  
  • Cauterization (burning)  
  • Surgical removal, including microscopically controlled surgical removal (Mohs’ surgery)  
  • Cryosurgery (freezing)  
  • Radiation

Expectations (prognosis)

Early treatment by a dermatologist may result in a cure rate of more than 95%. New sites of basal cell cancer can occur, so monitoring should be diligent. Regular examination by a health care provider is required.

Complications

A complication of basal cell cancer is an invasion of adjacent tissues or structures, causing damage to their appearance and function. This is most worrisome around the nose, eyes, and ears.

Calling your health care provider
Call your health care provider if any change occurs in the color, size, texture, or appearance of a skin lesion.

Call your provider if pain, inflammation, bleeding, or itching occur in an existing skin lesion.

Prevention

Prevention involves minimizing sun exposure:

     
  • Protect the skin by wearing protective clothing such as hats, long-sleeved shirts, long skirts, or pants.  
  • Ultraviolet light is most intense at midday, so try to avoid sun exposure during these hours.  
  • Use high-quality sunscreens, preferably with SPF (sun protection factor) ratings of at least 15.  
  • Look for sunscreens that block both UVA and UVB light.  
  • Apply sunscreen at least a half-hour before exposure, and reapply it frequently.  
  • Use sunscreen in winter, too.

Examine the skin regularly for development of suspicious growths or changes in an existing skin lesion. A new growth that ulcerates, bleeds easily or is slow to heal is suspicious.

Suspicious changes in existing growths include the following:

     
  • Changes in these attributes:       o Color       o Size       o Texture       o Appearance  
  • Development of these symptoms:       o Pain       o Inflammation       o Bleeding       o Itching

 

Johns Hopkins patient information

Last revised: December 8, 2012
by Brenda A. Kuper, M.D.

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