Basal cell carcinoma

Basal cell carcinoma

Basal cell carcinoma is a very common skin cancer, especially in sunny climates like South Africa’s. It is caused by sun exposure, and appears as  changes in the skin such as bumps or scaly patches. Most cases of basal cell carcinoma can be effectively treated - but it’s important to catch it early.

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Overview

Basal cell carcinoma - also called basal cell cancer, or BCC - affects the basal cells, which are found in the upper skin layers and are responsible for regeneration of skin cells. When the basal cells grow out of control, they become cancerous and can damage the skin and other surrounding tissues. Basal cell carcinoma is very common, accounting for 80% of skin cancers. It is characterised by skin lesions or abnormal spots that don’t heal and become a carcinoma, a type of tumour.1,2,3,4

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Causes and risk factors

Exposure to the sun’s ultraviolet (UV) rays causes basal cell carcinoma, which is why it usually occurs in parts most often exposed to the sun such as the skin of the face, neck and hands.2,3
The prevalence of basal cell cancer worldwide is increasing by up to 10 % annually.4
Factors that raise your risk for developing basal cell carcinoma include2,3:

• A fairer complexion, especially blue or green eyes, red or blonde hair, or pale skin that freckles easily

• Chronic sun exposure, especially if you live in sunny climates

• Family or personal history of skin cancer

• Older age

• Having had radiation therapy, for example from previous cancer therapy

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Signs and symptoms

Characteristics of basal cell cancer skin lesions may include2,3:

• White, waxy, scar-like lesions without a clearly defined border

• A brown, black or blue lesion

• A lesion with dark spots

• A shiny bump that is slightly see-through and the colour of your skin

• On pale skin, lesions may appear pink or pearly-white. On brown skin, they may look brown or glossy-black

• Tiny blood vessels may be visible on the lesion

• Eczema-like red or patchy areas

• A spot that scabs over or bleeds

• A scaly, flat patch that may increase in size and has raised edges

• A crusty-looking sore that bleeds, with a dent in the centre

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Diagnosis

See your doctor if you develop any lesions characteristic of basal cell carcinoma. In fact, if you notice any skin changes – new growths, changes to pre-existing growths, or recurring sores, it’s time to make an appointment. If basal cell cancer is diagnosed and treated early, almost all cases can be cured.2,3

Doctors can often tell if the spot is basal cell cancer simply by examining it.  However, to make sure they will also do a biopsy (send a sample of the suspect tissue for lab analysis).2 

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Impact on quality of life

Initially, basal cell carcinoma may not seem to have much of a negative impact on your life, although it can be unsightly, annoying and painful.

Left untreated, however, the impact may be profound: basal cell cancer can grow deeper, injure nerves and blood vessels and lead to more severe forms of cancer.  While the risk of basal cell cancer spreading to other parts of the body is low, the damage that occurs if this condition is not managed early can still be considerable.2,3,5

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Treatment

If diagnosed early, treatment of basal cell carcinoma has an excellent success rate. Also, there are now easier, less intrusive treatment options than surgical removal available – notably topical creams such as 5% Imiquimod cream.

Imiquimod cream is applied to the carcinoma daily for several weeks. This induces a local immune response which helps the body fight the cancerous cells, yet does not cause collateral structural damage to the skin area. Not only does the cream have proven efficacy, but is easily self-applicable and has a simple regimen, making it the preferred treatment method by patients.

Studies have shown that using Imiquimod cream produces significantly better results compared to other treatments, including the fact that patients are more likely to remain tumour-free post-treatment.4,5,6

Other treatment options include7,8,9:

• Chemotherapy: using anti-cancer drugs to shrink or kill cancerous cells and reduce their spread

• Electrodesiccation and curettage: scrapes off the carcinoma, then employs an electric current to stop bleeding and destroy remaining cancerous cells around the wound

• Excisional surgery: removes the carcinoma and a margin of healthy tissue

• Mohs micrographic surgery: removes the carcinoma while preserving healthy tissue

• Photodynamic therapy: uses drugs that interact with light to kill the cancerous cells

• Radiation therapy: uses high-energy radiation to shrink or destroy the carcinoma

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Prevention and lifestyle changes

Everybody – people who haven’t been diagnosed with basal cell carcinoma and patients who’ve had it previously – can practise these prevention methods and lifestyle changes to avoid it occurring or recurring2,3,7:

• Don’t spend too much time in the sun, especially between 10:00 – 16:00 and especially during summer

• Always wear a broad-spectrum sunscreen, SPF15 or higher

• Use SPF30 or higher sunscreen when spending long periods outside

• Apply sunscreen 30 minutes before going outside

• Reapply sunscreen every 2 hours or more frequently if you’ve been sweating heavily or swimming

• Wear sun-safe clothes, broad-brimmed hats and sunglasses

• Avoid tanning beds and sunlamps

• Have any skin changes medically checked – a vital step in early diagnosis

• If you’ve had basal cell carcinoma previously, the chances of it returning are increased, so ask your doctor about regular skin check-ups

Medical References

  1. Basal Cell Carcinoma - Harvard Health [Internet]. Harvard Health. 2021 [cited 23 October 2021]. Available from: https://www.health.harvard.edu/a_to_z/basal-cell-carcinoma-a-to-z
  2. Basal Cell Carcinoma: Symptoms, Causes, Treatments [Internet]. Cleveland Clinic. 2021 [cited 23 October 2021]. Available from: https://my.clevelandclinic.org/health/diseases/4581-basal-cell-carcinoma-bcc#living-with
  3. Basal cell carcinoma - Symptoms and causes [Internet]. Mayo Clinic. 2021 [cited 23 October 2021]. Available from: https://www.mayoclinic.org/diseases-conditions/basal-cell-carcinoma/symptoms-causes
  4. Jia HX, He YL. Efficacy and safety of imiquimod 5% cream for basal cell carcinoma: a meta-analysis of randomized controlled trial. J Dermatolog Treat. 2020 Dec;31(8):831-838. doi: 10.1080/09546634.2019.1638883. Epub 2019 Jul 22. PMID: 31294669./syc-20354187
  5. Shumack S, Robinson J, Kossard S, et al. Efficacy of Topical 5% Imiquimod Cream for the Treatment of Nodular Basal Cell Carcinoma: Comparison of Dosing Regimens. Arch Dermatol.2002;138(9):1165–1171. doi:10.1001/archderm.138.9.1165
  6. Răducu L, Avino A, Purnichescu Purtan R, Balcangiu-Stroescu A, Bălan D, Timofte D et al. Quality of Life in Patients with Surgically Removed Skin Tumors. Medicina. 2020;56(2):66.
  7. Making Lifestyle Changes After Skin Cancer [Internet]. SkinCancer.net. 2021 [cited 23 October 2021]. Available from: https://skincancer.net/life-with-skin-cancer/making-lifestyle-changes-after-diagnosis-treatment
  8. Treatments [Internet]. Stanfordhealthcare.org. 2021 [cited 23 October 2021]. Available from: https://stanfordhealthcare.org/medical-conditions/cancer/basal-cell-carcinoma/treatments.html
  9. Overview [Internet]. Stanfordhealthcare.org. 2021 [cited 23 October 2021]. Available from: https://stanfordhealthcare.org/medical-treatments/p/photodynamic-therapy/about-this-treatment/overview.html

Figures:
Figure 1: Brown, J. 2017. Basal Cell Carcinoma Symptoms. University Health News Daily. [cited 23 October 2021].
Available from: https://universityhealthnews.com/daily/cancer/basal-cell-carcinoma-symptoms/

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