Basal Cell Carcinoma: Information on Causes, Diagnosis & Treatments

Basal Cell Carcinoma Overview

Basal Cell Cancers Basal cell carcinoma (BCC) refers to the growth of abnormal basal skin cells, which line the outermost layer of the skin at its deepest point. This cancer often appears as red patches, open sores, shiny bumps, pink growths, or scars. The cancer is often the result of a cumulative combination of occasional exposure to the intense sun. Unlike melanoma cancer, basal cell carcinoma rarely metastasizes (spreads) to any other site in the body including surrounding tissue. However, when it does spread, it can become life-threatening.

Doctors typically diagnose at least four million cases of basal cell carcinoma each year in America. The most affected areas on the body include the neck and face, and any skin area that is routinely or occasionally exposed to sunlight. While the tumors tend to burrow under the skin, they rarely metastasize to distant body parts.

What Causes Basal Cell Carcinoma?

Like all carcinomas, basal cell carcinoma develops as a DNA genetic mutation that continues to develop new cells without the old cells dying off. Because of the mutation, the cell’s process of new skin development that is controlled in the DNA no longer follows its normal pattern to mature, reproduce and die. Instead, when the accumulating abnormal genetic mutated cells continue to grow, they eventually form a cancerous tumor that appears on the outer layer of the skin.

Some of the known causes and risk factors of basal cell carcinoma include:

  • Exposure to Ultraviolet Light – Much of the mutation in the DNA of the basal cell is thought to occur through ultraviolet radiation from exposure to sunlight, tanning beds, and commercial tanning lamps. However, not all basal cell carcinoma cases occur on body parts exposed to sunlight. Because of that, scientists, doctors, and researchers believe that there may be other causes that are not clearly understood.

  • Radiation Therapy – Doctors often recommend radiation therapy as an effective treatment for acne, psoriasis, or other condition of the skin. However, radiation is known to increase the potential development of basal cell carcinoma on previously treated skin sites.

  • Gender – Males tend to develop basal cell carcinoma more than women. However, it maybe that many more men may spend time out exposed to the sun because of their occupation compared to women.

  • Fair Skin – Individuals who burner freckle easily or those with blonde, red or very light skin and light-colored eyes tend to be at higher risk of developing basal cell carcinoma compared to others.

  • Age – Most new cases of diagnosed basal cell carcinoma occurred individuals who are 50 years and older.

  • Immune Suppressing Medications – Many individuals take immune suppression medications, especially those who have undergone transplant surgeries. However, these drugs can increase the potential risk of developing skin cancer, including basal cell carcinoma. In addition, because the body is suppressing the immune system, the growth of basal cell carcinoma can easily spread to other areas of the body.

  • Arsenic Exposure – Arsenic is a highly toxic metal that is nearly everywhere in the environment. However, ongoing exposure to high doses of arsenic can increase the potential risk of basal cell carcinoma and other deadly cancers. People most at risk tend to be refinery workers, farmers, and individuals who drink water that has been contaminated by smelting plants.

  • Genetics – Individuals with a family history of malignant and benign skin cancers have an increased potential risk of developing basal cell carcinoma. Additionally, if the individual had carcinoma at least once, they are at a greater risk of developing the condition again compared to others who have never had the disease.

  • Inherited Skin Cancer Syndromes – Some skin cancer syndromes can be inherited, including Nevoid basal cells carcinoma syndrome that can cause serious problems including disorders of the nervous system, bones, skin, and eyes. This also includes Xeroderma pigmentosa who tend to be extremely sensitive to sunlight.

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Basal Cell Carcinoma Symptoms

Most cases involving basal cell carcinoma occur on by parts or exposed the sun, especially the neck and head. However, they can appear on the legs, the trunk, and rarely on male and female genitals and women’s breasts. Typically, these conditions never heal but can change the skin or form a lesion. The characteristics of the most common symptoms include:

  • A Waxy, White Scar – This type of lesion usually does not have a well-defined border. The untrained eye often overlooks the waxy scar lesion. However, it can be the most disfiguring and invasive cancer.

  • A Scaly, Flat Reddish Patch – This very large lesion appears to be a raised bump on the chest or back and can become significantly bigger over time.

  • A Blue, Black, or Brown Lesion – These kinds of lesions tend to appear with dark spots with borders that are translucent and raised slightly.

  • A Skin Color, Pink, or White Bump – These carcinomas tend to be translucent, meaning they are often hard to detect, especially in individuals with darker skin tones. They often appear on the neck, ears or face and can easily bleed, rupture or scab over.

Patients noticing any observable changes in the appearance of the skin lesion, bump or scar should seek out the advice and care of a dermatologist, especially if the sore is recurring or has grown previously at that area.

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Diagnosing Basal Cell Carcinoma

The confirm the diagnosis of basal cell carcinoma, the doctor will likely refer the patient to a dermatologist to conduct a comprehensive medical/personal history and a full physical examination. As a part of the diagnosis, the doctor will collect the general medical history to determine if the patient has a family history of skin cancers. The doctor will seek answers to various questions that include:

  • When was the lesion or skin growth first detected?

  • Have you noticed any significant change since it was first detected?

  • Is the lesion or growth ever painful?

  • Do you have any other lesions or growth on the body that are causing you concern?

  • What precautions do you take when exposed to the sun, including using sunscreen or avoiding the midday sunlight?

  • Do you routinely examine all areas of your skin?

To verify basal cell carcinoma, the doctor will typically perform a skin biopsy, removing only a small portion of the lesion, or the affected area, to be analyzed under a microscope in a laboratory. Not only will the biopsy confirm the disease, but revealed the specific type of skin cancer. This information will provide an opportunity for the dermatologist to develop an effective plan of care to manage or cure the disease.

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Treating the Disease

The dermatologist will have various options for treating basal cell carcinoma. Their decision on the best treatment is usually dependent on the size, location, and type of cancer and whether it is a recurring form or in its initial stage. The doctor often recommends one of the two most popular surgical options and medications that include:

  • Electrodesiccation and Curettage – This procedure generally removes superficial or small basal cell carcinomas where a carving instrument or blade is used to sear the cancer base followed by cryotherapy where liquid nitrogen freezes the area to allow a scab to form over the treated area.

  • Topical Medications – Medications containing fluorouracil and imiquimod are effective in treating low-risk basal cell carcinomas.

Additionally, staying out of the sunlight and using sunscreen routinely can help protect against the development of cancer.

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Sources:

http://www.mayoclinic.org/diseases-conditions/basal-cell-carcinoma/home/ovc-20251803

https://www.cancer.org/cancer/basal-and-squamous-cell-skin-cancer/about/key-statistics.html

https://www.cancer.org/cancer/basal-and-squamous-cell-skin-cancer.html

http://www.mayoclinic.org/diseases-conditions/basal-cell-carcinoma/diagnosis-treatment/treatment/txc-20252133

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