Basal cell carcinoma (BCC) is the most common skin cancer and usually develops in sun-exposed areas of the skin. Men, older people (>50), and those with a history of increased sun exposure are at higher risk for developing this cancer.
Basal cell carcinoma generally does NOT spread to lymph nodes or other parts of the body. There are some genetic syndromes that cause the appearance of multiple BCCs such as Gorlin syndrome, also known as Nevoid basal cell carcinoma syndrome (NBCCS).
There are three main types of BCC:
- Nodular is the most common type of BCC in the head and neck. These lesions typically appear as round, flesh-colored nodules with smooth borders. [photo A] There may also be a rolled edge with central “crater” type appearance associated with crusting, bleeding or ulceration. [photo B].
- Superficial spreading BCC is the second most common type of BCC. This is a less aggressive subtype and usually appears as a well-defined reddish-scaly plaque or thin patch [photo C].
- The morpheaform subtype of BCC is the most aggressive form because its subtle appearance often leads to a delayed diagnosis. These lesions typically have scar-like plaques or smooth, shiny, pink or whitish lesions. [photo D].
Diagnosis and Work Up: Diagnosis and workup of BCC starts with a skin and lymph node exam. Basal cell carcinomas often have a typical appearance so your doctor may diagnose the cancer by visual exam but a skin biopsy is usually done to confirm the diagnosis. [link diagnosis of skin cancer]. Most of the time, imaging and lab studies are not needed unless the cancer is large or there is other evidence that the cancer may be invading important deeper structures on the face, head, or neck.
Staging: Staging is a process to categorize the cancer by how big it has grown and how far it has spread.
- Stage 1 The tumor is <2 cm in width and has <2 high risk features It may involve the dermis of the skin but does not involve muscle, cartilage or bone and has not spread to lymph nodes or other organs.
- Stage 2 The tumor is > 2 cm in width and does not invade muscle, cartilage or bone and has not spread outside the skin.
- Stage 3 The tumor has grown outside the skin to structures such as muscle, bone, cartilage or lymph nodes that are nearby. It has not spread to distant organs.
- Stage 4 The tumor has spread to distant organs such as brain, or lung or has invaded nerves of the skull base
Treatment and Outcomes: Most basal cell carcinomas are highly curable with surgery alone. This can be done with a surgery to remove it with a surrounding rim of normal tissue, also called a Wide local excision [WLE link] or with Mohs micrographic surgery [MOHS link]. Radiation can also be used by itself to treat basal cell carcinoma or added after surgery for higher risk/ stage BCCs. Risk factors for recurrence include large size and other factors that can been seen on histology [when the cancer is examined under the microscope]. Patients with history of radiation and immunosuppression are also at higher risk for recurrence. If surgery is not an option, there are medical treatments available such as Vismodegib. [link to vismodegib].
Surveillance and Survivorship: Once you have developed a BCC, you are at a higher risk of having or developing another one, so please be sure to follow up with your dermatologist to discuss the need for routine full-body skin exams.
Article by Karen Choi, MD