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Basal cell carcinoma (BCC) is the most common form of skin cancer. It also is the most common cancer in the world, and the number of cases continues to rise. The reason for this rise might be that people are receiving more unprotected exposure to the harmful ultraviolet (UV) rays of the sun. The likelihood of developing BCC also increases when you have one or more of the following risk factors:

• Fair skin.
• Blond or red hair.
• Blue or green eyes.
  
• Family history of skin cancer.
  
• Weakened immune system.
  
• Received radiation therapy.
  
• Exposure to coal tar, pitch, creosote, or arsenic.

Age is another risk factor. BCC can occur at any age, but the risk of developing this skin cancer increases significantly with age.

Basal cell cancer does not usually metastasize or travel in the bloodstream; rather it infiltrates the surrounding area and destroys the tissue. For this reason, basal cell cancer should be treated promptly by your dermatologist with dermatologic surgical techniques.

WHAT THEY LOOK LIKE

Basal Cell Carcinoma

The BCC tumor appears in many shapes and sizes. It often looks like a small, dome-shaped, pimple-like growth that has a pearly color. Blood vessels might be visible on the surface. In a very early stage, BCC might be a shiny, pinkish patch on the skin. BCC also can appear as a sore that seems to repeatedly heal and return. A less common form, morpheaform, looks like a smooth white or yellowish waxy scar.

Most BCCs develop on sun-exposed areas such as the head, neck, trunk, and legs, but BCC can appear anywhere on the body. A dermatologist should examine all new growths and changes to your skin.

BASAL CELL CARCINOMA IS SERIOUS

BCC rarely spreads to other areas of the body, it can invade and destroy surrounding tissue, causing permanent disfigurement. When a BCC tumor develops near an organ such as an eye, ear, or nose, or grows near a nerve, this can be especially concerning. Complications such as loss of an eye can arise if the cancer invades. Early diagnosis and proper treatment can prevent this.

DIAGNOSIS

A biopsy is required to diagnose skin cancer. A dermatologist can perform this simple procedure in the office by numbing the area and then removing the suspicious lesion (or a portion of it). The removed tissue is examined under a microscope to see if cancer is present. In some cases, the dermatologist might perform the biopsy and provide treatment during the same office visit.

Basal Cell Carcinoma

TREATMENT

When the diagnosis is BCC, the dermatologist has a number of surgical and non-surgical options. The appropriate treatment depends on the size, location, and characteristics of the tumor, as well as the overall health and needs of the patient. Most BCCs are treated with one of the following:

• SIMPLE SURGICAL EXCISION

  The dermatologist cuts out the tumor and some of the surrounding healthy tissue. The removed tissue is examined under a microscope to see if all of the skin cancer has been removed.

• MOHS MICROGRAPHIC SURGERY

  Performed by a specially trained dermatologic surgeon, Mohs involves removing the visible tumor and then successive layers of skin one at a time until cancer cells are no longer found.

• ELECTRODESICCATION AND CURETTAGE

  The dermatologist removes the tumor by scraping or “curetting” it, and then burning the base with an electric needle. The latter is “electrodessication.”

• CRYOSURGERY

  The dermatologist destroys the tumor by freezing it with liquid nitrogen.

• RADIATION THERAPY

  High energy x–rays are used to damage/kill the cancer cells and prevent the growth of new cancer cells.

• LASER SURGERY

  High-intensity focused light waves are used to destroy the cancerous tissue.

• TOPICAL THERAPY

  The dermatologist prescribes a cancer-fighting medication, such as imiquimod or 5–fluorouracil, which the patient can apply to the skin cancer at home.

• PHOTODYNAMIC THERAPY

  A medication is applied to the skin, and light is used to activate the medication.
  

POST TREATMENT

After receiving treatment for BCC, follow-up appointments are scheduled. These appointments are essential because studies show that a person who develops BCC has an increased risk of developing another BCC or other form of skin cancer, including melanoma. Follow-up visits also are important because BCC can return after treatment. Cure rates and survival rates are highest with early detection and treatment.

You also should perform regular self-examinations of your skin as this can help detect skin cancer in its earliest stage. Be alert to any non-healing sore and other changes to your skin.

Basal Cell Carcinoma

PREVENTION

Proper sun protection may prevent new skin cancers, even if you have had BCC. So that people know how to protect their skin from the sun, the American Academy of Dermatology created Be Sun SmartSM:

• Generously apply a broad-spectrum water-resistant sunscreen with a Sun Protection Factor (SPF) of 30 or more to all exposed skin. “Broad-spectrum” provides protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Reapply approximately about every two hours, even on cloudy days, and after swimming or sweating.
• Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible.
• Seek shade when appropriate, remembering that the sun’s rays are strongest between 10 a.m. and 4 p.m. If your shadow is shorter than you are, seek shade.
• Protect children from sun exposure by playing in the shade, using protective clothing, and applying sunscreen.
• Use extra caution near water, snow, and sand because they reflect the damaging rays of the sun, which can increase your chance of sunburn.
• Get vitamin D safely through a healthy diet that may include vitamin supplements. Don't seek the sun.
• Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you've been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it.
  
• Check your birthday suit on your birthday. If you notice anything changing, growing, or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early.
  

Click here for the latest list of sun-protective products
that meet the stringent criteria of the AAD SEAL OF RECOGNITION®.

A dermatologist is a physician who specializes in treating the medical, surgical and cosmetic conditions of the skin, hair and nails. To learn more about BCC, log onto www.aad.org or www.skincarephysicians.com/skincancer.net, or call toll free (888) 462-DERM (3376) to find a dermatologist in your area.

© 2009 American Academy of Dermatology
Images used with permission of the American Academy of Dermatology
National Library of Dermatologic Teaching Slides
American Academy of Dermatology
P.O. Box 4014 Schaumburg, IL 60168-4014
AAD Public Information Center: (888) 462-DERM (3376)
AAD Member Resource Center: (866) 503-SKIN (7546)
AAD Web site: www.aad.org
PAM51 - 09/09

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