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Basal cell carcinoma: Diagnosis and treatment


If you find a spot on your skin that you think could be a skin cancer, an accurate diagnosis and treatment are essential. The following explains how dermatologists diagnose and treat the most common type of skin cancer, basal cell carcinoma (BCC).

Dermatologist treating BCC

When found early, basal cell carcinoma is highly treatable.

How dermatologists diagnose basal cell carcinoma

When you see a board-certified dermatologist, your dermatologist will:

  • Examine your skin carefully

  • Ask questions about your health, medications, and symptoms

If your dermatologist finds a spot on your skin that could be any type of skin cancer, your dermatologist will first numb the area and then remove all (or part) of it. This can be done during an office visit and is called a skin biopsy. This is a simple procedure, which a dermatologist can quickly, safely, and easily perform.

Having a skin biopsy is the only way to know for sure whether you have any type of skin cancer. After your dermatologist removes the spot, a doctor, such as your dermatologist or a dermatopathologist, will examine it under a high-powered microscope. The doctor is looking for cancer cells.

If the doctor sees cancerous basal cells, the diagnosis is BCC.

After the doctor examines the removed skin under a microscope, the doctor writes a report. Called a biopsy report or a pathology report, this document explains in medical terms what was seen under the microscope.

If the diagnosis is any type of skin cancer, the information in this report will tell your dermatologist the key facts needed to treat the cancer, including:

  • The type of BCC you have

  • How deeply the cancer has grown (when possible to tell)

Your dermatologist will carefully consider your health and the findings in the report before choosing how to treat the cancer.

How dermatologists treat basal cell carcinoma

When possible, BCC is treated with a procedure called “surgical removal.” If you have an early BCC, this can often be performed in your dermatologist’s office while you remain awake. The following explains the types of surgical removal used to treat BCC, along with other treatment options.

Surgical removal: Three types of surgical removal are used to treat BCC. The type of surgical removal you receive depends largely on the type of BCC you have, where it’s located, and how deeply it goes.

Here’s what involved with each type of surgical removal:

  • Excision: Your dermatologist cuts out the skin cancer and an area of normal-looking skin around it. Removing some normal-looking skin helps to remove stray cancer cells.

    What your dermatologist removed will be examined under a high-powered microscope. The doctor who looks at your removed tissue under a microscope will pay special attention to the normal-looking skin to see whether it contains any cancer cells.

    If cancer cells are found in the normal-looking skin, you will need more treatment. One option may be Mohs surgery.

  • Mohs (pronounced moes) surgery: On some areas of the body, such as an eyelid or your nose, removing an area of normal-looking skin along with the cancer would cause problems. There’s not enough skin in these areas.

    Mohs surgery eliminates the need to remove an area of normal-looking skin. This is possible because the surgeon can see where the cancer stops during the surgery.

  • Curettage and electrodessication: During this type of surgical removal, your dermatologist first scrapes the BCC from your skin, using a technique called curetting. Then, a procedure called electrodesiccation is used to destroy any remaining cancer cells with heat.

    This surgery is usually performed only when BCC develops on the trunk, an arm, or a leg.

Freezing or light therapy: While surgical removal (described above) is often the preferred way to treat BCC, one of these following procedures may be recommended for some patients.

  • Freezing: The procedure is called cryotherapy (cry-oh-ther-ah-pee), and it can be performed during an office visit. Cryotherapy involves spraying an extremely cold substance, such as liquid nitrogen, on the BCC to destroy the tumor.

  • Light therapy: The medical name for this procedure is photodynamic therapy (PDT). It’s a two-part procedure. First, a solution that makes your skin more sensitive to light is applied to the cancer and a bit of skin around it. You’ll sit with this solution on your skin for one to several hours.

    Once your skin is ready, it will be treated with a blue or red light to kill the cancerous cells.

    Light therapy can effectively treat some early BCCs, but you may need repeat treatments.

Medication applied to the skin: This is a treatment that you would use at home as prescribed. It’s often used before or after another treatment for BCC. When prescribed as the first treatment, applying medication to the skin cancer helps to reduce the size of the cancerous tumor. Applying the medication after having another treatment helps to kill any remaining cancer cells.

For a few patients, this may be the only treatment prescribed.

Two medications that you apply to the skin have been approved by the U.S. Food and Drug Administration (FDA) to treat BCC:

  • Imiquimod (eh-mick-quie-mod): This medication is usually applied once a day or once every other day for 6 weeks or longer.

  • 5-FU: This medication is usually applied twice a day for 3 to 6 weeks.

As these medications destroy cancer cells, you will likely feel the effects on the treated area. Side effects of these medications include skin redness, swelling, sores, crusting, itching, and tingling sensations.

Radiation treatments: If this is prescribed to treat BCC, you will need to go to a hospital or treatment center for radiation treatments. These are usually given over a period of several weeks.

For some patients, radiation may be the only treatment given. Radiation can also be used as a follow-up treatment for an aggressive BCC to help destroy cancer cells.

Radiation is typically only used to treat this skin cancer in people who are 60 years of age or older.

How is basal cell skin cancer treated when it grows deep or spreads?

While this skin cancer tends to grow slowly, early treatment is recommended. Without treatment, BCC can grow deep, destroying what lies in its way. This can be disfiguring. The medical term for this is advanced basal cell carcinoma.

It’s also possible for BCC to spread to other parts of your body, but this is rare. When the cancer spreads, it typically travels first to the lymph nodes closest to the tumor. From there, it tends to spread through the blood to bones, the lungs, and other parts of the skin. When this skin cancer spreads, it is called metastatic basal cell carcinoma.

For cancer that has grown deep or spread to the closest lymph nodes, treatment may involve:

  • Surgery to remove the tumor (and cancerous lymph nodes)

  • Follow-up treatment with radiation to kill any remaining cancer cells

For some patients, medication that works throughout the body may be an option. Medication may also be used to treat cancer that:

  • Returns after surgery or radiation treatments

  • Has spread to another part of the body

Two such medications have been approved by the U.S. Food and Drug Administration (FDA). Both come in pill form and are taken every day. A patient only stops taking the medication if the cancer starts to grow, or the side effects become too severe.

The two medications are:

  • Sonidegib (so-nī-deh-gib)

  • Vismodegib (vis-moe-deh-gib)

In clinical trials, these medications have been shown to stop or slow down the spread of the cancer and shrink the cancerous tumors in some patients.

Newer treatments for deep basal cell skin cancers and ones that have spread are being studied in clinical trials. If you have advanced BCC, you may be eligible for one of these trials.

What is the likely outcome for someone who has BCC?

When found early and treated, this skin cancer can often be removed. However, this skin cancer can return. You also have a higher risk of developing another BCC or other type of skin cancer.

That’s why self-care becomes so important after treatment for BCC. You’ll find the self-care that dermatologists recommend at, Basal cell carcinoma: Self-care.


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References
Bichakjian CK, Armstrong A, et al. “Guidelines of care for the management of basal cell carcinoma.” J Am Acad Dermatol 2018;78:540-59.

Bichakjian CK, Olencki T, et al. “Basal cell skin cancer, Version 1.2016, NCCN Clinical Practice Guidelines in Oncology.” J Natl Compr Canc Netw. 2016;14(5):574-97.

Cameron MC, Lee E, et al. “Basal cell carcinoma: Epidemiology; pathophysiology; clinical and histological subtypes; and disease associations.” J Am Acad Dermatol 2019;80:303-17.

Cameron MC, Lee E, et al. “Basal cell carcinoma: Contemporary approaches to diagnosis, treatment, and prevention.” J Am Acad Dermatol 2019;80:321-39.

Nouri K, Ballard CJ, et al. “Basal cell carcinoma.” In: Nouri K, et al. Skin Cancer. McGraw Hill Medical, China, 2008: 61-81.

Xie P, Lefrançois P. “Efficacy, safety, and comparison of sonic hedgehog inhibitors in basal cell carcinomas: A systematic review and meta-analysis.” J Am Acad Dermatol 2018;79:1089-100.

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