Basal Cell Carcinoma

Long-term exposure to ultraviolet radiation like sunlight is the most important risk factor. Additional factors that predispose individuals to BCC include fair skin that burns easily, a history of prior skin cancers, a history of tanning bed use, older age and certain genetic conditions or a weakened immune system.

BCC is most common on sun-exposed skin like the face, ears, scalp, neck and arms, but it can occur anywhere. Signs to look for include:

• A non-healing sore, or a sore that heals then returns repeatedly
• A lesion that bleeds or scabs easily
• A pimple-like lesion or a pearly/shiny bump
• A scaly pink plaque
• A scar-like, pale or waxy area

Treatment depends on the BCC subtype, location, size and extent of the cancer. Treatment options may include Mohs surgery, surgical excision, electrodesiccation and curettage, prescription topical creams, laser, radiation, or medicines that target the cancer pathway or immune system for advanced cases.

Nodular

Nodular (the most common). Usually appears as a pearly, flesh-colored or pink bump that may bleed or ulcerate

Superficial

These are often pink scaly plaques, and they are more common on the trunk, shoulders or limbs.

Morpheaform

Morpheaform/sclerosing, infiltrative, micronodular and basosquamous subtypes behave more aggressively

• Morpheaform often looks like a pale scar. Its borders are less-defined, and it can extend more aggressively into surrounding tissue
• Infiltrative. Thin strands of tumor cells extend into surrounding tissue and because of this, there is often more skin cancer microscopically than what we see with the naked eye
• Micronodular. Small nests of tumor cells grow aggressively with greater tendency for deeper or more extensive local growth
• Basosquamous has features of both BCC and squamous cell carcinoma

Not all basal cell carcinomas are created equal, and a few characteristics of your particular tumor determine your cure rate after Mohs surgery.

One of these is the tumor subtype – if your basal cell is infiltrative, morpheaform/sclerosing, or micronodular, your cure rate is lower than if it were a nodular basal cell carcinoma.

Certain locations like the mid-face and ears are also associated with lower cure rates.

Other characteristics that lower your cure rate include:

1. the tumor is particularly large or particularly deep
2. the tumor is recurrent, meaning it has come back after being treated previously
3. the tumor is growing along a nerve, which we call perineural involvement

You should contact your doctor if you have a new or changing skin lesion that:

• Bleeds easily
• Does not heal within several weeks
• Changes in size, shape, color

Confirmation of the diagnosis is typically through a skin biopsy.