Basal cell carcinoma: Diagnosis, treatment, and outcome

Basal cell carcinoma: Diagnosis, treatment, and outcome

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The only way to diagnose any type of skin cancer, including basal cell carcinoma (BCC), is with a skin biopsy. Your dermatologist can perform this procedure during an office visit.

A skin biopsy should not cause anxiety. To perform a skin biopsy, your dermatologist will remove the entire growth or part of it. Your dermatologist may send this to a laboratory or look at it under a microscope. The findings will be communicated in a biopsy report.

If the biopsy report states that you have BCC, your dermatologist will consider many factors to determine which treatment will be best for you. There are several ways to treat BCC:

Excision: This is a surgical procedure that your dermatologist often can perform during an office visit. It involves numbing the area to be treated and cutting out any remaining tumor plus some normal-looking skin around the tumor.

Like the skin biopsy, this removed skin is examined under the microscope. This may be done at a laboratory or by your dermatologist. The doctor who looks at the removed skin needs to see whether the normal-looking skin is free of cancer cells. If not, more skin will need to be removed. This is a common way to treat BCC.

Curettage and electrodessication
: This treatment consists of two steps. First, your dermatologist scrapes away the tumor. Then electricity is used to destroy any remaining cancer cells. The two steps are then repeated.

Mohs surgery:
Named for the doctor who developed this surgery, Mohs (pronounced "moes") is a specialized surgery used to remove some skin cancers. It offers the highest cure rate for difficult-to-treat basal cell cancers. Your dermatologist will tell you if Mohs is right for you.

If Mohs is recommended, this is what you can expect. The surgeon will cut out the tumor plus a very small amount of normal-looking skin surrounding the tumor. While the patient waits, the Mohs surgeon uses a microscope to look at what was removed. The surgeon is looking for cancer cells.

If necessary, the Mohs surgeon will continue to remove a very small amount of skin and look at it under the microscope. This continues until the surgeon no longer sees cancer cells.

Cryosurgery
: This treatment uses liquid nitrogen to freeze cancer cells, causing the cells to die.

Radiation: This treatment usually is reserved for BCCs that cannot be cut out, or when surgery may not be the best choice. A patient may need 15 to 30 radiation treatments.

Photodynamic therapy (PDT):
This treatment uses light to remove early skin cancers. PDT is a two-step process. First, a chemical is applied to the skin. The chemical remains on the skin for some time so that it can be absorbed. Then the skin is exposed to a special light to kill the cancer cells.

Medicated creams: Creams that contain a drug, such as imiquimod or 5-fluorouracil, can be used to treat early BCC. A patient applies the medicated cream at home as directed by his or her dermatologist.

Pills: While extremely rare, there are reports of BCC spreading to other parts of the body. Patients who have BCC that spreads may be prescribed vismodegib. This medication also may be prescribed for patients who have advanced BCC that cannot be cut out or treated with radiation.

Outcome

Nearly every basal cell cancer can be cured, especially when the cancer is found early and treated.

Learn more about basal cell carcinoma:

References:

Carucci JA, Leffell DJ. “Basal Cell Carcinoma” In: Wolff K et al. Fitzpatrick’s Dermatology in General Medicine, 7th edition. USA. McGraw Hill Medical; 2008, p. 1036-42.

National Cancer Institute, “FDA Approval for Vismodegib,” January 30, 2012. 

Neville JA et al. “Management of nonmelanoma skin cancer” In: 2007 Nat Clin Pract Oncol. 2007 Aug; 4(8):462-9.

Telfer NL et al. “Guidelines for the management of basal cell carcinoma.” Brit J of Dermatol 2008;159;35-48.

Sterry, W. “Nonmelanoma skin cancer.” EJD, 2007; Nov-Dec; 17(6):562-563.

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