Characteristic features of BCCs may include:
- A few millimetres to several centimetres in diameter
- Waxy small raised lesions (papules) with a depressed centre
- Pearl-like and translucent in appearance
- Ulcer-like in appearance
- Tendency to bleed
- Red and scaly, oozing or crusted areas
- Raised borders
- Black-blue or brown areas.
This is the most common treatment for BCC and involves cutting out the BCC along with a small area of surrounding tissue, and stitching up the skin. In many cases, this can be done by a GP. For larger, more extensive BCC's (particularly if they are in a difficult position) a referral to a plastic surgeon or other appropriate specialist may be required. After excision of the BCC a graft or skin flap may be used in order to repair the defect.
This surgical technique enables BCCs and other skin cancers to be more precisely but completely excised whilst preserving as much healthy skin tissue as possible. During surgery an initial excision is made and the tissue is carefully examined under a microscope. If necessary, further slices of tissue are removed until it is clear on microscopic examination that all the cancer has been removed. Mohs surgery is performed under local anaesthetic by a dermatologist who has special training in the technique. This technique is not appropriate for the treatment of all skin cancers. It is mainly indicated in the treatment of basal and squamous cell carcinomas that are in areas of the body where preservation of surrounding tissues avoids the need for complex reconstructions, although reconstructive surgery may be required occasionally after Mohs' surgery. The technique is not appropriate for melanoma skin cancers.
This treatment uses liquid nitrogen to freeze off the BCC. This is used in the treatment of superficial BCCs only.
This treatment uses specialised cutting instruments to remove the BCC layer by layer.
X-ray treatment to destroy the BCC may be used for lesions on the face or for lesions that are considered to be inoperable. This form of treatment is not usually recommended for people under the age of 65 years.
A special cream is applied to the BCC and the lesion is exposed to a special light (either laser or non-laser) several hours later. The photochemical reaction between the cream and the light selectively destroys the cancer cells.
A topical cream that stimulates the immune system is sometimes used in the treatment of superficial BCCs. It works by stimulating the immune system to release chemicals that help to destroy the cancer cells. The most commonly used topical medications are imiquimod cream and fluorouracil cream. They are mainly effective against small superficial BCCs.
Avoiding exposure to the sun is the best way to reduce the risk of developing a BCC. If exposure to the sun is unavoidable the Cancer Society of New Zealand recommends the following precautions:
- Use a sunscreen that has sun protection factor of at least SPF30
- Wear a wide brimmed hat, protective clothing and sunglasses
- Avoid being out in the sun between 11am and 4pm
- Seek shade eg: from trees, umbrellas, buildings, canopies and marques
- Avoid tanning beds, which emit UV radiation that can increase the risk of skin cancer.
Bader, R.S. (2017). Basal cell carcinoma (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/276624-overview [Accessed: 24/10/17]
Mayo Clinic (2016). Basal cell carcinoma (Web page). Rochester, NY: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/basal-cell-carcinoma/symptoms-causes/syc-20354187 [Accessed: 24/10/17]
Oakley, A. (2015). Basal cell carcinoma (Web page). Hamilton: DermNet New Zealand. https://www.dermnetnz.org/topics/basal-cell-carcinoma/ [Accessed: 24/10/17]
O’Toole, M.T. (Ed.) (2013). Basal cell carcinoma. Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed.). St Louis, MI: Elsevier Mosby.