Basal cell carcinoma (BCC) is the most common form of skin cancer; an estimated 2.8 million BCCs are diagnosed annually in the US.  In fact, it is the most common of all cancers.

The estimated lifetime risk of BCC in the Caucasian population is 33-39% in men and 23-28% in women.  BCC usually presents as a slow growing, skin colored or reddish, shinny, non-healing growth.  Mild trauma, such as face washing, shaving or drying with a towel, may cause bleeding.  Other presentations include a pink growth, reddish patch or scar-like area.

BCC typically occurs in areas of chronic sun exposure and is typically seen on the face, ears, scalp, neck, or upper trunk.  Chronic recreational or occupational sun exposure as well as intense sun exposure during childhood or young adulthood all contribute to the development of BCC.

Anyone with a history of sun exposure can develop BCC. However, people who are at highest risk have fair skin, blond or red hair, and blue, green, or grey eyes.

BCCs are rarely fatal, usually slow growing and rarely metastasize.  The treatment is, however, essential to prevent significant local destruction and potential disfigurement.  Prognosis is excellent with proper therapy.

To prevent development of BCC, avoidance of sun UV radiation is essential.

Individuals with one BCC have a 30% greater risk of having another BCC either in the same area or elsewhere on the body compared with the risk in the general population.  All previously treated sites must be monitored after therapy as incompletely treated BCCs may recur.

Treatment

The choice of therapy depends on the size and location of the tumor, its histological subtype, whether or not the tumor has been previously treated and the patient’s health condition and personal preferences.

Both medical and surgical therapeutic options exist for BCCs and are easily treated in their early stages. The larger the tumor has grown, however, the more extensive the treatment needed.

Medical therapy includes chemotherapeutic (5-fluorouracil, 5-FU, Efudex, Carac), immune-modulating agents (imiquimod, Aldara, Zyclara) and photodynamic therapy (PDT) and is usually reserved for most superficial forms BCC.  Surgical treatment can almost always be performed on an outpatient basis in the physician’s office with a local anesthetic.

The common surgical treatment modalities include cryotherapy (freezing), curettage, excision with margin examination, Mohs micrographic surgery (LINK), and radiotherapy.

• For superficial or small (less than 1 cm) lesions of the trunk, cryosurgery, curettage and electrodesiccation (ED&C) provides an acceptable cure rate and good cosmetic outcome.  ED&C is not the preferred treatment for facial lesions, and is not recommended for large primary BCC, morpheaform or recurrent BCC.  Complications resulting from ED&C and cryosurgery include scarring and post-inflammatory pigmentary changes.
• Indications for Mohs micrographic surgery:
  • Facial lesions greater than 1 cm in diameter
  • Tumors greater than 2 cm in size on the body
  • Lesions located in the temple, eyelid, medial canthus, nose, and nasolabial fold that are more likely to recur
  • Recurrent BCCs
  • Lesions with clinically indistinct margins
  • Histopathology is morpheaform or micronodular pattern
  • Tumors that will require extensive reconstruction to repair the surgical defect