Basal Cell Carcinoma

The most common type of cancer in the world, basal cell carcinoma (BCC) is diagnosed ~3 million times in the United States each year. And although it most commonly affects fair skin types, BCC can develop in people of all colors, backgrounds, ages, and ethnicities. Sun and UV exposure are by far the most important risk factors, as most patients admit to frequent tanning and poor use of photoprotection.

Together with squamous cell carcinoma, BCC is considered a non-melanoma skin cancer (NMSC) that is far less aggressive than its melanoma counterpart. As such, BCC tends not to be life-threatening, as it grows rather slowly and seldom spreads to other parts of the body. Nevertheless, early diagnosis and treatment remain critical, as such cases tend to be cured without lasting implications. On the other hand, when intervention is delayed, it allows the skin cancer to grow both larger and more deeply, invading important nearby structures such as nerves, blood vessels, cartilage, or bone. The associated tissue destruction will be permanent, and there is a high likelihood for long-term effects such as scarring, disfigurement, neuropathy, and more.  

DIAGNOSIS / TREATMENT

The two keys to early diagnosis are self-monitoring and routine skin exams by a board-certified dermatologist. When spots are identified as suspicious or concerning, diagnosis must be confirmed by skin biopsy or shave removal. Finally, once the lesion is diagnosed and microscopically assessed, it will be treated either surgically or with superficial radiation (SRT). Cure rates overall are >95%, and the variations in treatment are outlined as below.

• Curettage & Electrodessication (“C&E” or “ED&C”): The lesion is first ‘scraped’ from your skin with a sharpened instrument and technique known as curetting. Then the area is ‘burned’ or ‘cauterized’ by a specialized device that uses electrodesiccation to destroy any remaining cancer cells with heat. The wound is left open, without stitches, and heals over the following days to weeks.
• Excision & Suture (“E&S”): The visible skin cancer is cut out, along with a rim of normal-appearing tissue known as the margin. The specimen is sent for microscopic assessment to confirm that all cancer cells have been removed and that the spot is essentially ‘cured.’ Stitches are typically used to close the hole or defect which ultimately improves the long-term cosmetic outcome.  
• Mohs Micrographic Surgery: This specialized procedure allows removal of the cancer and same-day microscopic assessment. The specimen is processed in-clinic and examined by the surgeon directly. This eliminates the need for “margins” and minimizes the loss of normal tissue. As such, Mohs is often used for cosmetically sensitive areas (e.g. eyelids or nose) or for large aggressive tumors to ensure complete removal. 
• Superficial Radiation Therapy (SRT): With image-guided technology and low-dose radiation (comparable to that of a chest x-ray), cancer cells are selectively destroyed without surgical intervention. Treatment involves several brief in-office sessions over a period of weeks. Cure rates are equal to surgery, without any significant downtime, discomfort, infection, or scarring.