Skin Cancer: Basal Cell Carcinoma

Diagnosis

Tissue from a suspected lesion must be examined microscopically to make a definitive diagnosis. A doctor will suspect basal cell carcinoma based on its characteristic appearance, but a biopsy and examination under a microscope is required to be certain of the diagnosis. Classification is important to determine the prognosis and best treatment options for this condition. There are several types of BCC that can be distinguished microscopically; these include nodular, superficial, and infiltrative subtypes. Classifying the subtype is important, as it helps direct treatment options and identify lesions with an increased risk of recurrence. The nodular subtype is the most common, and usually grows slowly. Infiltrative lesions are the most difficult to treat, and the most likely to behave aggressively.

Prevention and Screening

Protection from excessive sun exposure--especially though regular use of sunscreen with SPF 15 or higher, protective clothing, and avoiding the midday sun--is essential for reducing the risk of all types of skin cancer. Light-skinned individuals who burn easily should be especially cautious. The following precautions should be taken by everyone to guard against excessive exposure to UVA and UVB radiation.

• Try to schedule time outdoors for sports and other recreational activities before 10am and after 4pm. By doing this you will avoid excessive exposure to UVB radiation. Clouds and haze do not significantly block harmful ultraviolet radiation.
• When outdoors, wear clothes that cover as much skin as possible; such as lightweight, long-sleeved shirts, long pants, and a broad-brimmed hat.
• Use particular care around reflective surfaces such as water, sand, concrete, and white-painted areas.
• Everyone over 6 months of age should use a broad-spectrum sunscreen that protects from UVA and UVB rays, and has a skin protection factor (SPF) of at least 15. Apply to exposed skin twenty minutes before exposure and reapply every two hours. More frequent re-application may be necessary after exercise or water-related activities.
• Sunscreen products that contain zinc oxide or titanium dioxide offer the best broad spectrum of protection.
• There is no such thing as a “safe” or “healthy” tan. Avoid tanning booths and sun lamps as they are associated with development of skin cancer and promote premature aging of the skin.

Check your skin regularly and have your doctor check your skin at your annual checkup. Experts recommend that individuals conduct a thorough screening of their own skin periodically. Having a partner check your back and other hard-to-see places is ideal. You can also use a hand-held mirror to check your back yourself. Consider drawing a map of your body, and indicate the location of moles, areas of discoloration, and other blemishes. Each month note if a new growth has developed, or if there has been any change in shape, color, or size of lesions. See your doctor if you have any questions or suspicions.

At your annual checkup, ask your doctor to look at your skin, especially in areas you can't see. People with major risk factors, such as a history of significant sun exposure and a fair complexion with a history of burning easily, should be checked at least annually by a dermatologist.