Skin Cancer: Basal Cell Carcinoma Treatment

  • Treatment

    Use sunscreen with SPF 15 or higher, wear protective clothing when in the sun, avoid being out in the midday sun, and check yourself regularly for new or changing skin lesions and non-healing sores.

    Your doctor is the best source of information on the drug treatment choices available to you.

    Radiation is an alternative to surgery in certain circumstances. Surgery is the preferred treatment option for BCC, although radiation has a role in managing selected tumors. For example, radiation is used in cases where the patient is not an ideal surgical candidate. Radiation can also be used after surgery if there is any indication that cancer cells have been left behind in the area surrounding the removed tissue. Radiation works well for superficial types of BCC, or for nodular types that do not invade deeply.

    Radiation cure rates are lower than those resulting after surgery. There is an overall increased risk of developing a skin cancer in the radiated site as a long-term potential consequence. Most doctors agree that the tumors that recur after radiation therapy behave particularly aggressively.

    Radiation may also be used in combination with surgery and/or chemotherapy in the rare cases when basal cell carcinoma has spread to regional lymph nodes or throughout the body. One major drawback to radiation, however, is that the tumor/scar is not sampled at the end of treatment. Therefore, it is difficult to determine if the course of therapy was successful.

    Surgical removal of a BCC will usually eliminate the disease for good. Several options are available depending on the type of lesion.

    • Curettage and electrodessication can be used to treat selected lesions. This involves scraping the cancer away with a sharp, ring-shaped instrument (curette), and cauterizing the base with an electric wand.
    • Cryosurgery destroys the tumor by freezing it.
    • Radiotherapy destroys cancer cells and shrinks the tumor using radiation.
    • Simple excision using a scalpel is a common treatment for tumors with well-defined borders, and in sites with low risk for recurrence (e.g., back, chest, neck, etc.).
    • Mohs' micrographic surgery is a more complex procedure. The lesion is removed, and then a very thin layer of tissue is cut from the border. This thin layer of tissue is examined under a microscope to identify residual cancer cells. If residual cancer is identified, the surgeon will remove an additional layer. This technique is indicated if it is difficult to distinguish the borders of the tumor, if tumors are particularly large, if they are in locations that threaten nearby structures, or if they are in places that have a high likelihood of recurrence, such as on the eyelid or nose. Mohs' surgery is also indicated for the infiltrative type of BCC or any type of lesion that has recurred.

    The vast majority of BCCs are completely cured after removal. A very small percentage behave aggressively with local invasion or metastasis. Most cases of BCCs are of the nodular type which, when small (about half an inch, or less than 1.5 cm in diameter), carry a low risk. When left untreated, however, BCC can have an unpredictable growth pattern. They can grow laterally and deeply, but at a slow rate. They can also invade deeper structures, even penetrating bone and other vital structures.

    Up to one-half of 1% of basal cell carcinomas spread throughout the body via the blood or lymphatic systems, a process known as metastasis. Metastasis is usually seen only in tumors that have been ignored for many years, and have grown large. In such cases, cure rates are significantly reduced. When metastases occur, they are most commonly found in the regional lymph nodes or lungs.

    Immediate follow-up depends on the extent of surgery. Thereafter, annual skin exams are important. The doctor may or may not recommend immediate follow-up, depending on the extent of the lesion removed. Anyone who has had BCC has an increased chance of developing a second BCC or other types of skin cancer. For this reason, careful self-monitoring is advised, and a thorough skin exam by a physician every six months for five years following occurrence of the first tumor is important.

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