Basal Cell Carcinoma (BCC)

Too much exposure to UV rays causes most basal cell carcinomas. Natural sunlight and tanning beds both contain harmful UV rays that damage skin.

Anyone can develop basal cell carcinoma, but some people are more at risk than others.

Risk factors for BCC include:

• Long-term sun exposure. People who work outdoors, especially in sunny climates, face a greater risk of developing BCC. People who live in the mountains also have a higher risk due to greater UV ray exposure.
• Tanning bed use. No amount of tanning bed use is safe for skin.
• Fair skin. People with light skin have fewer protective melanocytes. These pigment skin cells safely absorb UV radiation and protect the skin.
• Light-colored eyes and hair. If you have blonde or red hair and gray, green, or blue eyes, you are at increased risk for skin cancer.
• Older age. BCCs tend to grow slowly. The older you are, the more time BCCs have had to develop.
• Previous radiation therapy. Radiation used in treating skin conditions, like acne, can increase your risk of skin cancer later in life.
• Previous organ transplant. The immune-suppressing drugs that people take after transplant surgery can increase skin cancer risk.
• History of skin cancer. For every previous BCC you have had, the risk of developing more increases significantly.

Although basal cell cancers almost never become life-threatening, they can grow deep into the skin. Untreated growths can even spread to nearby bone. When that happens, treatment becomes more challenging and can lead to extensive scarring.

Many BCCs can be prevented by limiting sun exposure with these strategies:

• Avoid being outdoors during peak hours (between 10 a.m. and 4 p.m). Schedule leisure activities for before or after these times, if possible. Seek shade if you must be outside then.
• Wear sunscreen every day, even when it's cloudy. Apply sunscreen every two hours to all skin that's not covered by clothing. Choose one with an SPF of 30 or higher.
• Wear protective clothing. Choose dark-colored garments with a tight weave. Cover your arms and legs, if possible. Some manufacturers have created clothing with built-in SPF.
• Don't forget a hat and sunglasses. Broad-brimmed hats give the most protection, but baseball caps and visors help, too. Wear sunglasses outdoors even when it's not sunny. The best ones block both kinds of harmful UV rays, UVA and UVB.
• Do not use tanning beds. All tanning bed use increases your chances of developing skin cancer.

BCCs can occur anywhere on the body, but they most often grow on exposed skin. Your face, scalp, ears, neck, chest, shoulders, back, arms, and hands are the most likely places to develop basal cell cancers.

Develop the habit of checking your skin regularly. These warning signs should prompt you to schedule a doctor visit:

• Slow-to-heal open sore. Look for bleeding, oozing, or a crust. The sore might not heal at all, or it might appear to heal and then return.
• Reddish, irritated skin patch. This patch may crust, itch, or hurt. Alternatively, it may be painless.
• Shiny bumps or nodules. Look for a pearly, clear, pink, red, or white appearance. BCCs may have a tan, brown, or black color, especially in dark-skinned people. They may even look like regular moles.
• Pink growth with a rolled edge. It may have a raised edge and include an indented center. The indent may eventually develop tiny blood vessels.
• Scar-like area without explanation. Look for a flat, white or yellow area where you had no cut or injury. Your skin might be shiny or pulled tight. The area might have wavy borders.

When you arrive at your doctor's office, expect to disrobe and change into a gown.

Your doctor will start with a general physical exam, and examine your skin closely using a magnifying glass.

In order to diagnose BCC, your doctor will need to take a skin biopsy. Your doctor will send the sample to the lab where pathologists will examine it under a microscope for signs of cancer.

Based on the biopsy results, your doctor will design and explain a basal cell carcinoma treatment plan that's best for you. Your doctor will consider several factors in creating a treatment plan.

These include the tumor's:

• Size
• Location
• Depth
• Involvement with other tissues

In general, the goal in treating BCC is to remove the entire tumor while getting a good cosmetic result.

Common treatment options include:

• Minor surgical procedures
• Mohs surgery
• Topical medication

In the rare case that BCC has spread beyond its original site, you may need other treatments:

• Radiation therapy
• Chemotherapy
• Immunotherapy

Minor surgical treatments for basal cell carcinoma

our doctor will choose among a variety of possible minor surgical techniques to treat your BCC.

In some cases, the biopsy that diagnosed your BCC also removed the entire growth, which means no additional treatment will be necessary and you'll continue with annual follow-up exams.

If you need an additional procedure, your doctor will tell you what to expect. Treatments for BCC usually don't require much preparation or recovery time. These include:

• Excision. Doctors cut out the skin cancer and stitch the skin together.
• Curettage. Doctors scrape away cancer cells using a small, scooped tool. They often use this technique to treat small or shallow BCCs.
• Electrodessication. Doctors use electricity to kill any cancer cells that remain after curettage.
• Mohs surgery. A specially trained dermatologist removes all the visible tumor and examines it under a microscope. If cancer cells are present, the doctor removes another layer of skin. This process continues until there are no signs of the cancer. Doctors usually use Mohs surgery for skin cancers on the face, ears, and other delicate areas.

Topical treatments for basal cell carcinoma

When your doctor diagnoses a BCC that has remained small, using less invasive treatments may be possible.

For example, your doctor may use:

• Medication. Your doctor may prescribe a special skin cream to kill cancer cells.
• Cryosurgery. Your doctor kills the cancer cells by freezing them with liquid nitrogen or a similar substance. When the spot heals, the diseased skin sloughs away.
• Photodynamic therapy. Your doctor can use a light-activated chemical to kill BCC cells.

BCC is a highly curable disease. Most patients recover quickly and have no lasting effects, although they'll have to remain alert for recurrence.

Very rarely, BCC spreads to the lymph nodes and then other body parts.

Older adults and people with suppressed immune systems have a higher risk of dying from these types of skin cancer.

UPMC Hillman Cancer Center is western Pennsylvania's only Comprehensive Cancer Center designated by the National Cancer Institute. With more than 70 UPMC Hillman Cancer Center locations, world-class treatments backed by best practices are right in your backyard.

UPMC board-certified, fellowship-trained dermatologists work closely with colleagues in related specialties, including:

• Medical oncology
• Radiation oncology
• Surgical oncology
• Pathology

Additionally, UPMC Hillman Cancer Center has the highest number of certified Mohs surgeons in the western Pennsylvania region.