A complete guide to basal cell carcinoma
Basal cell carcinoma is the most common type of skin cancer, typically caused by overexposure to UV radiation rays from the sun
In this blog, we will look at what basal cell carcinoma looks like, common causes, its symptoms, and how it’s often treated. We’ll also answer some commonly asked questions surrounding the disease to clear up any myths or misunderstandings.
What is basal cell carcinoma (BCC)?
Basal cell carcinoma is a type of non-melanoma skin cancer that forms in the basal cells within the top layer of the skin (the epidermis). Basal cells are a type of skin cell that helps your body produce new skin cells to replace the old ones as they die off.
Non-melanoma cancers often get mixed up for melanoma cancers, but they are completely different types of skin cancer. Melanoma cancer develops in pigment-producing cells called melanocytes located in the top layer of the skin. Melanoma can spread (metastasize) very rapidly, while non-melanoma skin cancers are slower growing.
What are the risk factors for basal cell carcinoma?
BCC is most common type of skin cancer and also the most common general cause of cancer worldwide. It is important to know what can put you at risk, so you can be more aware of your chances of developing the disease.
There are some factors that we can control that can impact the chances of developing BCC. These are known as modifiable risk factors. However, there are some we have no control over. These are known as non-modifiable risk factors.
Elements that can put you at risk of the disease include:
Modifiable risks
- Exposure to ultraviolet (UV) light radiation
- Exposure to industrial compounds, such as arsenic, coal tar, soot, and certain petroleum products
- Exposure to radiation, such as cancer treatment
Non modifiable risks
- Age – BCC often occurs in adults who are older, with most cases occurring in people over 50
- Sex – Men are more likely to develop BCC than women
- People who have fairer skin – particularly those with freckles or who burn easily, blue or green eyes, or who have naturally red or blonde hair are at high risk
- Family history of skin cancer, including BCC
- Personal history of skin cancer, including BCC
- Certain rare genetic diseases, such as Gorlin syndrome and xeroderma pigmentosum
Individuals who have a weakened immune system are also at risk of BCC. This includes people who have conditions such as HIV, lymphoma, or leukaemia, and patients receiving treatment such as radiotherapy.
Does basal cell carcinoma increase the risk for other cancers?
Studies have suggested that if you have basal cell carcinoma you are at a significantly increased risk of developing other cancers including blood, breast, colon, and prostate cancer.
The reason for this isn’t yet clear, but it is suggested that it may be due to underlying mutations in the genes responsible for repairing DNA damage or a weakened immune system.
What causes basal cell carcinoma?
The most common cause of basal cell carcinoma is ultraviolet (UV) light radiation. Being overexposed to UV radiation can cause damage to your DNA, leading to a mutation in the way your cells produce and grow.
Typically, natural sunlight and tanning beds are main sources of UV radiation. UV treatment for skin conditions, such as psoriasis and eczema, can also put you at risk of developing BCC.
BCC can appear anywhere on the body. It most often appears on parts of the body that are highly exposed to the sun, such as the face, head, neck, and ears.
BCCs can also develop from an old scar or an area of chronic inflammation, although this is rare.
What are the symptoms of basal cell carcinoma?
The key sign of basal carcinoma is change in the skin, such as a lump, sore or patch that does not heal. This change can take on many appearances, including:
- A shiny, pearly, or translucent bump that may appear white, pink, or darker colour depending on skin tone. You may also see small blood vessels across the surface of the affected area
- A flat, scaly, or crusty patch with or without a raised edge, sometimes red or irritated
- A white, yellow or waxy scar-like area that looks shiny and taut, often with borders that aren’t defined
- An open sore that bleeds, oozes, or crusts and does not heal or heals and returns
- A pink growth with a slightly raised, rolled edge and a dent in the middle
BCCs are often painless but you may feel an itch, bleed, or become sensitive or numb in the affected area.
Your BCC may look different to another’s because there are different types of basal cell carcinoma, each with their own look and behaviour. Some of the common subtypes include:
- Nodular basal cell carcinoma (nCBB)
- Superficial basal cell carcinoma (sBCC)
- Morphoeic basal cell carcinoma (mBCC)
- Pigmented basal cell skin cancer (pBCC)
If your cancer has advanced, it may break down and form open sores or ulcers that can become infected and cause pain.
BCC is a slow-growing form of cancer that is unlikely to spread to other parts of your body. This means that you are less likely to experience wider health symptoms such as a fever, weight loss, or fatigue.
To help spot skin cancer early, it helps if you know how your skin normally looks so you'll notice any changes more easily.
Basal cell carcinoma stages
Basal cell carcinoma is not often staged, as the cancer is slow growing and is usually treated before it spreads to other parts of the body.
However, if the cancer has spread, your doctor will use the following stages to class your BCC.
Stage 0
At this stage, your cancer is still located in the place where it first developed and hasn’t spread or grown into surrounding areas of the skin.
Stage 1
At this stage, your cancer has grown to a maximum of 2cm across.
Stage 2
At this stage, your cancer is between the sizes of 2cm and 4cm across.
Stage 3
At this stage, your cancer may be behaving in many different ways.
One way may be that your cancer hasn’t spread to your lymph nodes, but it is larger than 4cm across, has grown into nearby bones, has grown into the space around a nerve, or has grown below the layer of fat under the skin.
Another way may be that your cancer is smaller than 4cm across, but it has spread to a single lymph node that is 3cm or smaller on the same side of the body as your cancer.
Stage 4
At this stage, your cancer is at any size and has spread to one or more lymph nodes. It can also mean the cancer has:
- Spread to only one lymph node which is larger than 3 cm and smaller than 6 cm
- Spread to lymph nodes on the other side of your body to the cancer
- Spread to bone marrow or bone and has damaged the bone
- Spread to another part of your body, such as the lungs
Grades
Your cancer will also be graded, so it can be determined how much your cancer cells look like normal cells. Your consultant may use this to help figure out how your cancer may behave, and which treatment options may be best for your condition.
The grades are as follows:
Grade 1: Cells look mostly like normal cells
Grade 2: Cells look a bit like normal cells but are starting to change
Grade 3: Cells look very abnormal and not like normal cells at all
BCC is most common type of skin cancer and also the most common general cause of cancer worldwide [...] According to NICE, around 75,000 cases of basal cell carcinoma are diagnosed each year in the UK.
How to treat basal cell carcinoma
There are many treatment options available for basal cell carcinoma. The goal for treating BCC is to remove the cancer completely. Your treatment will depend on the type, location, and size of your cancer. It will also be based on whether this is your first time having BCC or whether it is a reoccurring case.
Surgery
Surgery is often the preferred choice for treating basal cell carcinoma. The type of surgery conducted will depend on how the cancer has presented itself.
Surgical excision
For this type of surgery, it involves cutting out the BCC and the surrounding ‘healthy’ skin. This area is sealed through stiches or a skin graft from another part of the body.
In some cases, the open wound area is left open to heal. The edges of the skin are then removed and tested to check whether the BCC has been fully removed.
Mohs surgery
Mohs surgery involves removing the cancer layer by layer and examining the removed skin under a microscope. If any cancer is found at the edges of the sample, more skin will be removed and examined again. This allows your surgeon to be certain the entire growth is removed and avoid taking an excessive amount of surrounding healthy skin.
This type of surgery is usually recommended for those with complex cases or sites more difficult to treat such as the face.
Curettage and electrodessication (C and E)
For this procedure, your surgeon will use a semi sharp instrument with a spoon-shaped edge (known as a curette) to remove the cancerous tissue. Once that is done, an electric needle is used to control the bleeding. This technique also destroys any cancer cells that may remain around the edge of the tumour.
This treatment is often recommended for small basal cell carcinomas that are less likely to recur usually found in areas such as on the neck, the central part of the body (trunk), arms, or legs.
Photodynamic therapy (PDT)
During photodynamic therapy, a liquid drug that makes the cancer cells sensitive to light is applied to the skin. A light that can destroy the skin cancer cells is shone on the area.
This procedure is usually recommended to treat superficial skin cancers or when surgery isn’t an option.
Topical treatments
Specifically prescribed creams or ointments may be recommended to treat small, thin superficial BCCs, or when surgery isn't an option.
Other treatments
Other treatments for basal cell carcinoma include:
- Cryotherapy
- Radiation therapy
- Chemotherapy
- Targeted drug therapy, such as immunotherapy
Basal cell carcinoma FAQs
Are basal cell carcinomas hereditary?
BCC doesn’t usually run in families. However, you can inherit factors that can increase your risk of developing the disease (e.g. fair skin, freckles, and blue eyes).
In rare cases, BCC can be the result of an inherited genetic condition (such as Gorlin syndrome).
Can BCC turn into melanoma?
Basal cell carcinoma and melanoma are two different types of skin cancer. This means that BCC cannot develop into melanoma and vice versa.
They share many risk factors, which might be why they’re often mistaken for one another. However, how each cancer behaves, how it is treated, and the outlook for patients varies greatly between each type.
How serious is basal cell carcinoma?
The severity of your BCC will depend on what stage your cancer is in. Generally, basal cell carcinoma grows slowly and is easily treatable in its early stages.
It is important to know what to spot when checking for signs of BCC, as the earlier the diagnosis, the better the chances of successful treatment.
Get help with Circle Health Group
Worried about your risk of skin cancer?
At Circle Health Group, our expert consultants specialise in diagnosing and treating a range of skin cancer types, including basal cell carcinoma.
Book an appointment online today or give us a call directly, and we'll help you find the right specialist for you.
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If you're concerned about symptoms you're experiencing or require further information on this subject, talk to a GP or see an expert consultant at your local Circle Hospital.