Question: My dermatologist said my scab was a Basal Cell Carcinoma…Now what? Do I have cancer?
Answer: Relax. A Basal Cell Carcinoma (BCC) is rarely the spreading cancer that requires the systemic chemotherapy you’re thinking of. Cure rates for BCCs are close to 100 percent, and are easily treated when caught early.
After having your skin examined, the diagnosis of BCC is confirmed by biopsy, which is when the skin is numbed with a local anesthetic and a sample of your lesion is removed and sent to be a lab for examination under a microscope. If tumor cells are present, treatment is required. BBCs rarely spread beyond the original tumor site so we simply remove them by any number of methods depending on the type, size, location and depth of the tumor as well as your age and general health. Since BCCs are visible on the surface of the skin, we also take the likely outcome to your appearance into consideration.
Usually, treatment is performed on an outpatient basis in a dermatology office.
A local anesthetic is almost always used so pain during the procedure is minimal, although you may have some mild discomfort afterwards. After removing a small BCC, wounds heal and the scars are usually cosmetically acceptable (and there are many other methods or repairing or improving any resulting damage that is undesirable to you).
The types of treatment include:
- Curettage and electrodesiccation: The growth is scraped off with a sharp, ring-shaped instrument (called a curette), and the tumor is dried out (dessicated) and destroyed with an electrocautery needle. The procedure is often repeated during the same procedure to ensure that all the cancer cells are eradicated. It has a 95 percent success rate for smaller lesions (and often for the first biopsy), although often not useful for aggressive BCCs or in those sites that where any scarring would be highly undesirable as sometimes a white scar is left at the surgical site.
- Mohs Micrographic Surgery: A physician specially-trained in Mohs Micrographic Surgery removes a thin layer of tissue containing the cancer and while the patient waits, the frozen previously removed sections are examined under a microscope by the Mohs surgeon. If skin cancer is still present in any of the tissue, the procedure is repeated only on the area where those cancer cells were identified, until the last layer is cancer-free. This technique saves a great amount of healthy tissue and has a high cure rate of 99 percent or better. It is often used in cosmetically important or large, critical areas and in those areas that have recurred, are hard to pinpoint or in critical areas with little tissue to spare such as around the eyes, nose, lips and ears.
- Excision surgery: We use a scalpel to remove the entire growth along with a surrounding border of apparently normal skin (called a safety margin) and then the site is closed with stitches. A specimen is sent to the laboratory for microscopic examination to verify that all cancerous cells have been removed. Although cure rates are above 95 percent, if the tissue analysis shows cancer cells at the margin of tumor, a repeat excision may be necessary.
- Radiation: X-ray radiation may be used in tumors that are hard to manage surgically, elderly patients or other patients in poor health. The radiation is directed at the tumor, with no need for cutting or anesthesia and total destruction usually requires several treatments a week for a few weeks. Cure rates are around 90% because the technique is not precise in identifying and removing cancer remaining at the margins of the tumor
- Cryosurgery: While not often used, sometimes we can destroy very superficial BCCs by applying liquid nitrogen to the growth with a Q-tip or a spray to freeze it, which also does not require cutting or anesthesia. After the treatment, it may be blistered, crusty and fall off within weeks and the procedure can be repeated.
- Erivedge™ (vismodegib): The first oral medication approved by the FDA for the treatment of advanced BCC which is used for the limited circumstance where the nature of the cancer prevents the use of other treatment options. (Should not be used in woman who are pregnant or child-bearing.)
- Topical medications: Certain prescription topical creams, gels and solutions are FDA-approved to treat limited specific BCCs and some are used to prevent possible BCCs from growing.
The best treatment for BCCs is prevention: Always wear sunscreen of SPF 30 or higher on exposed skin exposed and wear a hat whenever possible!
What’s your story about BCCs?