BCC is the commonest skin cancer and can occur at any age but are more common as you age.
Where do they occur?
They tend to occur on skin that has had a lot of sun exposure. They are often found around the nose, ears and eyes. Whilst BCCs do not spread throughout the body they can be very difficult to treat when found in these areas.
How do I know I may have a BCC?
There are many types of BCC, all of which look quite different. Of course, you won’t go to your dermatologist or GP concerned that you may have a BCC (unless you have had one before), but you will become concerned that you have an area of skin that is changing, possibly bleeding or scabbing, or that just looks different.
Most BCCs are reasonably easy for an experienced clinician to diagnose. Some are very subtle and only able to definitively diagnosed with a biopsy. Very early BCCs are actually impossible to diagnose but will always become apparent with time.
Different types of BCC.
The following are the different types of BCC.
Shows as a small lump which may ultimately ulcerate and bleed
A red, slightly scaly flattish patch
A yellow-white scar-like patch that feels firm
Frequently quite dark in colour mimicking a melanoma
Showing mixed features
What are the treatment options?
BCCs are slow growing compared to Squamous Cell Carcinomas (SCC) and Melanoma. However, if left untreated, they will gradually enlarge to involve quite large areas. Diagnosis of larger BCCs may be relatively simple to the clinician, but early BCCs may be quite subtle and require biopsy and subsequent microscopic diagnosis by a pathologist. A biopsy is necessary, even in larger lesions, to accurately classify the type of BCC, so that the correct treatment is chosen.
Treatment depends on many factors, including the type of BCC and anatomic site. Treatment options include:
Surgical excision including Mohs Surgery
Mohs Surgery is a highly specialized treatment for the total removal of skin cancers. The visible component of the cancer is surgically excised and then subjected to microscopic analysis whilst the patient waits.
Curettage and cautery
This is a time honoured technique used almost exclusively by dermatologists. The curette is an instrument that “scrapes” away the soft tissue that comprises the bulk of some skin cancers. Normal tissue is not affected by curetting.
Superficial X-ray Therapy (SXRT) is a modality which is highly effective for the treatment of Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC). It is not a preferred therapy for Melanoma.
Photodynamic Therapy (PDT)
Whilst becoming increasingly used by doctors world over, PDT is not new, having been successfully used at our premises since 1995. Certainly the technology has greatly improved over this time.
This is a topically applied drug which works by stimulating the body’s own immune system to destroy cancer cells. It was actually first used in the treatment of genital warts.
In this technique, liquid nitrogen (which has a boiling point of a (very low) minus 200°C) is applied to the skin with the purpose of destroying surface-based tumors.
Remember, not all BCCs are the same and will require the correct treatment to be cured.
BCCs are notoriously prone to recur, and the most common reason for this is inadequate or inappropriate treatment in the first instance.
BCCs which occur in the difficult anatomic sites are generally best treated surgically, with Mohs Surgery.