Basal Cell Carcinoma (BCC) Patient Information - what you need to know

Basal cell carcinomas are the most common type of skin cancer in Australia. It usually appears on areas of the skin that have been exposed to the sun, such as the face, neck, arms, and hands.

What is a Basal Cell Carcinoma?

Basal cell carcinoma (BCC) is a type of skin cancer that grows slowly and rarely spreads to other parts of the body. BCCs can appear in different forms and exhibit different growth patterns, which can affect how they are treated. Here are some of the main types of BCCs:

• Superficial basal cell carcinoma: This is the most common type of BCC. It tends to grow slowly and can appear as a red, scaly patch or a pink, pearly bump on the skin. It is usually found on the face, scalp, arms, or legs.

• Nodular basal cell carcinoma: This type of BCC often appears as a smooth, pearly or waxy bump on the skin that can bleed or develop a crust. It tends to grow more quickly than the superficial type and can be found on the face, neck, or trunk. 

• Infiltrative basal cell carcinoma: This type of BCC often appears as a flat, white or yellowish plaque that grows more aggressively and can invade the surrounding tissue. It is often found on the face or scalp.

• Micronodular basal cell carcinoma: This type of BCC is less common and tends to also grow more aggressively. It appears as small, dark bumps on the skin and can be found on the face, neck, or trunk.

• Morpheaform (morphoeic) basal cell carcinoma: This type of BCC is rare but can be difficult to treat because it has a subtle, waxy appearance that can resemble scar tissue. It tends to grow slowly and can be found on the face, ears, or neck.

It's important to note that while BCCs are generally slow-growing and rarely metastasize, they can still cause damage to surrounding tissues if left untreated.

What Causes Basal Cell Carcinoma?

The main cause of BCC is exposure to the sun's harmful ultraviolet (UV) rays. People who have a history of intense sun exposure, especially without sun protection, are more likely to develop this type of skin cancer. Other risk factors include having fair skin, light-colored hair, and blue or green eyes. Solarium use, lowered immune system, and a family history will also put you at higher risk.

How is Basal Cell Carcinoma Treated?

Treatment for basal cell carcinoma depends on the size and location of the tumor, as well as the patient's health and lifestyle. It is important to know that not all basal cell carcinomas require surgery, or sometimes it requires specialised Mohs micrographic surgery. The treatment should be tailored to your specific circumstance.

The treatment options for basal cell carcinomas include:

• Imiquimod cream: This is a topical cream that helps the body's immune system fight the cancer cells. The cream is applied directly to the affected area for several weeks, usually five days a week. Imiquimod cream can be effective for small, superficial basal cell carcinomas.

• Photodynamic therapy: This treatment involves applying a special photosensitizing agent to the affected area and then exposing it to a specific wavelength of light. This causes the cancer cells to die. Photodynamic therapy is often used for superficial basal cell carcinomas or for those in areas where surgery is not practical, such as near the eyes.

• Curettage and cautery: This treatment involves scraping the tumor off the skin with a special tool called a curette, and then cauterizing (burning) the area to destroy any remaining cancer cells. This method is often used for small, superficial basal cell skin cancers.

• Mohs micrographic surgery: This is a specialized tissue-sparing surgical technique that removes the cancer layer by layer until all cancer cells are gone. A thin layer of tissue is removed and then examined under a microscope to see if any cancer cells remain. If so, another layer is removed and examined until the entire tumor is removed. Mohs surgery is often used for cosmetically sensitive areas, or more aggressive BCCs.

• Surgical excision: This is a common treatment for basal cell skin cancer, especially for tumors that are larger or deeper. The cancerous tissue is removed along with a 4mm margin of healthy tissue to ensure that all the cancer cells have been removed.

• Radiotherapy: This treatment uses high-energy radiation to kill cancer cells. Radiotherapy may be used for basal cell skin cancers that cannot be surgically removed, or as a follow-up treatment if the cancer has not been completely removed by surgery.

• Immunotherapy: This is a type of treatment that helps the body's immune system fight cancer cells. Immunotherapy drugs can be used to treat advanced or metastatic basal cell carcinoma, meaning cancer that has spread beyond the original site.

Prevention Tips

The best way to prevent basal cell carcinoma is to protect your skin from the sun's harmful rays. Here are some tips to help you stay safe in the sun:

• Wear protective clothing, such as long-sleeved shirts and hats.

• Use a broad-spectrum SPF 50+ sunscreen, and reapply it every four hours or after swimming or sweating.

• Seek shade during the hottest part of the day (between 10 am and 4 pm).

• Avoid tanning beds and sunlamps, as they can also cause skin damage.

Remember, early detection is key to successful treatment of basal cell carcinoma. If you notice any changes in your skin, such as a new bump or a spot that doesn't heal, make an appointment to see your doctor or dermatologist right away.

What should I do if I have a basal cell carcinoma?

If you have a BCC, make an appointment to see a dermatologist. Your dermatologist will assess your BCC and suggest the most appropriate treatment tailored for your skin cancer.