Basal Cell Carcinoma

By Tina M. St. John, MD. May 7th 2016

Basal cell carcinoma, a slow-growing form of skin cancer, may not be a term you’re familiar with, but more people in the U.S. are treated for this each year than all types of non-skin cancer combined. To put this into perspective, the number of new basal cell carcinoma cases every year is more than seven times that of breast or prostate cancer.

While anyone can develop basal cell carcinoma (BCC), your skin tone affects your level of risk. The National Cancer Institute reports that roughly 1 in 3 Caucasians develop BCC during their lifetime. The odds are substantially lower for men and women of color.

The good news is that BCC is highly treatable and curable in most cases, especially if detected and treated early. Additionally, you can reduce your risk for BCC by taking some simple steps to protect your skin from the sun and other forms of ultraviolet radiation. It’s never too late — or too early — to start protecting your skin.

What Is Basal Cell Carcinoma? 

Skin cancers are broadly grouped into melanoma and nonmelanoma types. Basal cell carcinoma is a nonmelanoma skin cancer and accounts for roughly 80 percent of cases. The other 20 percent of nonmelanoma skin cancers are mostly squamous cell carcinoma.  

The “basal” in BCC derives its name from the cells in which the cancer originates, the basal cells. These cells are located at the bottom of the uppermost layer of your skin, called the epidermis. Basal cells multiply regularly, replenishing older cells shed from the surfaces of your skin.

Unlike melanoma, BCC rarely spreads to other areas of your body that are distant from the site of the cancer. Therefore, BCC is usually curable and not life-threatening. However, untreated BCC can invade underlying and nearby tissues. Large BCC tumors can be disfiguring and may cause serious complications or, rarely, death.

BCC can develop at different sites on your skin — at the same time or one after another. This is because all commonly exposed areas of your skin have sustained similar amounts of radiation damage. If you have been diagnosed with BCC, you have approximately a 50 percent chance of developing another BCC within five years.

Risk Factors

Exposure to ultraviolet radiation (UVR) from the sun is the primary risk factor for BCC and other skin cancers. UVR can damage the genetic material in your basal cells. Over time, this damage accumulates and may cause the cells to become cancerous.

Sporadic bouts of sun exposure, which often lead to sunburns, are particularly important as this pattern of UVR exposure significantly increases your risk for BCC. People who don’t spend a lot of time outdoors, other than on weekends and during vacations, often get this type of sporadic sun exposure. Your total lifetime UVR exposure is also a contributing factor.

Other factors that increase your risk for BCC include:

  • Fair skin that burns easily in the sun,
  • Naturally blond or red hair,
  • Age older than 50 (although BCC can occur in younger adults),
  • A personal or family history of skin cancer,
  • A weakened immune system,
  • UVR exposure from sunlamps or indoor tanning beds, and
  • Occupational or environmental exposure to certain chemicals including arsenic, organophosphate insecticides and petroleum products, such as tar and asphalt.

What Does BCC Look Like?

Basal cell carcinoma tends to occur in areas that are typically exposed to the sun. While melanoma can develop anywhere on your body, BCC usually occurs on your face, scalp, shoulders and neck. BCC may bleed easily and/or cause itchiness, and it varies considerably in appearance. For example, it may appear as:

  • A raised, waxy, flesh-colored or pink growth that slowly enlarges;
  • A flat pink area that gradually spreads outward and may resemble a patch of eczema or psoriasis;
  • A depressed, scar-like area or an ulcerated lesion on your skin that doesn’t heal; or
  • A new mole that expands over time.

The most consistent characteristic of BCC is that it appears different than the surrounding skin and gradually increases in size rather than going away.

Next Steps

For Patients

BCC is highly treatable and usually curable, especially if detected early. If you notice any new spot on your skin that does not go away, see your doctor. A biopsy — a procedure in which a doctor takes a sample of the tissue and examines it under the microscope — is the only way to know for sure whether a skin spot is cancerous.

When it comes to preventing basal cell carcinoma, you can reduce your risk by taking simple steps to protect your skin from the sun and other forms of ultraviolet radiation.

  • When you’re in the sun, protect your skin from UVR with clothing and a hat. A full-brimmed hat is ideal because it shades both your face and neck.
  • Use broad-spectrum sunscreen with an SPF rating of at least 15 on exposed skin when you are outdoors and reapply according to product directions. Sunscreen with an SPF of 30 or greater provides the highest level of protection and is the best choice if you sunburn easily.
  • Avoid using tanning beds and sunlamps.
  • If you use a facial moisturizer or cosmetic foundation, opt for a product that includes sunscreen.

For Caregivers

Many skin cancers are first noticed by a friend or family member. Keep an eye on the skin of your loved ones, especially the elders in your life. Basal cell carcinoma and other skin cancers are most likely in seniors, but elders may not notice a new skin spot due to failing eyesight or other health problems. If you notice any skin changes or abnormal growths on a loved one, discuss it and encourage a visit to the doctor.

There are also preventative measures you can take to help reduce your loved ones’ risk of BCC and other forms of skin cancer.

  • Protect your children’s skin from excess sun exposure with protective clothing, hats and sunscreen. At about age 9 or 10, try giving your child some personal responsibility for skin protection. This helps instill healthy skin habits to last a lifetime.
  • The American Academy of Pediatrics recommends keeping babies younger than 6 months out of direct sunlight. If you must be in the sun with your baby, use light-weight clothing, blankets and hats to protect your little one’s delicate skin.
  • Discourage tanning bed and sunlamp use among the teens in your life. This may require some heavy-duty negotiating, but it’s important to protect their skin and health long term.

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