BASAL CELL CARCINOMAS
Not all skin cancers are the same. There are three common types:
- Basal cell carcinoma
- Squamous cell carcinoma
How common are they?
Basal cell carcinoma (BCC) is by far the most common skin cancer. It is in fact the most common cancer of any kind in paler skinned people. It is 10 to 15 times more common than melanoma.
What are they?
They are tumours of the cells that produce the epidermis – the top layer of skin. Persistent ultraviolet damage reduces the skin’s ability to stop these cancers developing. They are thus most common on the most sun exposed areas of the skin – face, nose, neck, upper trunk, limbs being the most common sites.
Who is affected?
In Australia they start to develop in people as young as their late 20s and become increasingly common as people get older. They are most common in people who have had a heavy lifetime UV exposure such as outdoor workers particularly if they have a paler skin type (red / blonde hair).
How dangerous are they?
They are fortunately less aggressive than other cancers as they hardly ever metastasise (ie. spread to lymph glands or distant organs such as the liver or lungs). However left untreated they will slowly grow and erode the skin and underlying structures such as cartilage. An older name for BCCs is ‘rodent ulcer‘ because of this eroding effect. If neglected BCCs can grow very large and become extremely disfiguring, especially on the face.
What types are there?
There are several different sub types:
- Nodular BCCs are pink, raised lesions which can bleed or ulcerate.
- Superficial BCCs are pink/red flat plaques which can often go unnoticed for a long time as they do not bleed or itch or cause any other symptoms.
- Sclerosing or Morphoeic BCCs are pale flat, sometimes indented lesions often scar like in their appearance. Their edges are difficult to define and so they can prove more difficult to excise completely. They are considered a more aggressive type of BCC. Pigmented BCCs are more common in people with darker skin types eg. people from Mediterranean countries or India. They have melanin pigment within them an appear dark brown which means they can be confused with melanoma.
- Cystic BCCs are clear or pale yellow cystic lesions which are quite common on or around the eyelids.
How can I tell if I have one?
Any nodule (lump), ulcer or persistently pink/red patch on the skin should be reported to a doctor sooner than later, especially if it bleeds.
What is the treatment?
Surgical excision under local anaesthetic is the treatment of choice for most BCCs. Some suitable lesions can be treated with anticancer creams such as Aldara or the photosensitising treatment photodynamic therapy (PDT). However non surgical treatments have a higher rate of recurrence. They are often used where surgery is likely to cause more complications eg. the lower legs in older people. Radiotherapy has been used in the past for multiple or very large BCCs but is not often used now.
How do I prevent them?
BCCs are very much related to UV exposure. The less UV that falls on the skin the better. This is particularly true for those who have already had a skin cancer. Don’t ever take the attitude “Well the damage is done now so there’s no point wearing sun block “. We recommend that every adult has a routine full body skin check once a year. If you have a history of skin cancers, a paler skin type or heavy sun damage to your skin, the doctor may recommend more frequent checkups.