Basal Cell Carcinoma - Western SummaryWestern Medicine Summary

Western Medicine

Western Summary

Basal cell carcinoma (BCC), also known as a basal cell skin cancer, is the most common skin cancer in the United States. In 1994, it was estimated that the lifetime chance to develop a BCC among those with Caucasian skin was 33 to 39% in men and 23 to 28% in women.[1] This risk appears to be continuing to increase.[2]

Symptoms

BCCs are skin cancers that develop due to overgrowth of mutated cells known as keratinocytes in the epidermis, which is the superficial layer of the skin. There are several subtypes of BCCs

  • Superficial: This type of BCC is entirely in the epidermis. 
  • Nodular: This type of BCC forms as clumps of mutated cells in the dermis. 
  • Infiltrative: This type of BCC grows into the dermis as single strands of cells. 
  • Micronodular: This type of BCC forms as clumps similar to the nodular subtype. However, the clumps are much smaller. 
  • Morpheaform: This type of BCC has a scar like appearance and can look like a scar or scarred down area.  

BCCs can have several different features on the skin including: 

  • Pearly in appearance: The skin can look more smooth and reflective than the surrounding skin. 
  • Arborizing blood vessels: Close examination may show thin blood vessels, known as telangiectasias, which have an arborizing appearance (like the pattern of ends of bare trees in the winter). 
  • Ulcers: Sometimes, BCCs can form small ulcerations our wounds on the surface of the skin cancer because the cells have outgrown their blood supply.
  • Scar-like appearances: Some BCCs can look like a scar and can be subtler in appearance than other BCCs. 

Causes

BCC are caused by overexposure to sunlight and ultraviolet radiation.[3] In particular, sunburns have been linked to their formation. Sunburns lead to mutations in the skin cells that lead to the formation of BCCs. 

Treatments

There are several treatment options available depending on the subtype of BCC.[4] 

Topical Medications

Topical medications can be used for specific subtypes of basal cell carcinomas and should be discussed with a qualified health professional. 

  • 5-fluorouracil: 5-fluorouracil is a topically applied chemotherapy chemical that mimics the molecules of DNA to affect rapidly dividing cells and destroy them. This treatment is applied over 2-3 weeks and should be discussed. 
  • Imiquimod: Imiquimod is topically applied. This chemical activates cell surface receptors that reduces cell division in the AK and promotes cell death. The imiquimod is typically over several weeks.[5] 

Oral Medications

In rare cases, an oral medication known as vismodegib may be used for the treatment of basal cell carcinomas. Some examples include a large basal cell carcinoma that is cannot be removed with surgery easily or to control the development of basal cell carcinomas in people that are genetically predisposed to form basal cell carcinomas, such as basal cell nevus syndrome. 

There are several surgical treatment options for the treatment of BCC and a qualified health professional can discuss these options in detail. 

 

Electrodesiccation and Curettage

Known a “scrape and burn” procedure, the lesion is anesthetized and then the lesion is surgically curetted (“scraped”) which is immediately followed by electrically cauterizing the wound. This process is typically repeated in three cycles sequentially at the same visit.  

 

Surgical excision

A qualified health professional can cut out the skin cancer with a margin. 

 

Mohs micrographic surgery (MMS)

This is a technique of surgery that was originally developed by Dr. Frederic Mohs and has been continually refined. MMS is performed by removed the skin cancer with mapped borders and processed in a way that the entire border can be analyzed microscopically. Any areas where skin cancer is still present as the borders of the excision is mapped so that further tissue can be excised from the carefully mapped areas. Overall, this allows for the minimum amount of tissue to be removed in excising the skin cancer and allows for high cure rates since the borders of the excision are checked for clearance before the procedure is completed.

​1.    Miller DL, Weinstock MA. Nonmelanoma skin cancer in the United States: incidence. J Am Acad Dermatol.1994;30(5 Pt 1):774-778; PMID: 8176018.

2.    Rogers HW, Weinstock MA, Harris AR, et al. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol.2010;146(3):283-287; PMID: 20231499.

3.    Situm M, Buljan M, Bulat V, et al. The role of UV radiation in the development of basal cell carcinoma. Coll Antropol.2008;32 Suppl 2:167-170; PMID: 19138022.

4.    Clark CM, Furniss M, Mackay-Wiggan JM. Basal cell carcinoma: an evidence-based treatment update. Am J Clin Dermatol.2014;15(3):197-216; PMID: 24733429.

5.    Geisse J, Caro I, Lindholm J, et al. Imiquimod 5% cream for the treatment of superficial basal cell carcinoma: results from two phase III, randomized, vehicle-controlled studies. J Am Acad Dermatol.2004;50(5):722-733; PMID: 15097956.