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Basal Cell Carcinoma

Basal Cell Carcinoma (BCC) is the most common human cancer, with perhaps up to 2 million diagnosed per year in the US.  BCC arises from the top layer of skin (epidermis) and is found most often on areas of high sun-exposure such as the head and neck.  There is a strong link between BCC and sun exposure, and it occurs most frequently in patients with very fair skin.   It does also occur in patients who tan well and with more darkly pigmented skin (Hispanic patients).  The tendency to develop BCC can also run in families.

Every basal cell carcinoma has a different growth pattern.  Many BCCs grow in a uniform nodular pattern, and it can be quite easy to see the margins and cure with simple excision or curettage.  The superficial BCC grows along the very surface without invasion.  Although the margins can be occasionally hard to see with a superficial BCC, often these respond well to topical medical treatments as well as surgical ones.  Other growth patterns are more aggressive.  These include infiltrative, micronodular, morpheaform and sclerotic.  These types can grow deeper and wider than can be seen with the naked eye and are much more likely to recur if not completely removed. 

Basal cell carcinomas can present in different ways.  Nodular BCC tend to be a slow-growing, pearly bump with small, visible red blood vessels.  Superficial BCC is a very thin, rough pink patch.  Morpheaform and sclerotic BCCs can form a yellow, waxy firm lesion that resembles a scar.  Most BCCs are fragile and can ulcerate and bleed with mild trauma or rubbing the area.

Left untreated, basal cell carcinoma can grow quite large and disfiguring.  Large BCC tumors cause pain, irritation, and bleeding.  It is extremely rare for BCC to metastasize (spread internally through lymph nodes or the blood stream), but they grow by direct extension and can eventually spread into cartilage, nerves, sinuses, eyes, and even bone, requiring extensive procedures to treat.  It is rare for BCC to be fatal.

Mohs micrographic surgery is the gold standard for the treatment of BCC.  Mohs yields cure rates of 99% for previously untreated BCC, and 95% for previously treated BCC.


 

Classic appearance of a nodular BCC.  It is dome-shaped, with a pearly sheen, small visible blood vessels and breakdown with scab formation. 
This BCC is forming a non-healing sore on the forehead of a 32 year-old woman.
Loss of eyelashes at the site of this BCC indicates that the tumor is destroying underlying structures of the skin that it invades. 
Some BCC are pigmented, or dark in color.  This is often seen in darker-skinned patients.

Some BCC are quite subtle. This small tumor is more noticeable as a change in texture of the cheek in this 43 year-old woman.
This irritated, scaly patch on the lower leg of a 55 year-old woman is a superficial BCC.  It grows slowly with little invasion. It is so superficial that it may be cured by curettage (scraping the top layer of skin away), or even by treatment with topical medication.
   
 
 
                 
Recurrent BCC: Tumor was left behind. Note the ring of pink tumors extending toward the eye from white scar from previous treatment. Recurrent BCC tumors can be extensive and difficult to cure.
  


   
What happens if you don't treat a BCC? It can grow deep and cause extensive tissue damage. This neglected tumor is destroying the soft tissue and underlying cartilage of this woman's nose.



   
Infiltrative BCC.  This aggressive tumor extended under the skin beyond what could be seen with the naked eye, and required major reconstructive surgery to the repair the resulting wound.