Basal Cell Carcinoma

Basal cell carcinoma is the most common form of skin cancer. This tumor is not life threatening, except in the rarest of circumstances when tumors go untreated for decades. For most, basal cell carcinoma grows slowly over years, and appears as a pimple-like growth that bleeds, heals, and re-bleeds. If untreated for many years, basal cell carcinoma my penetrate and destroy deeper tissues and can be mutilating.

Most basal cell carcinomas are caused by ultraviolet rays from the sun. It is known that chronic sun exposure, radiation, and tanning bed use can lead to the development of basal cell carcinomas. Genetics also plays a role, thus making some people more susceptible to this tumor.

Dr. Bader is the lead author in the leading online Dermatology textbook on basal cell carcinoma. Read about the treatment for Basal Cell Carcinoma on Medscape by clicking here.

Different TYPES of basal cell carcinoma

There are different histologic subtypes of basal cell carcinoma. These types are classified based on growth patterns that can be identified under the microscope.

Is this important? YES!!!!  Some types of basal cell carcinoma are more difficult to treat. Some are simpler. Some are deeply invasive. Some only grow superficially. Some may respond well to one treatment while other types may not.

Therefore, when one asks, "What is the best treatment for basal cell carcinoma?", one must take into account several factors when choosing the "best" treatment option, or even consider the option not to treat.

Such factors include: the age of the patient, the location of the tumor (i.e. is it close to the eye), the size of the tumor, the overall health of the patient (i.e. are able to undergo surgery), current medications (i.e. are they on blood thinners that they are unable to stop, the histologic subtype of the tumor, the cure rate for a specific treatment, the after care that might be required, the ability or desire of the patient to care for the site, the importance of a good cosmetic outcome after treatment, and cost.

Histologic Subtypes of Basal Cell Carcinoma:

There are several different types of basal cell carcinoma that are categorized by how they look under the microscope. Here are the most common types:

Nodular Basal Cell Carcinoma

Nodular Basal Cell Carcinoma is the most common type of basal cell carcinoma. This tumor usually looks like a pimple that bleeds, heals, and then re-bleeds. With time, these tumors enlarge and usually ulcerate (form an open sore) usually in the center. Under the microscope, these tumors grow as large, ball-like collections (or nodules), hence the name nodular basal cell carcinoma. This type of tumor is often treated with excision, electrodesiccation & curettage, Mohs’ micrographic surgery, or radiation.

Nodular Type

Basal Cell Carcinoma

Nodular Type

Ulcerated Basal Cell Carcinoma

Superficial Basal Cell Carcinoma

Superficial Basal Cell Carcinoma is common, and looks like a pink patch of skin that may have some scale and may have one or more tiny scabs. This type of basal cell is often misdiagnosed as eczema, ringworm, or psoriasis. The tumor cells are attached to the undersurface of the epidermis, the top layer of skin. Hence, it has been termed a superficial basal cell carcinoma. Treatment for this type of basal cell carcinoma is similar to those listed above for Nodular basal cell carcinoma, although topical creams, such as Aldara or 5-Fluorouracil, can be used.

basalcellsuperficial
basalcellsuperficial

Infiltrating Basal Cell Carcinoma

Infiltrating Basal Cell Carcinoma grows as strands of tumor cells the grow (infiltrate) between the collagen fibers within the dermis. For this reason, it is more difficult to identify the margins of the tumor clinically (by looking). These tumors do not have the typical pimple-like appearance of a nodular basal cell. These tumors are best treated using Mohs’ Micrographic Surgery, although wide excision and radiation are often used.

Morpheaform or Sclerosing Basal Cell Carcinoma

Morpheaform or Sclerosing Basal Cell Carcinoma often appears as a waxy, yellowish area or a scar. As they do not have the typical appearance of a nodular basal cell, rarely ulcerate, and look rather harmless, they are often not detected by the patient and non-Dermatologists. Often, these tumors are much larger than they appear, making treatment more difficult than other types of basal cell carcinoma. For this reason, Mohs’ Micrographic Surgery is the treatment of choice.

basalcellsclerotic
basalcellsclerotic

 

Read about the treatment for Basal Cell Carcinoma on Medscape by clicking here.