Basal Cell Carcinoma (BCC)

Basal cell carcinoma (BCC) is the most common skin cancer in humans. However it rarely spreads to other parts of the body or kills but it can cause significant destruction and disfigurement by invading surrounding tissues.

Basal cell skin cancer tumours typically appear on sun exposed skin and are slow growing. The majority (70%) of basal cell skin cancers occur in the head and neck region, 25% occur on the trunk of the body and 5% in the remainder of the body.

People with fair skin are more prone to develop BCCs and the likelihood of developing basal cell skin cancer increases with age. People aged 50 - 80 are affected most often, but the damaging effects of the sun begin at an early age and may not appear for 20 - 30 years.

Causes of Basal Cell Carcinoma

The exact cause of BCC is unknown but environmental and genetic factors are believed to predispose patients to BCC.

Sunlight particularly chronic exposure is the most frequent association with the development of BCC. The risk correlates with the amont and nature of accumulated exposure, especially during childhood. Ultraviolet (UV) light (particularly UVB) can lead to DNA damage and mutations which can lead to skin cancer.

Types of Basal Cell Carcinoma

There are several different types of BCCs which include:

Nodular BCC                                                 - shiny skin coloured or pinkish lump
                                                                          - blood vessels cross its surface
                                                                          - may have central ulcer (rodent ulcer)
 
Superficial BCC                                            - pink or red scaly irregular plaques
                                                                         - bleed or ulcerate easily

Morphoeic BCC                                            - also known as sclerosing BCC
                                                                          - skin coloured, waxy, scar like
                                                                          - can infiltrate nerves and therefore reoccur

Pigmented BCC                                            - brown, blue or greyish in appearance
                                                                         - may look like a melanoma

Treatment of Basal Cell Carcinoma

There are many treatments for basal cell carcinomas. The treatments depend on the type of BCC you have and where it is located in the body. 

Mr Stanley Loo is a specialist in the treatment of basal cell skin cancers and can advise on the best treatment for you in a consultation at his rooms at East Care Medical Specialist Centre, 260 Botany Road, Howick, Auckland

Treatments for BCC include: 

Creams
5 Flurouracil (Effudix) is a chemotherapeutic agent which can be used for superficial BCCs.  The treatment period is several weeks.

Imiquimod is an immune response modulator which is recommended for superficial BCCs. The treatment period ranges from 6 – 16 weeks. Cryotherapy (Freezing) Cryotherapy is a treatment for superficial BCCs. Liquid nitrogen is used to freeze the superficial lesion. A blister forms, crusts over and heals with a small scar over several weeks.  

Photodynamic therapy (PDT)

Photodynamic therapy is a technique where superficial BCCs are treated with a photosensitising chemical cream (Metvix) and exposed to light several hours later. 

Curretage and Cautery
Some well defined Bccs can be removed by removing the top layers of the skin. However this can be unreliable due to the inability to determine whether the whole basal cell skin cancer has been removed.  

Surgical Excision

This treatment is suitable for all types of basal cell carcinomas. The advantage of this treatment is that the specimen is sent to the laboratory to confirm the diagnosis and the extent of excision of the skin cancer can be determined. 

Mohs micrographically controlled excision
This is a technique which is useful in the removal of ill defined or aggressive BCCs in high risk areas such as the eyes. It involves examining the tissue removed in the procedure under the microscope layer by layer. This procedure can take a prolonged period of time to complete. 

Radiotherapy
Radiotherapy  uses X rays to treat BCCs. It may be suitable for those who cannot tolerate surgery or other treatments.  

Vismodegib
Vismodegib is a new treatment for advanced or metastatic basal cell carcinoma. It was approved by the FDA in March 2012.


If you would like to discuss this further a consultation can be made with Mr Stanley Loo at East Care Medical Specialist Centre, 260 Botany Rd, Howick, Auckland. Phone no. (09) 277 1540 or Ormiston Specialist Centre, 125 Ormiston Rd, Flat Bush, Auckland, Ph (09) 271 3305

Post operative care for skin cancer surgery