Basal cell carcinoma

Basal cell carcinoma (BCC) is the most common type of skin cancer diagnosed in Australia. It is characterised by uncontrolled growth in the skin’s basal cells. It typically presents as a small, pearly bump or scaly red mark, often on sun-exposed areas such as the face, ears, and neck. BCCs grow slowly and rarely metastasise, but if left untreated, they can cause significant local damage.

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Key Points

What is basal cell carcinoma?

Basal cell carcinoma is a type of skin cancer that begins in the basal cells – a type of cell within the skin that produces new skin cells as old ones die off. It often appears as a slightly transparent bump on the skin, though it can take other forms as well.

Who gets basal cell carcinoma?

BCC is more common in individuals with fair skin, but it can occur in people of any skin type. Those with a history of frequent sun exposure or who have used tanning beds are at higher risk. It’s more common in older adults but can occur at any age.

Clinical features

BCC often presents as a small, shiny bump that’s pearly or translucent, and may have tiny blood vessels visible on the surface. It can also appear as a flat, scaly, reddish patch with a raised edge. There are several variants of BCC that can appear different to the typical BCC.

Diagnosis and differential diagnosis

Diagnosis involves a skin examination and usually a biopsy. Differential diagnosis includes squamous cell carcinoma, melanoma, and benign skin lesions such as intradermal naevi and seborrheic keratosis.

Impact and complications

While BCCs are slow-growing, they can invade surrounding tissue and bone if left untreated, leading to significant local damage. They seldom metastasise but can recur in the same place.

Subtypes and variants

The main subtypes of BCC include 

  • Nodular BCC –  Most common, pearly and translucent.
  • Superficial BCC –  Appears as a red, scaly patch.
  • Morphoeic or Infiltrating BCC –  White, waxy, scar-like.

Causes and triggers of basal cell carcinoma

  • Sun Exposure –  Primary cause, especially intense or prolonged exposure.
  • Genetic Predisposition –  Risk increases with family history of BCC.
  • Radiation Exposure –  Past radiation treatment can be a risk factor.
  • Immune System Suppression –  Immunocompromised individuals have higher risk.

Treatment options for basal cell carcinoma

The treatment for basal cell carcinoma (BCC) varies depending on the size, depth, and location of the cancer, with surgical removal being the most commonly employed method. Curettage with cautery, which scrapes away the cancer cells and uses electricity to kill any that are left is commonly employed for superficial BCCs. Topical treatments are also commonly employed treatment options for superficial BCCs. Photodynamic therapy is also a common option, where a photosensitising agent is used in conjunction with light exposure to effectively destroy cancer cells. Radiation therapy is considered for cases where surgery isn’t a viable option, such as when the cancer is in a difficult-to-treat location or for patients who cannot undergo surgery. Targeted drug therapy is reserved for advanced BCC that cannot be treated with surgery or radiation. The expectations and outcomes are generally positive, with high cure rates when the cancer is treated early. Regular follow-up appointments are crucial to monitor for any recurrence of the cancer.

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