Basal cell carcinoma (BCC) is a type of skin cancer that arises from the innermost layer of the epidermis and contains small round cells called basal cells. The basal cells continually divide, and new cells constantly push older ones up toward the surface of the skin, where they are eventually shed.

When basal cells become cancerous, they will divide without stopping, create pink bumps that may turn into sores, and start to invade deeper tissues. While BCC typically does not metastasize, it can be locally destructive, causing significant damage to the skin, tissue, and even bone.

The main risk factor for BCC is exposure to UV radiation, either from the sun or other artificial devices such as tanning beds. The main genetic risk factor for BCC is having fair skin and light-colored eyes.

Intense intermittent sun exposure that leads to sunburn is more closely associated with BCCs than chronic long-term sun exposure. Those with a history of sunburn and intense sun exposure during childhood (think “vacation” sunburns) have a higher risk of BCC, which is why pediatricians advocate for sun protection in children. It is estimated that aggressive sun protection before the age of 18 years could reduce the number of non-melanoma skin cancers by almost 80%.

Other risk factors for BCC include chronic arsenic exposure, radiation therapy, and long-term immunosuppression, as well as a number of rare genetic syndromes.

Individuals with a history of BCC are at increased risk for developing subsequent lesions. Approximately 40 percent of patients who have had one BCC will develop another lesion within five years.

BCCs can be classified by how they appear and grow on the skin, or what they look like under the microscope. There are several subtypes of BCCs, including:

• Nodular BCCs are the most common type. They present as a dome-shaped pink pearly, shiny bump with tiny blood vessels.
• Superficial BCCs can be a little more difficult to diagnose. They present as a shiny pink or red, slightly scaly patch that grows slowly. They are sometimes mistaken as a rash or eczema.
• Infiltrative BCCs are the most aggressive forms of BCCs. They can present as an ill-defined pink area, which sometimes looks like a scar.

If you have had a lesion for over one to two months and it is not healing, it needs to be evaluated. BCCs can be neglected for years because most of the time they don’t hurt. It is very common for patients to complain of a spot that scabs, heals, then bleeds and scabs again, having gone through multiple cycles.

Your dermatologist will perform a biopsy of the suspicious lesion and send it to the lab for analysis. A biopsy is a simple in-office procedure in which the skin is numbed and the specimen is removed with a blade. A bandage is applied on the site. You will be asked to keep the site clean and apply a small amount of Vaseline on it daily until it heals. During this time, the specimen will be evaluated in the lab by a dermatopathologist.

Basal cell carcinoma may be treated with surgical or nonsurgical techniques, depending on its subtype, size, and location. Surgical treatments include electrodissection and curettage (ED&C, also known as scraping and burning), excision, and Mohs micrographic surgery.

Nonsurgical techniques include topical treatments, oral medications, and radiation therapy. Superficial BCCs may be treated with topical creams. Radiation and oral medications are often reserved for large or metastatic cancers that cannot be treated surgically.

An excision is when the area around the skin cancer is cleaned and numbed, and the tumor is surgically removed with margins. The site is then immediately sutured. The specimen is sent to the lab and processed, which takes several days. A dermatopathologist then reads the slides under the microscope and determines if the cancer was fully removed. Many basal cell carcinomas can be treated effectively with an excision.

Mohs micrographic surgery is a procedure in which the tumor is removed and the margins are evaluated on the same day. The area is cleaned and numbed, and the tumor is surgically removed with margins. The Mohs surgeon evaluates the tissue and 100% of the margin is examined as the patient waits in the procedure room.

If a residual tumor is found, additional tissue is removed until it is all clear. Because the margins are narrower, Mohs often results in smaller scars.

Mohs is only indicated in certain circumstances, as in cases of tumors on critical areas (such as the face, hands, genitalia), or for aggressive subtypes or larger cancers.

Most basal cell carcinomas are treatable and curable. They rarely spread to other parts of the body (metastasis rate is < 1%). Better outcomes are always achieved when BCCs are diagnosed and treated early.

If left untreated, they will continue to grow, progressing to a lesion that bleeds, ulcerates, and never heals. Eventually, the tumor starts to invade underlying tissue such as muscle, cartilage, and bone, and is capable of extensive tissue destruction.

Call us at one of our offices to schedule an appointment with a dermatology provider, or request an appointment online.

• North and South Colorado Springs & Woodland Park: (719) 355-1585
• Pueblo & Cañon City: (719) 543-1111