Skin cancer is one of the most common cancers. In general skin cancer can be divided into non-melanoma (BCC and SCC) and melanoma (malignant melanoma). Sun exposure is the single most preventable risk factor for skin cancer.
What is a basal cell carcinoma?
- Malignant tumour of epidermal keratinocytes normally in older individuals
- Only rarely metastasies
Most common malignant skin tumour
What are the risk factors for basal cell carcinoma?
- Hx of frequent or severe sunburn in childhood
Skin type I (always burns, never tans)
- Increasing age
Prev hx of skin cancer
How does BCC present?
- Various morphological types → nodular (most common), superficial (plaque-like), cystic, morphoeic (sclerosing), keratotic and pigmented
- Nodular BCC is a small, skin-coloured papule or nodule w/ surface telangiectasia, and a pearly rolled edge; the lesion may have a necrotic or ulcerated centre (rodent ulcer)
- Most common over the head and neck
Generally, if a BCC is suspected, a routine referral should be made. What is the management for BCC?
Surgical excision → treatment of choice as it allows histological examination of tumour and margins
Mohs micrographic surgery (ie. excision of lesion + tissue borders are progressively excised until specimens are microscopically free of tumour) → for high risk, recurrent tumours
Radiotherapy → when surgery not appt
Curettage + Cautery
- Topical photodynamic therapy
Topical treaments eg. imiquimod, fluorouracil
What are complications of BCC?
Local tissue invasion and destruction
What is the prognosis for BCC?
- Depends on tumour size, site, type, growth pattern/histological subtype, failure of prev treatment/recurrence, and immunosuppression
- Most BCCs are cured by treatment. Cure is most likely if treatment is undertaken when the lesion is small.
About 50% of people with BCC develop a second one within 3 years of the first. They are also at increased risk of other skin cancers, especially melanoma. Regular self-skin examinations and long-term annual skin checks by an experienced health professional are recommended.
How can basal cell carcinoma be prevented?
The most important way to prevent BCC is to avoid sunburn. This is especially important in childhood and early life. Fair skinned individuals and those with a personal or family history of BCC should protect their skin from sun exposure daily, year-round and lifelong.
- Stay indoors or under the shade in the middle of the day
- Wear covering clothing
- Apply high protection factor SPF50+ broad-spectrum sunscreens generously to exposed skin if outdoors
- Avoid indoor tanning (sun beds, solaria)