Basal Cell Carcinoma
How Is Basal Cell Carcinoma Treated?
There are many ways to successfully treat a basal cell carcinoma. The doctor's main goal is to remove or destroy the cancer completely with as small a scar as possible. To plan the best treatment for each patient, the doctor considers the location and size of the cancer, the risk of scarring, and the person's age, general health, and medical history.
Methods used to treat basal cell carcinomas include:
Curettage and desiccation: Dermatologists often prefer this method, which consists of scooping out the basal cell carcinoma by using a spoon like instrument called a curette. Desiccation is the additional application of an electric current to control bleeding and kill the remaining cancer cells. The skin heals without stitching. This technique is best suited for small cancers in non-crucial areas such as the trunk and extremities.
Surgical excision: The tumor is cut out and stitched up.
Radiation therapy: Doctors occasionally use radiation treatments for skin cancer occurring in areas that are difficult to treat with surgery, particularly in elderly patients. Obtaining a good result generally involves many treatment sessions, perhaps 15 to 20.
Cryosurgery: Some doctors trained in this technique achieve good results by freezing basal cell carcinomas. Typically, liquid nitrogen is applied to the growth to freeze and kill the abnormal cells.
Mohs micrographic surgery: Named for its pioneer, Dr. Frederic Mohs, this technique of removing skin cancer is better termed, "microscopically controlled excision." The surgeon meticulously removes a small piece of the tumor and examines it under the microscope. This sequence of cutting and microscopic exam is repeated in a painstaking fashion so that the basal cell carcinoma can be mapped and taken out without having to estimate or guess the width and depth of the lesion. This method removes as little of the healthy normal tissue as possible. The cure rate is very high, exceeding 98%. Mohs micrographic surgery is preferred for large basal cell carcinomas, those that recur after previous treatment, or lesions affecting parts of the body where experience shows that recurrence is common after treatment by other methods. Such body parts include the scalp, ears, and the corners of the nose. In cases where large amounts of tissue need to be removed, the Mohs surgeon sometimes works with a plastic (reconstructive) surgeon to achieve the best possible post-surgical appearance.
A new drug, vismodegib, has recently been approved by the FDA for locally recurrent or advanced basal cell carcinoma.
How Is Basal Cell Carcinoma Prevented?
Avoiding sun exposure in susceptible individuals is the best way to lower the risk for all types of skin cancer, including basal cell carcinoma. Regular surveillance of susceptible individuals, both by self-exams and regular physical exams, is also a good idea for people at higher risk. People who have already had any form of skin cancer should have regular medical checkups.
Common sense preventive techniques include:
- Limiting recreational sun exposure, especially between the hours of 10 a.m. and 2 p.m.
- Avoiding unprotected exposure to the sun
- Wearing broad-brimmed hats and tightly-woven protective clothing while outdoors in the sun
- Regularly using a water-resistant sunscreen with UVA and UVB protection and SPF number of 30 or higher
- Undergoing regular checkups and bringing any suspicious-looking or changing lesions to the attention of the doctor