Doctors Say These are the Signs of Basal Cell Cancer, Including Skin Spots
Skin cancer is preventable, yet remains the most common type of cancer and the statistics are scary. According to the Skin Cancer Foundation, "1 in 5 Americans will develop skin cancer by the age of 70." While many cases are successfully treated, skin cancer can be deadly. The SCF states, "In the U.S., more than 9,500 people are diagnosed with skin cancer every day. More than two people die of the disease every hour."
There's a few different types of skin cancer, but, "Basal cell carcinoma (BCC) is the most common form of skin cancer. An estimated 3.6 million cases of BCC are diagnosed in the U.S. each year," the SCF says and there's one big misconception about the cancer. "This is not just a disease of "old people," Jennifer Gordon, MD, board-certified dermatologist, Westlake Dermatology, Austin, tells us. "We are seeing it consistently more often in younger patients- even in their 20s and 30s."
While basal cell carcinoma can affect anyone, there is good news. Dr. Gordon says, "Basal cell carcinoma is the most common form of skin cancer, however it is also the easiest to treat and cure. I always say, if you have to have cancer, this is the type you want to have. With local skin surgery and monitoring, it should not be life-threatening." Seeing a dermatologist at least once a year is also recommended. Dr. Gordon advises, "If you think you have a suspicious spot, go see your dermatologist for a skin check. Often they will find spots you haven't even noticed yet. Although BCCs are easily cured by surgery most of the time, the longer you let a spot go, the bigger it will become so the scar will be larger." Eat This, Not That! Health spoke with several experts who share what to know about basal cell carcinoma and signs that indicate you could have the disease. As always, please consult your physician for medical advice.
What to Know About Basal Cell Carcinoma
Kim Margolin, M.D., FACP, FASCO, medical oncologist and medical director of the Saint John's Cancer Institute Melanoma Program at Providence Saint John's Health Center in Santa Monica, CA says, "It is the single most common skin cancer/any cancer and behaves VERY unaggressive, but in rare instances, can grow aggressively and require more invasive procedures than a simple excision by a dermatologist."
Dr. Brian Toy, a dermatologist with Providence Mission Hospital in Mission Viejo, Calif. tells us, "Basal cell carcinoma is the most common form of cancer in the United States. It is more common than breast, colon, and prostate cancer combined. Basal cell carcinoma is slow growing, and in most cases, is completely curable. Because the five-year survival rate is virtually 100%, basal cell carcinoma does not grab headlines in the news like other, more lethal forms of cancer. However, First Lady Jill Biden was diagnosed with two basal cell carcinomas just in the last week."
Karan Lal DO MS FAAD Double Board certified adult and pediatric dermatologist and fellowship trained Cosmetic dermatologist. Affiliated Dermatology Scottsdale, AZ, Northwell Health, NY adds, "Basal cell carcinoma is the most common skin cancer. It is often located in areas of intense sun exposure. It is due to prolonged and unprotected sun protection."
Why Basal Cell Carcinoma is So Common
Dr. Margolin says, "It is almost entirely attributable to chronic sun exposure, and most people who live in warm climates spend enormous amounts of time getting sun exposure without adequate sun protection."
Dr. Toy states, "Basal cell carcinoma is caused by ultraviolet radiation from the sun. Cumulative, lifetime exposure to the sun is directly correlated to risk of developing basal cell carcinoma. As our life expectancy has increased over the past few decades, so has our relative risk for developing skin cancer. The baby-boomer generation, which grew up in the era of tanning with baby oil and iodine, is now confronting an epidemic of skin cancer."
Dr. Gordon tells us, "We know that UV radiation is a common contributor to the cause of BCC, however there are likely other factors that also trigger their potential formation (such as genetics, other potential carcinogens, etc). BCCs happen because of a transformation of your skin cells into a cancerous cell that overgrows. Since they are derived from actual skin cells in the basal layer of your skin (hence the name), it makes sense that they are one of the most common types of skin cancer."
Dr. Lal says, "It is most common amongst white patients given their susceptibility to sun burns and sun damage. Sun exposure induces mutations in the skin genes that induce basal cell cancer formation."
Dr. Margolin explains that risk factors include, "Steady, chronic sun exposure and fair skin that doesn't tan well—there are also familial syndromes of multiple BCCs."
According to Dr. Toy, "Individuals at highest risk for developing basal cell carcinoma are typically fair skinned. Those with darker complexions can be affected too, albeit more rarely. Cumulative, lifetime exposure to the sun plays the biggest role, which is why basal cell carcinoma is seen more commonly in older individuals. However, I have occasionally diagnosed basal cell carcinoma in teenagers and twenty-year-olds, too."
Dr. Gordon says, "Sun exposure! Particularly sun burns and use of tanning beds. Basal cell carcinomas are sometimes more common in people with long-term sun exposure, so certain professions, hobbies and locales can put you at a higher risk over time. There are also some genetic risk factors."
Signs of Basal Cell Carcinoma
According to Dr. Margolin, "Most often, they are medium-sized (from about a quarter of an inch) to about a half of an inch, with a color that is the same or a little darker than underlying skin, and the edges are often slightly rolled up."
Dr. Toy explains, "Basal cell carcinoma begins as a spot on the skin that just doesn't heal. It typically occurs on a sun-exposed area like the face, although it can occur anywhere on the body with enough sun exposure. Basal cell carcinoma gets progressively worse over time, and the spot may form an ulcer and begin to bleed. This is a telltale sign that something isn't right. Skin cancers never get better on their own – they just continue to grow over time and only get worse. I tell my patients if they have a spot on their skin that just won't heal and it's been more than a month, then they need to see a dermatologist."
Dr. Gordon says, "Normally it can look just like a small, pearly skin colored papule (bump). It often bleeds easily and slowly grows. Over time it can start to cause an ulcer or chronic wound. Sometimes they can present as just a small pink, scaly patch as well. Since they are very non-specific, it is always good to have your board certified dermatologist do an examination for you. They are often present in the most sun-exposed areas, but can be present anywhere."
Dr. Lal states, "They often look like pearly bumps or pimples that don't heal. They are friable and bleed easily with trauma. Sometimes they can look like an ulcer."
You Can Help Lower the Risk of Basal Cell Carcinoma
Dr. Margolin emphasizes, "Take maximal sun-protective measures. This will also protect against squamous carcinoma, a somewhat more aggressive skin malignancy that has similar risk factors to BCC but is less common, and melanoma, which is much less common but much more aggressive. Whether dietary measures like enhanced vitamin D intake can prevent any of these diseases remains controversial, and it should not be counted on to confer protection."
Dr. Toy shares, "Basal cell carcinoma is best prevented by taking precautions in the sun. Judicious use of sunblock, wearing sun-protective clothing, and limiting sun exposure during the peak daylight hours will all mitigate your risk of developing skin cancer. Monthly self-examinations at home and annual, preventative visits with your dermatologist will lead to early detection. Early diagnosis is the key to an optimal outcome, as treatment can be cosmetically disfiguring the longer you wait. When in doubt, see a board-certified dermatologist who can make a diagnosis easily and recommend the best treatment option for you."
Dr. Gordon advises to wear a daily "SPF! Daily no matter what and with re-application every 1-2 hours. Seek shade, wear hats and sun-protective clothing, limit your time outside during peak UV radiation and make sure to get your yearly screenings with your dermatologist."
Dr. Lal explains, "The best thing you can do is wear sunscreen. This is the one thing that we know can reduce your risk of developing skin cancer. You want to make sure you wear an SPF 30 broad spectrum sunscreen and reapply it every 2 hours when out in the sun."
Dr. Margolin says, "Many BCCs will grow slowly and will never bother the person. However, as mentioned above, they can rarely grow more aggressively, infiltrating into normal tissues requiring surgery or chemotherapy or immunotherapy to control. Sometimes their behavior changes with certain mutations that make the cells look different than a typical BCC and possibly not respond as well to these measures."
Dr. Toy explains, "Most basal cell carcinomas can be cured with a surgical procedure under local anesthesia. Chemotherapy and radiation are rarely needed and only used in the most unusual of cases. There is a topical form of chemotherapy, called fluorouracil 5% cream, which can be used in very early basal cell carcinoma (called superficial basal cell carcinoma), thus avoiding surgery. The vast majority of basal cell carcinomas, however, are treated surgically. These procedures involve scraping and burning of the tumor (called curettage and electrodessication) or excising the lesion with a scalpel and sewing the skin back together. A specialized procedure called Mohs surgery is reserved for delicate locations like the eyelids, nose, and ears."
If left untreated, Dr. Gordon says, "Over time they will grow and cause local destruction to your skin. Rarely do they metastasize and cause internal cancer, however it can happen."
Dr. Lal explains, "Basal cell carcinoma is notorious for forming large non healing wounds. If untreated these cancers can grow and destroy local tissue. Basal cell skin cancer rarely metastasizes but it can."