Stanley Loo Plastic SurgeonStanley Loo Plastic SurgeonBasal cell carcinoma (BCC) is the most common type of skin cancer.
It usually develops on areas of skin that receive significant sun exposure, particularly the head and neck.
BCCs generally grow slowly and are unlikely to spread to distant parts of the body, but they can cause significant local tissue destruction if left untreated.
Early assessment and treatment can therefore be important.
What Does Basal Cell Carcinoma Look Like?
BCC can have different appearances.
It may appear as:
A pearly or shiny lump
A persistent sore
A lesion that repeatedly crusts
A lesion that bleeds
A non-healing wound
A pink or red area
A lesion with visible small blood vessels
A skin lesion cannot reliably be diagnosed from appearance alone.
Causes and Risk Factors
Cumulative exposure to ultraviolet radiation is an important risk factor for BCC.
Other factors can influence risk, including individual skin characteristics, previous sun exposure and immune status.
Diagnosis
Diagnosis begins with clinical assessment.
A biopsy or excision may be required to confirm the diagnosis.
The current practice describes excisional biopsy as one method of confirming a skin cancer diagnosis.
There are several different types of BCCs which include:
Treatment of Basal Cell Carcinoma
There are many treatments for basal cell carcinomas. The treatments depend on the type of BCC you have and where it is located in the body.
Dr Stanley Loo is a specialist in the treatment of basal cell skin cancers and can advise on the best treatment for you in a consultation at his rooms at Auckland Plastic Surgery Group, Unit 6 / 31 Highbrook Drive, Highbrook, Auckland 2013 Ph (09) 220 2580
Treatment depends on:
Size
Location
Type
Depth
Previous treatment
Whether the lesion has recurred
Surgical excision is commonly used.
Treatment options may be appropriate for selected lesions including:
Creams
5 Flurouracil (Effudix) is a chemotherapeutic agent which can be used for superficial BCCs. The treatment period is several weeks.
Imiquimod is an immune response modulator which is recommended for superficial BCCs. The treatment period ranges from 6 – 16 weeks. Cryotherapy (Freezing) Cryotherapy is a treatment for superficial BCCs. Liquid nitrogen is used to freeze the superficial lesion. A blister forms, crusts over and heals with a small scar over several weeks.
Photodynamic therapy (PDT)
Photodynamic therapy is a technique where superficial BCCs are treated with a photosensitising chemical cream (Metvix) and exposed to light several hours later.
Curretage and Cautery
Some well defined Bccs can be removed by removing the top layers of the skin. However this can be unreliable due to the inability to determine whether the whole basal cell skin cancer has been removed.
Surgical Excision
This treatment is suitable for all types of basal cell carcinomas. The advantage of this treatment is that the specimen is sent to the laboratory to confirm the diagnosis and the extent of excision of the skin cancer can be determined.
Mohs micrographically controlled excision
This is a technique which is useful in the removal of ill defined or aggressive BCCs in high risk areas such as the eyes. It involves examining the tissue removed in the procedure under the microscope layer by layer. This procedure can take a prolonged period of time to complete.
Radiotherapy
Radiotherapy uses X rays to treat BCCs. It may be suitable for those who cannot tolerate surgery or other treatments.
Vismodegib
Vismodegib is a new treatment for advanced or metastatic basal cell carcinoma. It was approved by the FDA in March 2012.
BCC Excision and Reconstruction
Removing a BCC can leave a defect in the skin.
For a small lesion, direct closure may be possible.
Larger defects may require a skin graft or local flap.
Reconstruction of facial BCCs requires particular attention to structures such as the nose, eyelids, ears and lips.
Why Is Reconstruction Important?
The objective of reconstruction is not simply to close the wound.
It should also consider:
Function
Facial contours
Skin texture
Symmetry
Scar position
Long-term appearance
Follow-Up
Regular follow-up is important following treatment.
Your follow-up requirements depend on the type and location of the BCC and your individual risk factors.
FAQs
Is basal cell carcinoma dangerous?
BCC usually grows slowly and rarely spreads to distant organs, but untreated lesions can cause significant local damage.
Can BCC be completely removed?
Many BCCs can be successfully treated, but appropriate assessment and complete treatment are important.
Does BCC removal leave a scar?
Yes. The size and visibility of the scar depend on the lesion and reconstruction.
Can BCC come back?
Recurrence is possible, particularly with certain tumour types and locations.
Should I see a plastic surgeon for BCC?
A plastic surgeon can be particularly useful when the cancer is located on an area where reconstruction and preservation of function or appearance are important.
If you would like to discuss this further a consultation can be made with Mr Stanley Loo at Auckland Plastic Surgery Group, Unit 6 / 31 Highbrook Drive, Highbrook, Auckland 2013 Ph (09) 220 2580
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