Understanding the causes of basal cell carcinoma is critical for both prevention and early diagnosis. BCC is most commonly caused by excessive exposure to ultraviolet (UV) radiation, but there are several other factors that can contribute to the development of this skin cancer.

1. Ultraviolet (UV) Radiation Exposure

UV radiation from the sun or tanning beds is the primary cause of basal cell carcinoma. When skin is exposed to UV radiation, the DNA in the skin cells can become damaged. Over time, this damage can lead to abnormal growth and the formation of tumors, including BCC. UV radiation can be categorized into UVB and UVA rays:

• UVB rays: Responsible for sunburns and the direct DNA damage in the skin cells.

• UVA rays: Penetrate deeper into the skin, leading to premature aging and contributing to skin cancer development.

People who have significant and repeated sun exposure are at a higher risk of developing basal cell carcinoma. Activities such as outdoor sports, beach visits, or working outside without proper sun protection increase the risk. Moreover, sunburns during childhood can increase the lifetime risk of skin cancers like BCC.

2. Tanning Beds

Artificial tanning beds also expose the skin to harmful UV radiation, which is a significant risk factor for developing skin cancer, including BCC. The use of tanning beds has increased over the years, particularly among young women, and this trend has been associated with a rise in skin cancer cases.

3. Fair Skin Type

People with fair skin, light-colored eyes, and blonde or red hair are at a greater risk of developing BCC. This is because they have less melanin, the pigment that helps protect the skin from the harmful effects of UV radiation. Individuals with darker skin have a natural defense against UV rays, making them less prone to skin cancer, although they are not completely immune.

4. Age and Gender

Basal cell carcinoma is more common in older adults, particularly those over the age of 50. This is due to the cumulative effects of UV exposure over a lifetime. However, younger individuals, particularly those who have had a significant amount of sun exposure, can also develop BCC. Men are generally at a higher risk than women, possibly due to lifestyle factors, such as spending more time outdoors or working in sun-exposed environments.

5. Family History and Genetic Factors

Having a family history of skin cancer, particularly BCC, can increase the risk of developing the condition. Certain genetic mutations are linked to a higher likelihood of developing basal cell carcinoma, particularly in individuals with Gorlin syndrome, also known as nevoid basal cell carcinoma syndrome. This rare inherited condition leads to the formation of multiple BCCs at a young age.

6. Previous Skin Cancer

Individuals who have had basal cell carcinoma in the past are more likely to develop additional BCCs. Once a person has been diagnosed with one BCC, the skin’s vulnerability to cancerous changes increases, and recurrent or new tumors may form over time.

7. Immunocompromised States

People with weakened immune systems, such as those with HIV/AIDS, or those who have undergone organ transplants or long-term immunosuppressive therapy, are at an increased risk of developing basal cell carcinoma. These individuals are less able to repair damaged DNA and fight off abnormal skin cells, making them more susceptible to developing cancerous lesions.

The symptoms of basal cell carcinoma can vary depending on the type and location of the tumor. In many cases, BCCs develop on sun-exposed areas of the body and are typically slow-growing. Below are the most common symptoms and signs of BCC:

1. Pearly or Waxy Bumps

Basal cell carcinoma often presents as shiny, pearly bumps or nodules that are flesh-colored, pink, or white. These lesions are typically smooth with a raised edge and may have visible blood vessels running through them. They are often found on the face, ears, neck, or scalp, which are the areas most frequently exposed to the sun.

2. Open Sores or Ulcers

Another common form of BCC appears as open sores, ulcers, or crusted lesions that bleed or ooze. These lesions may form a scab and may have difficulty healing. Even if the lesion heals, it may recur after some time, which is characteristic of BCC.

3. Flat, Scaly Patches

Some types of basal cell carcinoma may appear as flat, scaly patches on the skin. These patches are typically lighter in color compared to the surrounding skin and may be more noticeable in areas such as the back, chest, or shoulders.

4. Itching or Tenderness

In some cases, BCCs may cause itching, tenderness, or a mild painful sensation. The skin around the tumor may feel irritated due to inflammation or the growth of the tumor.

5. Bleeding and Discharge

As the BCC tumor grows, it may begin to bleed, ooze, or produce a clear fluid. In some instances, there may be frequent scabbing and crusting, which can cause discomfort or embarrassment.

6. Slow Healing Wounds

One of the most common signs of basal cell carcinoma is a wound or lesion that does not heal. It may repeatedly scab, bleed, or become irritated but fail to heal properly. This is often due to the tumor obstructing normal skin regeneration processes.

Diagnosing basal cell carcinoma involves a combination of clinical examination, biopsy, and imaging tests. These steps help the healthcare provider confirm the presence of cancer, determine its stage, and develop an appropriate treatment plan.

1. Physical Examination

The process begins with a thorough physical exam, during which the healthcare provider will examine the patient’s skin, particularly areas of sun exposure. The doctor will note the appearance, size, shape, and characteristics of the suspicious lesion.

2. Skin Biopsy

To confirm the diagnosis, a skin biopsy is necessary. During a biopsy, a small sample of the suspicious lesion is taken and examined under a microscope. A punch biopsy or shave biopsy technique may be used, depending on the location and depth of the lesion. The biopsy helps determine if the lesion is cancerous and if it is a basal cell carcinoma.

3. Dermoscopy

Dermoscopy is a non-invasive technique that allows the dermatologist to examine the skin lesion in more detail using a special magnifying lens and light. This technique can help differentiate BCC from other benign skin conditions, such as seborrheic keratosis or actinic keratosis.

4. Imaging Tests

In some cases, imaging tests like CT scans or MRI may be used to assess the extent of the tumor and check for any spread to surrounding tissues or lymph nodes. This is typically reserved for larger tumors or when the BCC has invaded deeper tissues.

Treatment for basal cell carcinoma depends on several factors, including the size, location, type, and stage of the tumor. Most BCCs are highly treatable, and early intervention can prevent further complications. The main treatment options include:

1. Surgical Excision

The most common and effective treatment for basal cell carcinoma is surgical excision. This involves removing the tumor and some surrounding healthy tissue. Stitches are used to close the wound. Surgical excision is typically recommended for BCCs that are well-defined and located in areas where complete removal is possible.

2. Mohs Micrographic Surgery (MMS)

Mohs micrographic surgery is a highly precise surgical technique used for high-risk or cosmetically sensitive areas (e.g., face, ears). During the procedure, the tumor is removed in layers, and each layer is examined under a microscope to ensure complete removal of the cancerous tissue. MMS has the highest cure rate for basal cell carcinoma and is preferred for tumors that have ill-defined borders or have recurred.

3. Cryotherapy (Cryosurgery)

Cryotherapy involves the application of extreme cold to the tumor, using liquid nitrogen to freeze and destroy the cancerous cells. Cryosurgery is typically used for superficial BCCs that are small and not located in sensitive areas.

4. Radiation Therapy

For patients who are not candidates for surgery or for BCCs that are difficult to remove, radiation therapy may be used. Radiation can effectively shrink tumors and destroy cancer cells, though it is generally reserved for more complex cases.

5. Topical Treatments

For superficial BCCs, topical treatments such as 5-fluorouracil (5-FU) or imiquimod may be applied directly to the tumor. These medications help destroy cancer cells and are effective in treating early-stage BCCs.

6. Photodynamic Therapy (PDT)

In photodynamic therapy, a light-sensitive drug is applied to the skin, and the tumor is exposed to a specific wavelength of light, which activates the drug and destroys the cancer cells. PDT is most effective for superficial BCCs.

While basal cell carcinoma cannot always be prevented, taking steps to reduce UV exposure and practicing good sun safety can significantly lower the risk. Management also involves regular skin checks and early treatment of any suspicious lesions.

1. Sun Protection

The best way to prevent BCC is by protecting the skin from UV radiation:

• Use sunscreen with an SPF of at least 30 every day, even on cloudy days.

• Wear protective clothing, including hats and sunglasses, when outdoors.

• Avoid tanning beds and limit sun exposure, especially between 10 a.m. and 4 p.m., when the sun’s rays are the strongest.

• Seek shade whenever possible, especially during peak sunlight hours.

2. Regular Skin Examinations

Performing regular self-exams of the skin can help identify new or changing growths. Annual skin exams by a dermatologist are recommended for individuals with fair skin, family history of skin cancer, or multiple BCCs.

3. Post-Treatment Care

After treatment, it is important to follow post-surgical care instructions to ensure proper healing. This includes caring for the wound site, avoiding sun exposure during the healing process, and keeping follow-up appointments with your healthcare provider.

While basal cell carcinoma is rarely fatal, it can cause significant complications, particularly if left untreated:

1. Local Tissue Damage

If untreated, BCC can cause extensive tissue damage, particularly in critical areas like the eyes, nose, or mouth. Tumors can invade surrounding tissue and structures, leading to disfigurement.

2. Recurrence

BCCs can recur, especially if they were not completely removed or if treatment was delayed. Regular follow-ups and check-ups are essential for detecting recurrence.

Living with basal cell carcinoma requires regular monitoring and proactive care. Although it is typically not life-threatening, the emotional impact of a cancer diagnosis and ongoing care can be challenging.

1. Psychological Support

A skin cancer diagnosis can be emotionally overwhelming. Support from family, friends, and counselors is crucial for coping with anxiety, depression, or concerns about the appearance of the skin. Joining support groups for individuals with skin cancer may also provide comfort.

2. Ongoing Care

Routine skin examinations are vital for detecting new growths or changes in existing moles. After treatment, individuals should avoid excessive sun exposure and follow sun-safety protocols to reduce the risk of new tumors.

What is Basal cell carcinoma (BCC)?

Basal cell carcinoma (BCC) is the most common type of skin cancer that originates in the basal cells, which are located in the deepest layer of the epidermis (the outermost layer of the skin). BCC usually develops in areas that are frequently exposed to sunlight, such as the face, neck, and arms. It grows slowly and rarely spreads to other parts of the body, making it less dangerous than other forms of skin cancer.

2. What causes basal cell carcinoma?