Basal Cell Carcinoma – Diagnosis and Treatment
Diagnosis
Medical History and Physical Check
Doctors start by asking about any changes in the skin. They want to know how long a spot or lesion has been there.
They also ask if it hurts or bleeds. Questions often include family history of skin cancer and how the person protects themselves from the sun.
Common questions:
- When did you notice the spot?
- Has it changed in size or shape?
- Do you have pain or bleeding?
- Has anyone in your family had skin cancer?
- How do you protect your skin from the sun?
Doctors also do a general health check.
Full Body Skin Review
Doctors carefully look at the skin. They check not only the area of concern but also the rest of the skin.
This helps them find any other unusual spots. They may use a dermatoscope to look closer at moles and marks.
Testing a Piece of Skin
If needed, the doctor takes a small piece of the spot for lab testing. This is called a skin biopsy.
The test can confirm whether the growth is basal cell carcinoma or another kind of skin cancer.
Types of biopsies:
- Shave biopsy
- Punch biopsy
- Excisional biopsy
Doctors choose the type of biopsy based on the size and location of the growth.
Additional Details
Doctors may use more tests if needed. They might check the lymph nodes or take images if the spot is large or in a hard-to-treat area.
Most cases only need a skin check and biopsy to make a diagnosis.
Treatment
Surgical Options
Doctors treat most basal cell carcinomas with some form of surgery. The main goal is to remove all the cancerous tissue to lower the risk of it coming back.
The type of surgery depends on where the cancer is, its size, and other risk factors.
Common Surgical Methods:
| Surgical Method | When It’s Used | Key Points |
|---|---|---|
| Excisional Surgery | Small to medium lesions, lower risk of return. | Removes cancer with a border of healthy skin. |
| Mohs/Micrographic Surgery | Larger, deeper, or higher-risk tumors, especially on the face. | Removes layers one at a time; checks cells under a microscope, preserves healthy skin. |
In excisional surgery, the doctor cuts out the tumor and a rim of normal skin. The doctor checks the removed tissue to make sure it is all gone.
In Mohs surgery, the surgeon removes thin layers and looks at each under a microscope until only normal tissue remains. This method works well for growths on the face and areas where saving healthy tissue matters.
Alternatives to Surgery
Some people cannot have or do not want surgery. Doctors offer several other treatments.
These methods can be used alone or together:
| Treatment Type | How It Works | When Used |
|---|---|---|
| Curettage & Electrosurgery | Scraping & burning | Small, low-risk tumors on trunk, limbs |
| Radiation | X-rays or similar beams | Not a surgical candidate, high recurrence risk |
| Cryotherapy | Freezing with liquid nitrogen | Small, thin, surface tumors |
| Topical Medication | Medicinal creams or gels | Early, superficial cases |
| Photodynamic Therapy | Drug plus light destroys cancer cells | Surface cancers, surgery not possible |
- Curettage and Electrosurgery: The doctor scrapes away the cancer, then treats the area with electricity to destroy any leftover cells. This works best for small tumors on the body and is not usually used on the face.
- Radiation Therapy: Doctors use high-energy beams, like X-rays, to target cancer cells. This is an option if surgery is not possible or if cancer is at greater risk of coming back.
- Cryotherapy (Freezing): The doctor uses liquid nitrogen to freeze the cancer, causing it to fall off. This is most often used for very thin or small cancers.
- Topical Treatments: Doctors may prescribe creams and ointments for some thin, early-stage basal cell cancers.
- Photodynamic Therapy (PDT): Doctors apply a special drug to the skin, then use a light a few hours later to destroy cancer cells. PDT is usually for superficial lesions when other treatments are not a good choice.
When the Disease Spreads
Sometimes, basal cell carcinoma spreads to other tissues or lymph nodes. In these cases, doctors use medicines instead of surgery.
- Targeted therapy: These medicines block certain signals in cancer cells, stopping their growth or killing them. Doctors often use targeted therapy if other treatments do not work.
- Chemotherapy: Doctors use strong drugs to attack cancer throughout the body. They may use chemotherapy when the disease has spread beyond the skin and other treatments have failed.
Doctors choose these treatments based on how far the cancer has spread, which medicines the patient tolerates, and other health conditions.
Quick Facts Table
| Topic | Details |
|---|---|
| Most Common Approach | Surgical removal (excisional or Mohs) |
| Major Non-Surgical Tools | Radiation, cryotherapy, electrosurgery, topical meds, photodynamic therapy |
| Spread of Cancer | Rare, but advanced cases may need targeted therapy or chemotherapy |
| Outlook (Prognosis) | Usually excellent, especially with early treatment |
For additional medical advice, always check with a healthcare professional.
Getting Ready for Your Visit
Steps You Can Take Beforehand
Getting organized before seeing a doctor helps make the appointment more useful and less stressful. People should start by collecting important details about their health.
This includes:
- A written list of past and current medical conditions.
- Information about any radiation treatment received, even if it was many years ago.
- A record about exposure to sun or UV light, such as time spent outdoors, work as a lifeguard, or use of tanning beds.
- List of close family members with a history of skin cancer, like parents, siblings, grandparents, aunts, or uncles.
- An up-to-date list of all medications and supplements being taken, including prescription, over-the-counter, vitamins, or herbal remedies.
Bringing a family member or friend can help. A support person can listen, take notes, and give support.
It also helps to write down any questions before the appointment. This way, you will remember to ask about important topics.
Here’s a checklist for reference:
| Task | Details |
|---|---|
| List medical conditions | Past and current, including childhood illnesses |
| Note radiation therapy | Any, even long ago |
| Track sun/UV exposure | Jobs, hobbies, or regular tanning |
| Family history of skin cancer | Parents, siblings, aunts/uncles, grandparents |
| Medications & supplements | Include all current use |
| Write down questions | Any concerns about condition or treatment |
| Arrange for a support person | Someone to come with you and take notes |
Topics to Discuss With Your Healthcare Provider
Being ready with questions can make the visit more helpful. Some common questions for a doctor include:
- Is this diagnosis skin cancer? If so, what kind?
- How is this cancer different from other types?
- Has the cancer spread, and if so, how far?
- What treatments are suggested, and why?
- What side effects could the treatment cause?
- Will the treatment leave a scar?
- What are the chances the condition will return?
- Am I at risk for other skin cancers?
- How often are checkups recommended after treatment?
- Should my family members be concerned about their own risk?
Patients can add their own questions. If anything confusing or new comes up during the visit, it is okay to ask about it.
Doctors expect and welcome questions. Some people like to bring their list written or printed with space to jot down answers during the discussion.
Common Questions Your Doctor Might Ask You
Doctors often ask about symptoms and personal history to better understand your case.
You might hear these questions:
- When did you first notice a change in your skin or a new bump?
- Has it changed in size or shape since you first saw it?
- Is the spot or area painful?
- Are there any other spots on your skin that seem unusual?
- Have you ever had skin cancer before?
- Has anyone in your family had any form of skin cancer? Which kind?
- How much sun or tanning bed exposure did you get as a child or teen? How about now?
- Are you currently using any drugs, supplements, or herbal remedies?
- Have you ever had radiation for a disease?
- Have you taken medicines that affect your immune system?
- Do you have any serious medical conditions, now or in the past?
- Is there a history of smoking?
- Have you worked around chemicals like pesticides or herbicides?
- Do you use well water at home?
- What steps do you take to protect your skin from the sun?
- Do you check your skin regularly for any new or changing marks?
If you answer these questions clearly, your healthcare provider can decide which follow-up tests or treatments to suggest.
Before your visit, think about these questions and write down important points or dates. Bringing this information can help your visit go smoothly.
