Basal cell carcinoma

In order to assess any growths or changes in your skin, your doctor or a specialist in skin conditions (dermatologist) will conduct a medical history and exam.

History and general exam

Your doctor will conduct a general physical exam and ask you questions about your medical history, changes in your skin, or any other signs or symptoms you've experienced.

Questions may include:

• When did you first notice this skin growth or lesion?
• Has it changed since you first noticed it?
• Is the growth or lesion painful?
• Do you have any other growths or lesions that concern you?
• Have you had a previous skin cancer?
• Has anyone in your family had skin cancer? What kind?
• Do you take precautions to stay safe in the sun, such as avoiding midday sun and using sunscreen?
• Do you examine your own skin on a regular basis?

Skin exam

Your doctor will examine not only the suspicious area on your skin but also the rest of your body for other lesions.

Skin sample for testing

Your doctor may do a skin biopsy, which involves removing a small sample of a lesion for testing in a laboratory. This will reveal whether you have skin cancer and, if so, what type of skin cancer. The type of skin biopsy you undergo will depend on the type and size of the lesion.

The goal of treatment for basal cell carcinoma is to remove the cancer completely. Which treatment is best for you depends on the type, location and size of your cancer, as well as your preferences and ability to do follow-up visits. Treatment selection can also depend on whether this is a first-time or a recurring basal cell carcinoma.

Surgery

Basal cell carcinoma is most often treated with surgery to remove all of the cancer and some of the healthy tissue around it.

Options might include:

• Surgical excision. In this procedure, your doctor cuts out the cancerous lesion and a surrounding margin of healthy skin. The margin is examined under a microscope to be sure there are no cancer cells.

  Excision might be recommended for basal cell carcinomas that are less likely to recur, such as those that form on the chest, back, hands and feet.

• Mohs surgery. During Mohs surgery, your doctor removes the cancer layer by layer, examining each layer under the microscope until no abnormal cells remain. This allows the surgeon to be certain the entire growth is removed and avoid taking an excessive amount of surrounding healthy skin.

  Mohs surgery might be recommended if your basal cell carcinoma has a higher risk of recurring, such as if it's larger, extends deeper in the skin or is located on your face.

Other treatments

Sometimes other treatments might be recommended in certain situations, such as if you're unable to undergo surgery or if you don't want to have surgery.

Other treatments include:

• Curettage and electrodessication (C and E). curettage and electrodessication (C and E) treatment involves removing the surface of the skin cancer with a scraping instrument (curet) and then searing the base of the cancer with an electric needle.

  C and E might be an option for treating small basal cell carcinomas that are less likely to recur, such as those that form on the back, chest, hands and feet.

• Radiation therapy. Radiation therapy uses high-energy beams, such as X-rays and protons, to kill cancer cells.

  Radiation therapy is sometimes used after surgery when there is an increased risk that the cancer will return. It might also be used when surgery isn't an option.

• Freezing. This treatment involves freezing cancer cells with liquid nitrogen (cryosurgery). It may be an option for treating superficial skin lesions. Freezing might be done after using a scraping instrument (curet) to remove the surface of the skin cancer.

  Cryosurgery might be considered for treating small and thin basal cell carcinomas when surgery isn't an option.

• Topical treatments. Prescription creams or ointments might be considered for treating small and thin basal cell carcinomas when surgery isn't an option.

• Photodynamic therapy. Photodynamic therapy combines photosensitizing drugs and light to treat superficial skin cancers. During photodynamic therapy, a liquid drug that makes the cancer cells sensitive to light is applied to the skin. Later, a light that destroys the skin cancer cells is shined on the area.

  Photodynamic therapy might be considered when surgery isn't an option.

Treatment for cancer that spreads

Very rarely, basal cell carcinoma may spread (metastasize) to nearby lymph nodes and other areas of the body. Additional treatment options in this situation include:

• Targeted drug therapy. Targeted drug treatments focus on specific weaknesses present within cancer cells. By blocking these weaknesses, targeted drug treatments can cause cancer cells to die.

  Targeted therapy drugs for basal cell carcinoma block molecular signals that enable the cancers to continue growing. They might be considered after other treatments or when other treatments aren't possible.

• Chemotherapy. Chemotherapy uses powerful drugs to kill cancer cells. It might be an option when other treatments haven't helped.

The following information can help you prepare for an appointment.

What you can do

• Write down your medical history, including other conditions for which you've been treated. Be sure to include any radiation therapy you may have received, even years ago.
• Note any personal history of exposure to excessive ultraviolet (UV) light, including sunlight or tanning beds. For example, tell your doctor if you have worked as an outdoor lifeguard or spent lots of time at the beach.
• Make a list of immediate family members who have had skin cancer, to the best of your ability. Skin cancer in a parent, grandparent, aunt, uncle or sibling is important history to share with your doctor.
• Make a list of your medications and natural remedies. Include any prescription or over-the-counter medications you're taking, as well as all vitamins, supplements or herbal remedies.
• Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.
• Find a family member or friend who can join you for your appointment. Although skin cancer is usually highly treatable, just hearing the word "cancer" can make it difficult for most people to focus on what the doctor says next. Take someone along who can help take in all the information.

Questions for your doctor

Below are some basic questions to ask your doctor about basal cell carcinoma. If any additional questions occur to you during your visit, don't hesitate to ask.

• Do I have skin cancer? What kind?
• How is this type of skin cancer different from other types?
• Has my cancer spread?
• What treatment approach do you recommend?
• What are the possible side effects of this treatment?
• Will I have a scar after treatment?
• Am I at risk of this condition recurring?
• Am I at risk of other types of skin cancer?
• How often will I need follow-up visits after I finish treatment?
• Are my family members at risk of skin cancer?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to talk about in-depth. Your doctor may ask:

• When did you first notice this skin growth or lesion?
• Has it grown significantly since you first found it?
• Is the growth or lesion painful?
• Do you have any other growths or lesions that concern you?
• Have you had a previous skin cancer?
• Has anyone in your family had skin cancer? What kind?
• How much exposure to the sun or tanning beds did you have as a child and teenager?
• How much exposure to the sun or tanning beds do you have now?
• Are you currently taking any medications, dietary supplements or herbal remedies?
• Have you ever received radiation therapy for a medical condition?
• Have you ever taken medications that suppress your immune system?
• What other significant medical conditions have you been treated for, including in your childhood?
• Do you or did you smoke? How much?
• Do you now have or have you ever had a job that may have exposed you to pesticides or herbicides?
• Do you now use or have you used well water as your primary water source?
• Do you take precautions to stay safe in the sun, such as avoiding midday sun and using sunscreen?
• Do you examine your own skin on a regular basis?