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Basal Cell Carcinoma

WHAT YOU SHOULD KNOW

Basal cell carcinoma is a slow-growing type of cancer that affects the outer layers of the skin. Normal cells divide in an orderly way, making more cells only when needed. But when cancer develops, the cells begin to grow and divide without restraint, often forming a lump or bump called a tumor. In many types of cancer, the diseased cells spread to other parts of the body. Fortunately, basal cancer cells usually do not. This form of cancer strikes most often in fair-skinned, light-haired people who spend a lot of time in the sun. Like other types of skin cancer, it usually doesn't appear before age 40.

Causes

The main cause of skin cancer is exposure to ultra-violet (UV) rays from the sun. Sun lamps and tanning booths that use man-made UV rays are also a threat. You are more susceptible if you're frequently exposed to coal tars, pitch, creosote, arsenic, or radium.

Signs/Symptoms

The most common warning sign is a sore that does not heal. Other possibilities include:
  • A new raised bump on the skin. This tumor usually looks smooth, shiny, pale, or waxy.
  • A hard, red bump that looks like a scar.
Most sores or bumps appear on the neck or face, the area of your body most frequently exposed to the sun. Skin cancer also tends to show up on the hands, arms, chest, and upper back. Many women get skin cancer on their chest.

Care

Your doctor may first perform a biopsy, removing a sample of the tumor or sore for microscopic examination. If cancer cells are discovered, they'll be studied to determine what stage the cancer has reached. The doctor may also order a chest x-ray to see whether the cancer has spread. A variety of methods are available for removing the cancer. If there is any chance that the cancer has spread, radiation or chemotherapy may also be needed. The removal is frequently done in the doctor's office, using a local anesthetic to numb the area. Among the techniques you may encounter are the following:
  • Curettage (KURE-uh-taj) and Electrodesiccation: In this two-step procedure, the doctor first scrapes off the tumor with a sharp, spoon-shaped tool (the curettage part). Electricity is then used to stop bleeding and kill any cancer cells left behind (the electrodesiccation part). Electricity is used to only heat the needle used in the procedure; it is not sent into your body. Once the treated skin heals, it may show a white scar. Depending on the outcome, the procedure may have to be repeated.
  • Cryosurgery (KRI-o-SIR-jer-ee): This approach uses liquid nitrogen to freeze the tumor and kill the cancer cells. Several applications of nitrogen may be needed during the procedure. After the area thaws, the dead skin falls off. While there is usually no pain from the nitrogen, the area may become swollen and painful once it thaws. Like curettage, cryosurgery may leave a white scar---and may have to be repeated.
  • Mohs' Surgery: This procedure is designed to remove only cancer cells, leaving as much healthy tissue as possible. It's a favored treatment for big or deep tumors, and tumors in places that are hard to treat. The doctor scrapes off many thin layers of the tumor one at a time, examining each layer for cancer cells through a microscope. The scraping continues until the tumor is gone. The size of the scar depends on the size of the treated area.
  • Laser Therapy: This approach relies on a narrow beam of light to kill the cancer cells in the outer layers of skin. Laser therapy produces very little scarring, but the treated area is usually painful until it heals.
  • Skin Grafting: If a large section of skin has been removed, the doctor may cover the injured area with a piece of healthy skin from elsewhere on the body. This aids healing and reduces scarring.
  • Topical Chemotherapy: The form of therapy attacks the tumor with cancer-killing medications applied in cream or lotion form. The medication causes pain and inflammation during treatment, but usually leaves no scar.
  • Radiation: Focused beams of x-rays or gamma rays are frequently used to kill skin cancer cells in hard-to-treat areas, such as the eyelid, tip of the nose, or the ear. This treatment can cause a rash or make the skin dry or red. After the treatment, the area may be discolored or feel unusual.

Risks

The risks from this type of skin cancer are few, and the treatments can be unpleasant. Nevertheless, treatment is advisable. Otherwise, there is a slight but real chance that the cancer will spread.

WHAT YOU SHOULD DO

  • If you are taking topical chemotherapy, be careful to keep the medication on only that part of the skin undergoing treatment. If any gets on healthy skin, wash it off immediately with soap and water. If it gets on your clothes, wash them right away.
  • As a precaution, some people see their doctor at least every 3 months for the first year after treatment, and every 6 months for 4 years after that.
  • Sun starts damaging your skin from the first exposure. Guard your skin from the sun's UV rays by:
    • Wearing sunscreen with an SPF of at least 15 and protection against UVA and UVB rays. Follow the directions on the label and reapply the lotion if you are in the sun for more than 1 hour.
    • Wearing pants and long sleeved shirts to protect the skin on your arms and legs.
    • Wearing a hat with a wide brim to protect both your face and neck.
  • Check for new bumps on the skin once a month.
    • Become familiar with the appearance of your regular birthmarks and moles (small, dark bumps on the skin). Most normal moles show up by the time you are 30 to 40 years old. A mole that appears after you reach 30 should be watched closely for changes.
    • Check all parts of your body, including your scalp, the area between your toes and your buttocks, and the palms of your hands.
    • The best time to look for new bumps is after a shower or bath. Make sure you do this in a room that has good light. Use either a full-length or a hand-held mirror.

Call Your Doctor If...

  • You notice any sore or bump that might be a cancer.

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