Basal Cell Carcinoma - What is, Stages, Causes, Symptoms and Treatments

Basal Cell Carcinoma begins in the Epidermis, which is the outermost layer of the skin. This slow-growing form of Skin Cancer implies abnormal and uncontrolled growth of lesions in the skin's Basal Cells. It mostly develops in areas exposed to the sun, such as the head and neck. It may develop in other parts of the body as well. This Cancer mostly develops in middle-aged and older people. However, young people are also vulnerable to this Cancer due to their prolonged exposure to the sun's radiation. In this blog we will discuss early stage basal cell carcinoma and its causes, symptoms, diagnosis, treatment, possible complications and precautions.

What is basal cell carcinoma?

Basal cell carcinoma is a type of skin cancer. When skin cells get damaged by the sun's rays over time, they can turn into cancer cells, and this kind is called basal cell carcinoma. It usually appears as a small, shiny bump or a red patch on the skin. It can grow and spread if not treated at the initial stage, causing more harm. Advanced basal cell carcinoma means the cancer has grown deeper or wider into the skin.

Early Stage Basal Cell Carcinoma

A stage may be designated in some rare circumstances, such as when the initial lesion is thicker than 2 millimeters or has spread to the lower skin layers. The stages are 0 to 4, with higher numbers denoting more aggressive forms of cancer. The scale listed below is used by most oncologists:

Stage 0 basal cell carcinoma (carcinoma in situ): Stage 0 is the earliest and least advanced form of skin cancer. It means that the cancer cells are only in the top layer of the skin and haven't spread to deeper layers. Early stage basal cell carcinoma skin cancer is treated with simple procedures like surgery or applying a cream.

Stage 1 basal cell carcinoma: This means the cancer has grown a bit deeper into the skin, but hasn't spread to other parts of the body. It's still considered early and can often be treated successfully. Treatment may involve removing the cancer through surgery or other methods.

Stage 2 basal cell carcinoma: Stage 2 Indicates the cancer has grown deeper into the skin and may have reached nearby tissues, but it hasn't spread to other parts of the body. Also, a Patient may notice the tumor continuing to grow, becoming larger, or changing in appearance. While it's more advanced than Stage 1, it's still treatable.

Stage 3 basal cell carcinoma:This is an advanced stage where the cancer has spread deeper into the skin and may reach nearby tissues. At this stage, a patient may experience additional signs such as the tumor becoming larger, changing in appearance, and causing ulcers or sores that don't heal.

Stage 4 basal cell carcinoma: This stage of skin cancer indicates the cancer has spread to other parts of the body, such as lymph nodes or organs. At this stage, patients may experience additional signs like the tumor growing more prominent, changing appearance, and causing ulcers or sores that don't heal. You should immediately visit a skin cancer doctor for prompt treatment in such a situation.

Basal Cell Carcinoma Types

There are mainly four types of basal cell carcinoma:

Nodular basal cell carcinoma - Nodular basal cell carcinoma is a common subtype of skin cancer characterized by a raised, smooth, and shiny nodule that may have a pearly appearance.

Superficial spread of basal cell carcinoma - Superficial spread of basal cell carcinoma refers to a subtype characterized by thin, flat lesions that grow outward on the skin's surface, often with well-defined borders.

Sclerosing basal cell carcinoma - A sclerosing basal cell tumor is perhaps the most destructive form of skin cancer. In its early stages it is unimpressive. Flush with the surface of the skin and with few color changes, it often goes unnoticed for a long time. Eventually the normal skin contour fades and the loss of tissue substance becomes apparent.

Pigmented basal cell carcinoma - Pigmented basal cell carcinoma is a subtype with dark or pigmented areas, resembling melanoma, and requires careful examination for accurate diagnosis.

Basal Cell Carcinoma Causes

There are various factors that may lead to the development of Basal cell carcinoma (BCC). This includes:

• Prolonged exposure to ultraviolet radiation from the sun.
• BCC is common in sun exposed skin areas such as the face, neck, scalp, nose, eyelids and hands. 
• Individuals with fair skin, green or blue eyes are at a higher risk of developing basal cell carcinoma.
• Individuals with a history of sunburns, exposure to arsenic and a weakened immune system are more likely to develop basal cell carcinoma.

Regular use of sun protection measures is recommended to prevent this condition from occurring.

Basal Cell Carcinoma Symptoms

The symptoms of basal cell carcinoma may appear on the skin as follows:

1. Persistent and Non-Healing Open Sore
2. Reddish Patch or Irritated Area, with or without Itching
3. A Shiny, Pearly, Translucent Bump or Nodule
4. Pink Growth with a round border
5. A White, Yellow, or Waxy Scar-like Area with poorly defined areas

Diagnosis of Basal cell carcinoma

The symptoms of all skin disorders are mostly similar. Hence, it is extremely essential to carefully evaluate and assess the symptoms of Basal Cell Carcinoma to rule out other benign lesions, such as Sebaceomas, Intradermal Naevus, Fibrous Papules, Acne Scars, and Hypertrophic Scarring. The doctor will carry out the following Diagnosis:

• History The doctor will ask for information about the medical history of the patient, such as when did the mark on the skin first appear, the change in its size & appearance, any symptoms of itching or bleeding, the family history of Skin Cancer, and past exposure to factors inducing Skin Cancer.
• Physical ExaminationThe doctor will carefully examine the scarred area and check for Bleeding or Scaling. He may also check other parts of the body for Spots or Moles related to Cancer.
• Tests: The best way to diagnose Basal Cell Carcinoma is to conduct a Skin Biopsy. This involves taking a sample of the skin and examining it under a Microscope to look for Cancer Cells. There are different ways of conducting Skin Biopsy, such as, Shave Biopsy, Punch Biopsy, Incisional Biopsy, and Excisional Biopsy. The choice of biopsy will depend on factors, such as, type of cancer, size of the affected area, and many more. Some studies suggest that punch and shave biopsy techniques are about 80% accurate in diagnosing the various subtypes of basal cell carcinoma.

Basal Cell Carcinoma Treatment

There are different types of treatments for basal cell carcinoma available here. The choice of treatment depends on several factors, such as the size of Cancer, the patient's age, overall health, and risk of scarring.

• Curettage and Desiccation: This procedure involves scraping off cancerous growth with the help of a sharp, ring-shaped instrument known as Curette. An electric current controls the bleeding and destroys the residual Cancer Cells
• Surgical Excision:This involves cutting out of the tumor with the help of a scalpel, followed by the closing of the surgical site with stitches.
• Cryosurgery: In this procedure, doctors apply liquid nitrogen to cancerous growth to freeze and kill the Cancer Cells
• Radiation Therapy: This involves the use of X-Ray beams directed at the tumor to destroy the Cancer Cells
• Mohs Micrographic Surgery: This outpatient procedure involves cutting off the tumor along with a thin layer of tissue around it. The surgeon repeats the process until the last layer is Tumor-Free.

Possible Complications

Basal Cell Carcinoma seldom spreads to other parts of the body. However, if left untreated, it may grow into the surrounding areas, such as nearby tissue and bones. Tumors developed around the Nose, Eyes, and Ears are troublesome.

Precautions

Basal Cell Carcinoma has high chances of recurrence. It may develop in previously treated area or some other area of the body. It is essential for the patient to regularly visit the Dermatologist for routine check ups. It is also advisable for the patient to carry out self-examination of the treated area as well as other parts of the body. It is of paramount importance for the patient to protect himself/herself from sun's Ultraviolet Radiation.

Prevention of Disorder from Happening or Recurring

One should follow the below mentioned preventive measures to protect oneself from occurrence/recurrence of Basal Cell Carcinoma:

• Avoid unprotected exposure to sun's Ultraviolet Radiation
• Avoid sun exposure between 10 a.m. and 4 p.m.
• Use water-resistant sun screen with UVA and UVB protection
• Wear broad-rimmed hat and protective clothing while outdoors
• Regularly examine the skin for unnatural growth or changes
• Seeking medical help if any suspicious-looking lesion occurs

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