If you’ve noticed a new or changing spot on your skin and are concerned about skin cancer, getting an accurate Basal Cell Cancer Diagnosis is the first and most crucial step. Basal cell carcinoma (BCC) is the most common type of skin cancer, and fortunately, it is highly treatable, especially when detected early by a board-certified dermatologist.
How Dermatologists Diagnose Basal Cell Carcinoma
When you visit a dermatologist for a skin check, the process for basal cell cancer diagnosis is thorough and designed to provide clarity and guide treatment. Your dermatologist will:
- Conduct a Comprehensive Skin Examination: This involves a visual inspection of your skin, often using a dermatoscope, a specialized magnifying device, to get a closer look at suspicious spots.
- Inquire About Your Medical History and Symptoms: You will be asked about your overall health, any medications you are taking, and any symptoms you’ve noticed related to the skin spot, such as changes in size, color, or texture, or if it bleeds or itches.
If, after the examination, your dermatologist suspects a basal cell carcinoma or another form of skin cancer, the next step is typically a skin biopsy.
Skin Biopsy: The Definitive Diagnostic Tool
A skin biopsy is the gold standard for basal cell cancer diagnosis. It is a simple, safe, and quick procedure that can usually be performed right in your dermatologist’s office. Here’s what to expect during a skin biopsy:
- Numbing the Area: The dermatologist will first numb the area around the suspicious spot with a local anesthetic. This ensures you will feel little to no discomfort during the procedure.
- Removing the Skin Sample: Once the area is numb, the dermatologist will remove all or a portion of the suspicious skin spot. The method used might vary depending on the size and location of the spot, but common techniques include shave biopsy, punch biopsy, or excisional biopsy.
- Laboratory Analysis: The removed skin sample is then sent to a lab where it is examined under a high-powered microscope by a dermatopathologist or pathologist. These specialists are trained to identify cancer cells and determine the type of skin cancer.
The skin biopsy is crucial because it is the only way to definitively confirm whether a skin spot is cancerous and, if so, what type of skin cancer it is. This information is essential for developing an effective treatment plan.
Understanding Your Pathology Report After a Basal Cell Cancer Diagnosis
After the microscopic examination of the biopsy sample, a pathology report, also known as a biopsy report, is generated. This report is a detailed document that outlines the findings from the lab and provides your dermatologist with critical information to guide your treatment. For a basal cell cancer diagnosis, the pathology report will typically include:
- Confirmation of Basal Cell Carcinoma: The report will confirm if cancerous basal cells were found in the sample, thus establishing the basal cell cancer diagnosis.
- Type of Basal Cell Carcinoma: There are different subtypes of basal cell carcinoma, such as nodular, superficial, and infiltrative. The pathology report will specify the subtype, which can influence treatment decisions.
- Depth of Invasion (if determinable): The report may indicate how deeply the cancer cells have grown into the skin. This is an important factor in determining the stage and aggressiveness of the cancer.
- Margins: The report will often describe the margins of the removed tissue. “Clear margins” mean that no cancer cells were found at the edges of the removed tissue, suggesting complete removal. “Positive margins” indicate that cancer cells were found at the edges, which may necessitate further treatment to ensure all cancer cells are eliminated.
Your dermatologist will carefully review your pathology report to fully understand your basal cell cancer diagnosis and determine the most appropriate treatment approach for your specific situation.
Basal Cell Carcinoma Treatment Options Following Diagnosis
Once a basal cell cancer diagnosis is confirmed, there are several effective treatment options available. The best treatment for you will depend on factors such as the type, size, and location of the BCC, as well as your overall health and preferences. Common treatment approaches include:
Surgical Removal Techniques
Surgical removal is often the preferred method for treating basal cell carcinoma, especially in its early stages. Various surgical techniques can be used:
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Excision: This involves cutting out the cancerous tissue along with a margin of surrounding healthy skin. The removed tissue is then examined to ensure all cancer cells have been eliminated.
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Mohs Surgery: Mohs surgery is a specialized technique particularly effective for BCCs in cosmetically sensitive areas like the face, ears, and nose, or for tumors that are large, aggressive, or recurrent. It involves removing the tumor layer by layer and examining each layer under a microscope until no cancer cells are detected. This method minimizes the removal of healthy tissue while ensuring complete cancer removal.
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Curettage and Electrodesiccation: This technique is often used for smaller, superficial BCCs. It involves scraping away the cancer cells using a curette, followed by electrodesiccation, which uses an electric current to destroy any remaining cancer cells and control bleeding.
Non-Surgical Treatment Options
For certain basal cell carcinomas, non-surgical treatments may be appropriate:
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Cryosurgery (Freezing): Cryosurgery involves freezing the cancerous tissue with liquid nitrogen. This is a quick, in-office procedure suitable for some superficial BCCs.
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Photodynamic Therapy (PDT): PDT is a two-stage treatment that involves applying a light-sensitizing agent to the skin, followed by activation with a specific wavelength of light. This process destroys the cancer cells. PDT is often used for superficial BCCs.
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Topical Medications: Prescription creams or ointments, such as imiquimod or 5-FU, can be applied directly to the skin to treat superficial BCCs. These medications stimulate the immune system to attack cancer cells or directly kill cancer cells.
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Radiation Therapy: Radiation therapy uses high-energy rays to destroy cancer cells. It may be used for BCCs that are difficult to treat surgically, for patients who are not good surgical candidates, or in combination with surgery for advanced BCCs.
Treatment for Advanced Basal Cell Carcinoma
While basal cell carcinoma is rarely life-threatening, it can become more serious if it grows deeply or spreads. Advanced basal cell carcinoma refers to BCC that has grown deep into tissues or spread to other parts of the body (metastatic BCC), though metastasis is uncommon. Treatment for advanced BCC may include:
- Surgery and Radiation: Surgery to remove the tumor and any affected lymph nodes, followed by radiation therapy to eliminate remaining cancer cells, may be necessary.
- Targeted Drug Therapy: For metastatic or locally advanced BCC, targeted medications like sonidegib or vismodegib may be used. These oral medications target specific pathways involved in BCC growth.
- Immunotherapy: Immunotherapy drugs like cemiplimab can be used to treat advanced BCC, particularly when targeted therapy is not effective or tolerated. Immunotherapy helps the body’s immune system fight cancer cells.
Prognosis and Importance of Follow-Up After Basal Cell Cancer Diagnosis
The prognosis for basal cell carcinoma is generally excellent, especially when basal cell cancer diagnosis is made early and treatment is promptly initiated. Most BCCs are cured with treatment. However, it is important to be aware that:
- Recurrence is Possible: Basal cell carcinoma can recur in the same location after treatment.
- Increased Risk of New Skin Cancers: Having had BCC increases your risk of developing new basal cell carcinomas or other types of skin cancer in the future.
Therefore, regular follow-up appointments with your dermatologist are crucial after a basal cell cancer diagnosis and treatment. These follow-up visits allow your dermatologist to monitor for any signs of recurrence or new skin cancers and to provide guidance on sun protection and skin self-exams to minimize future risks.
By understanding the process of basal cell cancer diagnosis and the available treatment options, you can feel empowered to take proactive steps for your skin health and work with your dermatologist to achieve the best possible outcome.
References
Bichakjian CK, Armstrong A, et al. “Guidelines of care for the management of basal cell carcinoma.” J Am Acad Dermatol 2018;78:540-59.
Bichakjian CK, Olencki T, et al. “Basal cell skin cancer, Version 1.2016, NCCN Clinical Practice Guidelines in Oncology.” J Natl Compr Canc Netw. 2016;14(5):574-97.
Cameron MC, Lee E, et al. “Basal cell carcinoma: Epidemiology; pathophysiology; clinical and histological subtypes; and disease associations.” J Am Acad Dermatol 2019;80:303-17.
Cameron MC, Lee E, et al. “Basal cell carcinoma: Contemporary approaches to diagnosis, treatment, and prevention.” J Am Acad Dermatol 2019;80:321-39.
Nouri K, Ballard CJ, et al. “Basal cell carcinoma.” In: Nouri K, et al. Skin Cancer. McGraw Hill Medical, China, 2008: 61-81.
Xie P, Lefrançois P. “Efficacy, safety, and comparison of sonic hedgehog inhibitors in basal cell carcinomas: A systematic review and meta-analysis.” J Am Acad Dermatol 2018;79:1089-100.
Written by: Paula Ludmann, MS
**Reviewed by:Carrie L. Kovarik, MD, FAAD Natalie H. Matthews, MD, FAAD Darrell S. Rigel, MD, FAAD
Last updated: 4/28/23
