If you’ve noticed a new or changing spot on your skin and are concerned about skin cancer, getting an accurate diagnosis is the first crucial step toward effective treatment. Basal cell carcinoma (BCC) is the most common type of skin cancer, and when detected early, it is highly treatable. Understanding how dermatologists diagnose BCC can help alleviate anxiety and empower you to take proactive steps for your skin health.
How Dermatologists Diagnose Basal Cell Carcinoma: A Step-by-Step Guide
When you visit a board-certified dermatologist to evaluate a suspicious skin spot, they will conduct a thorough examination and ask detailed questions to understand your concerns and medical history. The Basal Cell Skin Cancer Diagnosis process typically involves the following key steps:
1. Comprehensive Skin Examination: Your dermatologist will meticulously examine your skin, paying close attention to the size, shape, color, and texture of the suspicious spot. They will also check for other signs of skin cancer and assess your overall skin health.
2. Medical History and Symptom Review: To gain a complete picture, your dermatologist will ask about your medical history, including any previous skin conditions, sun exposure habits, family history of skin cancer, and current medications. They will also inquire about any symptoms you may have noticed, such as itching, bleeding, or changes in the spot’s appearance.
3. Skin Biopsy: The Definitive Diagnostic Tool: If your dermatologist suspects basal cell carcinoma or another type of skin cancer, the only way to confirm the diagnosis is through a skin biopsy. This simple and safe procedure is usually performed right in the dermatologist’s office during your visit.
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Procedure Explained: Before the biopsy, the area will be numbed with a local anesthetic to ensure your comfort. Your dermatologist will then remove all or part of the suspicious spot. There are several biopsy techniques, and the choice depends on the size and location of the spot. Common techniques include shave biopsy, punch biopsy, and excisional biopsy.
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Microscopic Examination: The removed tissue sample is then sent to a specialized lab where a dermatopathologist (a doctor who specializes in diagnosing skin diseases under a microscope) examines it. They will carefully look for cancerous basal cells. If basal cell carcinoma cells are identified, a positive diagnosis is confirmed.
4. Pathology Report: Understanding Your Diagnosis: After the microscopic examination, the dermatopathologist prepares a detailed pathology report, also known as a biopsy report. This report is crucial for guiding treatment decisions. It provides essential information, including:
- Type of Basal Cell Carcinoma: There are different subtypes of basal cell carcinoma, and the report will specify the type, which can influence treatment choices.
- Depth of Invasion: The report may indicate how deeply the cancer has grown into the skin, when this can be determined from the biopsy sample. This information is important for staging and treatment planning.
- Other Microscopic Features: The report may also include details about the cancer cells’ characteristics, which can help predict the cancer’s behavior and guide treatment.
Your dermatologist will carefully review the pathology report in conjunction with your overall health and the clinical findings to determine the most appropriate treatment plan for your basal cell carcinoma.
Basal Cell Carcinoma Treatment Options: Tailored Approaches by Dermatologists
Once a basal cell skin cancer diagnosis is confirmed, dermatologists offer a range of effective treatment options. The choice of treatment is personalized and depends on several factors, including the type, size, and location of the BCC, as well as your overall health and preferences. Surgical removal is often the primary approach, especially for early-stage BCC.
Surgical Removal Techniques:
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Excision: This common surgical procedure involves cutting out the basal cell carcinoma along with a margin of surrounding normal-looking skin. This margin helps ensure that any stray cancer cells are removed. The excised tissue is then examined under a microscope to confirm that the margins are clear of cancer cells. If cancer cells are found at the margins, further treatment may be necessary, such as Mohs surgery.
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Mohs Micrographic Surgery: Mohs surgery is considered the gold standard for treating many basal cell carcinomas, particularly those in cosmetically sensitive areas like the face, ears, and nose, or those that are recurrent or high-risk. This specialized technique is performed in stages. The surgeon removes the visible cancer and a thin layer of surrounding tissue. This tissue is immediately examined under a microscope in an on-site lab. If cancer cells are still present, the surgeon precisely removes another layer only in the areas where cancer is detected, repeating this process until all cancer is removed while preserving as much healthy tissue as possible.
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Curettage and Electrodesiccation: This technique is often used for smaller, superficial basal cell carcinomas, especially those on the trunk, arms, or legs. The dermatologist first scrapes away the cancer cells using a curette (a sharp instrument). Then, electrodesiccation is performed, using an electric current to destroy any remaining cancer cells and control bleeding.
Non-Surgical Treatment Options:
For certain patients and specific types of basal cell carcinoma, non-surgical treatments may be recommended:
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Cryosurgery (Freezing): Cryosurgery involves freezing the basal cell carcinoma with liquid nitrogen. The extreme cold destroys the cancerous tissue. This technique is quick and can be performed in the office, but it may not be suitable for all types or locations of BCC.
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Photodynamic Therapy (PDT): PDT is a two-stage treatment that uses a photosensitizing agent and a light source to destroy cancer cells. First, a topical solution is applied to the BCC, making the cells more sensitive to light. After a waiting period, the area is exposed to a specific wavelength of light, which activates the solution and kills the cancer cells. PDT is often used for superficial BCCs.
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Topical Medications: Prescription creams or ointments containing medications like imiquimod or 5-FU can be effective for treating certain superficial basal cell carcinomas. These medications are applied directly to the skin cancer and work by stimulating the immune system to attack cancer cells or by directly killing cancer cells. Topical medications are typically used for several weeks or months.
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Radiation Therapy: Radiation therapy uses high-energy rays to destroy cancer cells. It may be used as a primary treatment for BCC in cases where surgery is not feasible or as an adjunctive treatment after surgery for advanced BCC. Radiation therapy is often delivered over several treatment sessions.
Treating Advanced Basal Cell Carcinoma:
While basal cell carcinoma is typically slow-growing and rarely metastasizes (spreads to distant parts of the body), if left untreated, it can grow deeply and become locally advanced. In very rare cases, it can spread to lymph nodes or other organs (metastatic BCC). Treatment for advanced or metastatic BCC may involve:
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Surgery and Radiation: Aggressive surgical removal of the tumor and affected lymph nodes, followed by radiation therapy, may be necessary for locally advanced BCC.
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Targeted Medications: For advanced BCC that has spread or cannot be treated with surgery or radiation, targeted medications like sonidegib or vismodegib may be used. These oral medications target specific pathways involved in BCC growth.
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Immunotherapy: For some advanced BCC cases, immunotherapy with cemiplimab may be an option. This medication helps the body’s immune system recognize and attack cancer cells.
Treatment for advanced BCC is complex and requires a multidisciplinary approach involving dermatologists, oncologists, and other specialists.
Prognosis and Importance of Follow-Up
The prognosis for basal cell carcinoma is excellent, especially when diagnosed and treated early. Most BCCs are completely cured with treatment. However, BCC can recur in the same location, and individuals who have had BCC are at a higher risk of developing new skin cancers, including BCC and other types of skin cancer, in the future.
Therefore, regular self-skin exams and follow-up appointments with your dermatologist are crucial after basal cell carcinoma treatment. These follow-up visits allow for early detection of any recurrence or new skin cancers, ensuring prompt treatment and continued skin health.
By understanding the basal cell skin cancer diagnosis process and available treatments, you can feel empowered to take charge of your skin health and work with your dermatologist for the best possible outcome. Early detection and appropriate treatment are key to successfully managing basal cell carcinoma and maintaining healthy skin for life.
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
