Basal cell cancers or BCCs are the most common form of skin cancer in Australia – one in three Queenslanders will have a BCC before the age of 60. Due to the high UV index in Brisbane, BCCs are more common here than in Sydney or Melbourne. BCCs can present as red scaly patches, or non-healing lumps and bumps. BCCs can be treated with either surgery or with a special non-surgical treatment called photodynamic therapy (PDT). Skin cancer doctors only recommend PDT for the treatment of superficial or thin cancers.
Important facts on BCCs
BCC occur most often on areas of the body that are frequently exposed to the sun such as the face, head/scalp, neck and hands.They often grow slowly over time and range in size from millimeters to 1-2 centimeters in diameter and have varied appearances. Frequently BCCs present as a pinkish nodule with a crater like indentation in the center.
Other features of BCCs can include the following:
Freezing the tumor with liquid nitrogen can be used for treat small superficial BCCs. A permanent white scarcan result from this treatment.Cure rates are lower than those seen with surgical treatments–approximately 85-90%.
Photodynamic Therapy (PDT)
A chemical cream is applied to the skin several hours prior toexposing the treated skinto light in order to activate the chemical. This is ideal for smaller more superficial BCCs.
Topical Chemical Treatments
Imiquimod cream (Aldara) is used mostly for small superficial BCCs and induces a localised inflammatory response. The skin is generally treated once a day for 5 days per week, for a total of 6-12 weeks.
5-Fluorouracil cream (Efudex)can be used for very superficial small BCCs usually requiring 12 weeks of application twice a day.
Involves the use of x-rays and generally requires several treatments per week for a few weeks for complete removal. Radiation may be most appropriate for the elderly or for tumors that are difficult to manage surgically. Cure rates are around 90%, however this treatment can result in long-term cosmetic problems and involves radiation risks.
Use of local anesthesia is required before surgical treatments.
Curettage and Electrodessication
The BCC is scraped off using a curette (a sharp, ring-shaped instrument). Curettage is often followed by the use of an electro-cautery needle to remove residual tumor and control bleeding. Although cure rates are similar to those of surgical excision this treatment may not be as useful for aggressive BCCs or when the BCC is in a high-risk or difficult site. Healing is usually complete within several weeks.
For larger BCCs a scalpel may be used to remove both the BCC as well as a surrounding border of normal skin as a safety margin. The skin is then closed with stitches, and the excised tissue is sent to a pathology lab for examination to confirm that all cancer cells have been removed. This method produces cure rates around 90%.
For large BCCs or those on specific areas of the body skin grafts may be necessary.
Mohs surgery. This is a procedure performed by a specialized skin doctor (dermatologist or Mohs surgeon). The cancerous cells are removed layer by layer. This technique is used frequently for tumors on delicate areas such as eyelids, temples and ears. This treatment has a high cure rate.
PDT is a highly effective method of treating superficial BCCs on virtually any area, including the face, scalp, hands and chest. It is a minimally invasive treatment that leaves little to no scarring with a relatively rapid recovery. The treatment makes use of photosensitizing agents such as Aminolevulinic acid hydrochloride (ALA) cream that is applied topically and becomes concentrated within cancer cells over 3-6 hours. When activated by light, the photosensitizing agents selectively destroy cancer cells, leaving normal cells largely unaffected.The resultant reaction usually appears much like sunburn and usually heals within 4-8 weeks with good cosmetic results. Cure rates are variable ranging from 70 to 90%.
Benefits of PDT include shorter treatment time compared with Imiquimod (Aldara) or Flurouracil (Efudex) creams.
Read more about Photodynamic Therapy
Superficial and nodular BCCs respond especially well to non-surgical treatments whereas larger lesions may require surgical excision. PDT can be used where multiple BCCs are present.
Despite most BCCs being cured by treatment, recurrence is always a possibility. Furthermore, those individuals affected by BCCs have an increased risk of developing other forms of skin cancer such as melanoma. For these reasons it is recommended the following steps are undertaken to manage your risks:
Avoid indoor tanning.