Your doctor will take a thorough history from you about the area of concern, about you risk factors for developing skin cancer and your health in general. The doctor will then proceed to check your skin and look at the size, shape, colour, and texture of any suspicious areas.
If a basal cell carcinoma (BCC) is suspected, a skin biopsy will be performed to remove a piece of skin from the area in order to examine it under a microscope. This must be done to confirm the diagnosis of basal cell carcinoma or other skin cancers. There are many types of skin biopsies and the exact procedure depends on the location of the suspected skin cancer.
Treatment varies depending on the size, depth, and location of the basal cell cancer. It can be removed using one of the following procedures:
- Surgical excision cuts the tumour out and uses stitches to place the skin back together. This procedure involves excision of the lesion including a margin of normal skin. This method is preferred for larger lesions (>6mm) on the cheek, forehead, trunk, and legs. The advantage of this treatment is that it is quick and inexpensive. However, the difference between normal and cancerous tissue must be judged with the naked eye. Sometimes a skin graft or other form of reconstruction may be required.
- Mohs surgery: Mohs’ micrographic surgery is a special type skin surgery that must be performed by an experienced Mohs’ surgeon. It involves excision of the tumour and immediate examination of the tissue under the microscope to determine margins. If any residual tumour is left, it can be mapped out and excised immediately. The process of excision and examination of margins may have to be repeated several times. The advantage of this technique is that it is usually definitive and has been reported to have a lower recurrence rate than other treatment options. The disadvantage is the time and expense involved. This technique is used in areas where the margin of the tumour is indistinct or the location is cosmetically sensitive, such as the nose or eyelid. After the Mohs’ surgery, a complication reconstruction might be needed to repair the defect and a plastic surgeon may need to be involved to perform this.
- Cryotherapy freezes and kills the cancer cells. It is used for early or superficial BCCs.
- Radiotherapy is used for some primary tumours in patients who are not fit for surgery or have inoperable tumours. It may also be used where tumours are difficult to excise or where it is important to preserve surrounding tissue such as the lip.
- Skin creams containing imiquimod or 5-fluorouracil may be used to treat superficial or very early BCCs.
- Photodynamic therapy (PDT) is used in limited circumstances, such as when the BCC is superficial and arises in thin skin on the front of the leg.
The vast majority of BCCs are cured by these methods.The rate of basal cell skin cancer returning is about 1% with Mohs surgery, and between 33% and 10% for other forms of treatment. Smaller basal cell carcinomas are less likely to come back than larger ones. It is exceptionally rare for a BCC to spread to other parts of the body.
Unfortunately, once patients have had one BCC another one is likely to develop over the following ten years. You should follow-up with your doctor as recommended and regularly examine your skin once a month, using a mirror to check hard-to-see places. Book an appointment with your GP if you notice any suspicious skin changes.