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What is the most common type of skin cancer? What you need to know and what to look out for

Washington University School of Medicine

Basal cell carcinoma (BCC), the most common type of skin cancer and the most common type of cancer in humans, accounts for about 8 out of 10 skin cancers. Basal cell carcinomas usually develop in skin that has been exposed to sunlight. These cancers grow slowly, meaning that most are curable and cause minimal damage when caught and treated early.

What is basal cell carcinoma?

Basal cells are one of the three main types of cells in the top layer of the skin. When DNA is damaged due to exposure to ultraviolet (UV) radiation from the sun or tanning beds, changes occur in the basal cells in the outermost layer of the skin, resulting in uncontrolled growth. This is when BCC most often occurs. However, it may also result from exposure to ionizing radiation and/or arsenic.

If you have fears concerning BCC and its potential consequences, you’re not alone

Finding out that you have BCC, or worrying that you might have it based on family history or changes in your skin, is a very scary experience and gives way to many types of fear: fear of the unknown, fear of needles, fear of mortality, fear of the future. Know that no matter the fear you may be feeling, Siteman will be there to support you throughout your skin cancer journey. It’s also important to remember that while receiving a diagnosis of BCC can certainly be frightening, it is rarely fatal. Still, if left untreated, it can become locally destructive.

BCC symptoms and skin changes to look out for

Keeping an eye on your skin is crucial to ensuring that you are able to identify abnormalities should they arise. Check for BCC where your skin is most exposed to the sun, such as the face, ears, neck, scalp, chest, shoulders and back (though this cancer can occur anywhere on the body). Five warning signs of BCC are:

  • Lumps or skin nodules that appear shiny or that have visible blood vessels. The lumps may grow over time
  • Areas on the skin that look like scars
  • Itchy patches of skin
  • Red or patchy areas of skin that resemble eczema
  • Sores that have a depression in the middle, look crusty or bleed often

Hereditary predisposition, skin color and increased risk for BCC

There are several genes and hereditary syndromes that are linked to the development of skin cancer. Basal cell nevus syndrome (also known as BCNS, Gorlin syndrome, Gorlin-Goltz syndrome or nevoid BCC syndrome), Bazex-Dupré-Christol syndrome (BDCS), Rombo syndrome and xeroderma pigmentosum are rare inherited skin disorders that can lead to basal cell carcinoma.

People with fair skin, blond or red hair, blue, green or grey eyes, or skin that burns easily are at highest risk of developing BCC. However, all people with a history of sun exposure or indoor tanning are at some level of risk, so ensuring that you are protected any time you’re exposed to UV radiation is critical.

BCC screening, diagnosis and beyond

Regular screening for basal cell carcinoma is not usually recommended, but if you find something on your skin that concerns you, you should make an appointment with your provider right away. During a skin exam, your provider will look for any growths, spots, moles or bumps that might be cancerous or precancerous. If something abnormal is found, your provider may do a biopsy, which will reveal whether you have skin cancer and, if so, what type. Being proactive about examining your skin and getting anything abnormal checked promptly means greatly reducing your risk of developing BCC.

BCC can almost always be cured when caught and treated early. While this type of cancer rarely spreads beyond the original tumor site, the lesions can become dangerous and grow deep into the skin, invading soft tissues, bones or nerves when left untreated. It is very rare that a BCC spreads to lymph nodes or metastasizes, and it almost never endangers life.

The Siteman approach

As a leader in cancer treatment, research, prevention, education and community outreach, Siteman has the expertise, experience and compassion to carry you through your cancer journey. With a multidisciplinary approach, a full team of specialists meets each week to discuss all cases, reviewing each one and determining the best treatment plan for each patient.

Many people diagnosed with skin cancer are concerned about what will happen to their appearance as a result of their cancer, particularly if tumors are on the face. Siteman is a leader in Mohs micrographic surgery, a procedure that minimizes damage to healthy tissue and leaves the smallest possible scar.

BCC treatment options

At Siteman, skin cancer patients receive treatment from multidisciplinary teams made up of dermatologists, dermatologic surgeons, medical and surgical oncologists, radiologists, radiation oncologists, ophthalmologists, otolaryngologists and plastic surgeons. Our physicians meet regularly to coordinate and discuss treatment options, putting together personalized treatment plans for each and every patient. No two cancers are the same; no two treatment plans should be, either.

Siteman currently offers the following treatment options for BCC:

Excision/Mohs micrographic surgery: excision involves the removal of a skin cancer along with some healthy tissue around it. Mohs micrographic surgery involves removing individual layers of cancer tissue in stages, allowing for the removal of the greatest number of cancer cells. Mohs has the highest cure rate of any BCC treatment.

Radiation therapy: low-energy X-ray beams are used to destroy the tumor, with no need for excision or anesthesia. It may take several treatments over the course of a few weeks, or daily treatments for a specified amount of time, to fully destroy the tumor.

Vaccines/immunotherapy: HPV is strongly linked with BCC and other non-melanoma skin cancers. The 9-valent HPV vaccine has been proven not only to prevent BCC from forming in the first place, but also to effectively treat BCC when injected directly into tumors. Immunotherapy involves the use of medicines to stimulate a person’s immune system to identify and destroy cancer cells.

Topical chemotherapy: this type of chemotherapy is put directly on the skin (usually in the form of a cream or ointment), rather than being given by mouth or injected into a vein. Since the drug is only applied to the skin and doesn’t spread to other areas of the body, it doesn’t cause the same side effects as systemic chemotherapy. Because topical chemotherapy can’t reach deep cancer cells or those that have spread to other organs, it is only ideal for those with superficial BCCs.

Surgery: in addition to excision and Mohs surgery, there are other surgical treatment options for BCC. Curettage and electrodesiccation is a treatment in which a spoon-shaped tool (curette) is used to scrape cancerous skin tissue, followed by the application of an electric current with a thin metal instrument or needle to destroy any remaining cancer cells. Additionally, laser ablation involves directing a carbon dioxide laser at the tumor(s) and can be used to treat superficial BCCs.

Our care team

The skin cancer treatment team at Siteman is comprised of a wide range of specialists, including medical oncologists, radiation oncologists, surgeons, dermatologists and psychologists. The diverse expertise of our collaborative team is what allows our specialists to create personalized and compassionate treatment plans for each and every patient.

The importance of getting screened

The American Cancer Society (ACS) recommends a cancer-related checkup, including skin examination, every three years for people aged 20-40. It also recommends that patients perform a skin self-examination monthly. By remaining proactive about wearing sunscreen when exposed to UV radiation, regularly monitoring your skin and seeing your provider when something looks concerning, you can greatly reduce or even eliminate your risk of developing BCC and other skin cancers.

You’ve been diagnosed with BCC. Now what?

If you’ve been diagnosed with BCC, you may be experiencing a wave of emotions including fear, anger and sadness. Siteman providers are here to support you every step of the way throughout your cancer journey. With our exceptional physicians, psychological services and survivorship care, we are committed to caring for your body, mind and wellness, even after treatment ends.

To schedule a skin cancer screening, please contact the Washington University Division of Dermatology. The division is made up of a team of dedicated doctors who are skilled at detecting and treating basal cell carcinoma as well as many other skin cancers. If you have found something concerning on your skin, or if you simply want to come in for a routine checkup, please call them at 314-362-8180. If cancer cells have already been detected during your screening exam and you wish to schedule a follow-up appointment with a skin cancer specialist at Siteman, please call 800-600-3606.