Identifying the Types of Basal Cell Carcinoma

Did you know that skin cancer is the most frequently diagnosed cancer in the US and globally? Of the various kinds of skin cancer, basal cell carcinoma (BCC) is the most common, with up to 4.3 million new cases discovered annually in America. The good news? In the early stages, most types of basal cell carcinoma have a high cure rate and cause very little damage.

This month, we’re exploring the types of basal cell carcinoma, including the causes, symptoms, and prognosis for recovery.

What is basal cell carcinoma?

The basal cells are the bottom layer of the epidermis, which is the uppermost layer of skin. They are responsible for producing new skin cells when old ones die. Basal cell carcinoma occurs when the basal cells begin to reproduce out of control.

The most common cause of BCC is unprotected and excessive exposure to UV rays, either from the sun or tanning beds. UV light damages the skin and, over time, can cause mutations in the different types of skin cells. When the mutation occurs in the basal cells, it causes basal cell carcinoma.

BCC is slow growing and, unlike many other types of cancer, doesn’t spread to other areas of the body easily. The most common areas to develop BCC are the places that get the most sun exposure, including the ears, nose, head, neck, and arms. However, any area of the body can develop basal cell carcinoma.

Early diagnosis and treatment are key to a great prognosis. When you catch it early, your dermatologist can often treat most types of basal cell carcinoma in-office with very little downtime for recovery. However, the tumor can grow deep into the skin, which can cause injury to the nerves and blood vessels. As it grows, it can leave the surrounding tissue permanently damaged and disfigured.

Skin cancer risk factors

The primary risk factor for skin cancer of all types is the amount of time a person spends outside or in tanning beds, especially if he or she does not wear sunscreen and protective clothing. Other risk factors are:

• Fair skin that burns and freckles easily
• Naturally blonde or red hair
• Green or blue eyes
• History of sunburns
• Geography – places at high altitudes and or with abundant sunshine year-round have more incidences of skin cancer
• History of previous skin cancers
• Weak immune system from other illnesses

Symptoms of basal cell carcinoma

The various types of basal cell carcinoma can take many different forms. Often, it may seem like a small bump that grows very slowly. Other symptoms are a:

• Pink, reddish spot that dips in the center
• Scaly patch, especially near the ears
• Sore that resembles a pimple, but that either doesn’t heal or heals but keeps returning
• Round growth that can be pink, red, brown, tan, black, or skin-colored
• Scar-like skin that isn’t from an injury

It’s important to note that the color and shape of the tumor may not be uniform. The spot may be flat or raised, it can be dipped in the center or not, and it can even appear shiny. Often, BCCs do not cause pain, but the area can be numb, sensitive, or itchy. It’s hard to self-diagnose a basal cell carcinoma because they can take so many different shapes. If you have a concerning spot, it’s best to schedule a dermatological appointment right away.

Types of basal cell carcinoma

Basal cell carcinomas are divided into different types to help physicians evaluate the progression of the disease and determine which course of treatment is best. Understanding the different ways that basal cell carcinomas grow in the skin helps determine the most optimal treatment approach.

Physicians also assess whether the basal cell carcinoma has any of the following high-risk features:

• Aggressive microscopic growth pattern
• Spread to lower dermis or subcutis layers of the skin
• Spread to the small nerves in the skin

Additionally, the health of the individual must be taken into consideration. Patients who are immunosuppressed due to certain medical conditions or medications may have basal cell carcinomas that behave more aggressively.

The classification of basal cell carcinomas is based on how they appear at a microscopic level and includes the following types most commonly:

Superficial basal cell carcinoma = the cancer originates at the basal layer of the epidermis and has spread only slightly deeper than this. These cancers are well less than 1 mm in depth

Nodular basal cell carcinoma = the cancer grows as a “ball” of cancer cells, spreading into the dermis, or collagen layer, of the skin. These nodular basal cell carcinomas often extend 1 mm or more into the skin

Infiltrative basal cell carcinoma = the cancer grows with a “root system” which is embedded into the dermis, or collagen layer, of the skin. Because of this root system, infiltrative basal cell carcinomas require certain procedures, including excision or Mohs surgery, to make sure that all of the roots are removed completely

Basal cell carcinoma prognosis

BCCs grow slowly and the prognosis is typically excellent. If left untreated, the basal cell carcinoma will continue to grow deeper and wider into the skin and may involve the nerves, muscle, or bone underneath the skin. When basal cell carcinomas have grown significantly, they will cause disfigurement. Even though they grow slowly, it’s essential to make an appointment with a dermatologist as soon as you discover a change in your skin.

Is it time for your annual skin check?

One of the best ways to prevent basal cell carcinoma is to take steps to protect your skin from the sun, including daily sunscreen, protective clothing, and seeking shade whenever possible. If you have a high risk of developing skin cancer, then make sure that you don’t miss your yearly skin check-up with your dermatologist.

Are you experiencing any symptoms that concern you? Schedule an appointment with the dermatologists at the Center for Surgical Dermatology. We’re now accepting patients for telemedical appointments!