Basal cell carcinoma is the most common form of cancer worldwide. In the vast majority of cases, it is thought to be caused by exposure to the harmful ultraviolet rays of the sun. It is becoming more common, perhaps because people may be spending more time outdoors. Some believe that the decrease in the ozone layer is allowing more ultraviolet radiation from the sun to reach the earth's surface. Basal cell cancer does not usually metastasize or travel in the bloodstream; rather, it infiltrates the surrounding area, destroying tissue. For this reason, basal cell cancer should be treated promptly by a dermatologist with dermatologic surgical techniques. At Miramar Dermatology/Skin and Cancer Associates, a board-certified pathologist is present so that microscopic margin evaluation can be performed intra-operatively when indicated. Because of Dr. Gottlieb's extensive training and experience in surgical excision and reconstruction, you are assured of the best surgical outcome.

What does basal cell cancer look like?

Basal cell cancer most often appears on sun-exposed areas such as the face, scalp, ears, chest, back, and legs. These tumors can have several different forms. The most common appearance of basal cell cancer is that of a small, dome-shaped bump that has a pearly pink color. Blood vessels may be seen on the surface. Basal cell cancer can also appear as a pimple-like growth that heals, only to come back again and again. A common sign of basal cell cancer is a sore that bleeds, heals up, and recurs. A less common form called morpheaform looks like a smooth, white or yellowish, waxy scar. At Miramar Dermatology/Skin and Cancer Associates, this type of skin cancer is surgically removed utilizing microscopic evaluation of the surgical margins intra-operatively. Again, a board-certified pathologist assists during this procedure. This allows for the greatest chance that the skin cancer is completely removed. After the skin cancer is removed, reconstruction utilizing plastic surgical techniques is then carried out.

I think I have a basal cell cancer. What should I do next?

If you have a sore that doesn't heal, or that looks like any of the growths described, you should make an appointment for evaluation. Board-certified dermatologists are the physicians that are specifically trained to diagnose and treat skin cancer. They will examine the growth, possibly utilizing a procedure called dermoscopy. This allows them to decide whether or not to perform a biopsy. A biopsy is a simple procedure done in the office under local anesthesia. A simple injection of a small amount of anesthesia is used. After the area is numb, a small sample of the growth is taken for a pathologic evaluation. A bandage will then be placed on the wound, and you will receive instructions on how to care for the wound. The area will heal over five to seven days. There are several different kinds of basal cell cancer. The biopsy results will indicate whether or not you have a basal cell cancer and what kind of basal cell cancer it is. In some cases, if the basal cell cancer is very thin and present only on the surface of the skin, your dermatologist may choose to perform the biopsy and treat the skin cancer at the same time.

The biopsy shows that I have a basal cell cancer. What is the next step?

The dermatologist or his physician assistant will discuss with you the various treatment options should your growth prove to be a basal cell cancer. One method is called electrodesiccation and curettage. In this procedure, the surface of the skin cancer is removed and the base of the skin cancer is gently cauterized with an electric current. When this is done, there usually is no need for further treatment. Simple surgical excision, in which the skin cancer is cut out and the skin sewn together using dermatologic plastic surgical techniques, will often be recommended. In this case, the specimen is examined under a microscope after the procedure to determine that all the skin cancer has been removed. Other treatment methods, such as topical treatments using imiquimod, are sometimes recommended.

In certain situations, your dermatologist may refer you for a technique called Mohs micrographical surgery. This method has a high cure rate but is not required for all skin cancers. In general, most dermatologists agree that recurrent skin cancers, meaning skin cancers that were previously treated and have come back, incompletely removed skin cancers, large skin cancers, and skin cancers in precarious cosmetic areas may benefit from the Mohs technique.

Regardless of the technique used, will I be scarred?

Because the vast majority of skin cancers occur on the face, many patients are understandably concerned about their cosmetic outcome. If the skin cancer is small, conservative methods usually produce an excellent cosmetic result. Every surgical procedure will result in some form of a scar. The first obligation of the surgeon is to assure that the skin cancer is completely removed, and the second obligation is to give his patient the best possible cosmetic result. With that said, some patients do seem to heal better then others. The board-certified dermatologists at Miramar Dermatology/Skin and Cancer Associates will guide you through the healing process and give you tips on what you can do to minimize the appearance of the surgical scar. Most patients find comfort in knowing that Miramar Dermatology has the only physician in Florida that is certified both in dermatology and facial plastic surgery.

If basal cell cancer does not travel in the blood stream to other organs like other cancers, why should I bother treating it?

Some people wonder whether it is worth treating basal cell cancer at all since it doesn't metastasize or travel in the bloodstream to other organs. It is important to remember that basal cell cancer is in fact a cancer, and it will continue to grow locally unless treated. It will become locally invasive. Keep in mind that smaller skin cancers require smaller surgical procedures. Basal cell cancer does not spontaneously go away on its own. In addition, if the skin cancer is located near important organs such as the eyes, ears, and nose, or is growing near a nerve, serious problems can arise if the skin cancer is neglected. The bottom line is, don’t be an Ostrich with your head in the ground. Recognize that you have a problem and get it taken care of in a timely fashion.

I have already had one basal cell cancer. Am I at risk for getting another?

If you have already had one basal cell skin cancer, studies have shown that you are at a 40% risk of getting a second basal cell cancer within five years. It is important that you have close follow-up with a board-certified dermatologist and be alert to any non-healing sores that develop on your skin.

I have had basal cell cancer. Am I at risk of developing other skin cancers, such as melanoma?

Individuals who have had multiple basal cell cancers or other skin cancers, such as squamous cell, are at an increased risk for melanoma. It is important to have a full body skin examination at least once a year to check for abnormal moles which could be precursors to melanoma or melanoma itself. It is also important to know that basal cell cancer does not turn into melanoma.

Is there anything I can do to prevent basal cell cancer?

Because basal cell skin cancer is caused by ultraviolet radiation from the sun in the vast majority of cases, proper sun protection may help to prevent the development of further basal cell cancers. Because 85% of lifetime sun exposure is acquired in childhood by age 18, careful sun protection in children may effectively prevent basal cell cancer later in life.

Follow these simple steps to decrease your risk of basal cell cancer:

1. Apply sunscreen with a sun protection factor (SPF) of 30 or greater while outdoors.
2. Wear a broad-brimmed hat and sun-protective clothing.
3. Avoid the sun between 10:00 a.m. and 4:00 p.m. as much as possible.

4. Keep in mind that the UVA and UVB cancer-causing ultraviolet radiation is present even on a cloudy day. Make sure that you always are protected with a facial sun block.

Many people wonder how often they have to reapply sunscreen. In general, if you are active outdoors, it is quite reasonable to apply sunscreen every 1 1/2 hours. As long as you practice good sun protection habits and enjoy the sun in moderate amounts, you should be able to minimize the chances of developing basal cell cancer.