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Are you turning a blind eye to basal cell carcinoma?

Dec 21, 2018

If you’ve had a chance to read other posts in our six-part skin cancer blog series, you’ll know there are three main types of skin cancers: melanoma(blog), squamous cell carcinoma(blog) (SCC) and basal cell carcinoma (BCC); listed from most to least life-threatening. You’ll also know that New Zealand’s rates of skin cancer are through the roof.

Despite education in schools and the ongoing ‘Slip, Slop, Slap and Wrap’ campaign, our results clearly show that our current approach isn’t working. Whether our alarming figures are due to a lack of public health education or public complacency or both, there is a grave need to raise awareness and accountability at an individual level. The take-home message about UV protection and regular skin checks hasn’t changed a great deal, but the urgency around early diagnosis and treatment has.

Let’s start by revisiting BCC. The most prevalent of all skin cancers, BCC’s reputation as ‘benign’ means we frequently underestimate the potential consequences.

Basal cell carcinoma – more than just a bother

Globally, BCC accounts for at least 32% of all cancers and of skin cancers other than melanoma, about 80% are BCC.

In New Zealand, skin cancer outnumbers every other type of cancer with BCC firmly topping the list. BCC gets less attention than its more invasive cousins because it has the lowest likelihood of spreading to other parts of the body and rarely causes death. However, they can, and do, result in considerable inconvenience and discomfort, disfigurement and scarring and cause loss of vision if poorly treated around the eyes. A tiny percentage of BCCs take a rare, aggressive form – without prompt, accurate diagnosis and management, they can be lethal.

An estimated 40% of New Zealanders will develop a BCC in the course of their lifetime and because the incidence continues to rise, BCC represents a significant health concern for our population. While two-thirds of BCC occur on sun-exposed areas of the body, there’s a genetic link as well, emphasised by one third of tumours occurring on unexposed skin.

So, what should you look for?

BCC can vary significantly in their appearance, but people often first become aware of them as a scab that bleeds occasionally and doesn’t heal completely. Some BCCs are very superficial and look like a pinky red flat mark; others have a pearl-like rim surrounding a central crater. If left for years, the latter type can eventually erode the skin causing an ulcer. Other BCCs are quite lumpy, with one or more shiny nodules crossed by small but easily seen blood vessels. Occasionally, the BCC can look like a scar. Most are painless, although sometimes they can be itchy or bleed, if caught on clothes or picked at.

The main characteristics are:

  • Slowly growing plaque or nodule
  • Skin coloured, pink or pigmented
  • Varies in size from a few millimetres to several centimetres in diameter
  • Spontaneous bleeding or ulceration

Now, what do we do about it?

Second only to vigilant UV-protection, the single best thing you can do is catch the BCC early. Regular self-monitoring*(blog) is the best way of ensuring you are aware of early changes. If you do notice a change, don’t waste a second debating whether it’s worth seeing a specialist – it is.

Surgery is usually the primary treatment, with Mohs surgery the proven gold standard. Other useful and proven therapies include liquid nitrogen (freezing), topical anti-cancer creams and a light treatment called photodynamic therapy (PDT). Each treatment will depend on the location, type, and size of the carcinoma.

Like all skin cancers, BCCs are much easier to treat in their early stages when the lesion is small. The larger the tumour has grown, the more extensive the treatment needed. The removal of small skin cancers usually results in scars which are cosmetically acceptable. If the tumours are very large, a skin graft or flap may be used to repair the wound to achieve the best cosmetic result and facilitate healing. About 50% of people with BCC develop a second one within three years of the first. They are also at increased risk of other skin cancers, especially melanoma*(w/s).

The cure rate for first-time BCC is 90% with standard surgery, 99% with Mohs surgery. If they recur, the cure rate drops to around 80%. Correct surgical management of BCC by a specialist is crucial: studies have shown that 40% of incompletely excised BCCs grow back in less than five years. By the time a recurrence becomes apparent on the skin, cancer will have had the opportunity to spread much more extensively under the skin.

Even if you haven’t found a spot or suspicious growth on your skin, you could be in a high-risk group for skin cancer if you’ve had a lifetime of sun exposure or are genetically predisposed to skin cancer. Skin Centre’s dermatologists have dedicated their entire professional lives to the prevention, detection and treatment of skin cancer. The team’s combined experience, training and state-of-the-art technology will ensure the best outcome possible.

Ring and book an appointment today on 0508 232 884.

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