Regardless of appearance, any change in skin growth, or the development of a new growth or open sore that fails to heal should prompt an immediate visit to a physician. After an examination, a biopsy will be performed to confirm the diagnosis of skin cancer. This involves removing a piece of the affected tissue and examining it under a microscope. If tumour cells are present, treatment (usually surgery) is required.
Fortunately, there are several effective ways to eradicate Basal Cell Carcinomas (BCCs). The choice of treatment is based on the type, size, location, and depth of penetration of the tumour as well as the patient’s age and general state of health. Treatment options should be discussed with your physician.
Treatment can almost always be performed on an outpatient basis in a physician’s office or at a clinic. A local anaesthetic is used during most procedures. Pain or discomfort is usually minimal with most techniques, and there is rarely much pain afterwards.
Curettage and Electrodessication
The growth is scraped off with a curette and the tumour site desiccated with an electrocautery needle. When treating BCCs, the procedure is typically repeated a few times to help assure that all cancer cells are eliminated. Local anaesthesia is required.
Along with the above procedure, this is one of the most common treatments for BCCs. Using a scalpel, the physician removes the entire growth along with a surrounding border of apparently normal skin as a safety margin. The incision is closed, and the entire growth is sent to the laboratory to verify that all cancerous cells have been removed.
Mohs Micrographic Surgery
The physician removes the visible tumour with a curette or scalpel and then removes very thin layers of the remaining surrounding skin one layer at a time. Each layer is checked under a microscope, and the procedure is repeated until the last layer viewed is cancer-free. This technique has the highest cure rate and can save the greatest amount of healthy tissue. It is often used for tumours that have recurred, those with aggressive growth behaviour and in locations where minimizing normal tissue removal is desirable (ie. the nose, around the eyes, etc.).
This is the most widely used treatment. It is especially useful when a limited number of lesions are present. Liquid nitrogen is applied to the growths with a cotton-tipped applicator or spray device. This freezes them without requiring any cutting or anaesthesia. They subsequently blister or become crusted and fall off. The procedure may be repeated to ensure total destruction of malignant cells. Some temporary redness and swelling can occur. In some patients, pigment may be lost, resulting in a white scar.
The skin’s outer layer and variable amounts of deeper skin are removed using a carbon dioxide or erbium YAG laser. Lasers are effective for removing actinic cheilitis from the lips and lesions from the face and scalp. They give the physician good control over the depth of tissue removed, much like chemical peels. Lasers are also used as a secondary therapy when topical medications or other techniques are unsuccessful. Local anaesthesia may be required. The risks of scarring and pigment loss are slightly greater than with other techniques.
Photodynamic Therapy (PDT)
PDT can be especially useful for lesions on the face and scalp. Topical 5-aminolevulinic acid (5-ALA) is applied to the lesions at the physician’s office. As soon as an hour later, those medicated areas can be activated by a special wavelength of light. This treatment selectively destroys lesions while causing minimal damage to surrounding normal tissue. Some redness and swelling can result from this newer therapy.
X-ray beams are directed at the tumour. Total destruction usually requires several treatments a week for a few weeks. This is ideal for tumours that are hard to manage surgically, where surgery may cause disfigurement and for elderly patients who are poor surgical candidates.
Imiquimod and 5-FU are also approved, although rarely used, for the treatment of superficial basal cell carcinoma (sBCC).
Treatment of advanced BCCs (aBCCs)
Until June 2013 there were limited medical therapies available to treat advanced BCCs. Patients whose disease has spread to the surrounding tissue may require the removal of key sensory organs such as the eye, ear or nose to control the disease. Those whose disease has metastasized will have a median survival of just eight to 10 months.
Vismodegib was recently approved for use in Canada for the treatment of adult patients with histologically confirmed metastatic BCC or locally advanced BCC inappropriate for surgery or radiotherapy.