Treatment of Basal Cell Carcinoma

Basal cell cancer (BCC) can be treated in a number of ways. The treatment depends on where the cancer is and how large it is. The exact treatment can only be determined by your physician after a through examination. The common methods of treating BCC are:

Electrodessication and curettage: Electrodessication is basically a method which involves killing the BCC with an electrical current and scarping it off (Curettage). This may require several session over a period of weeks. The treatment is best for removing the small and new BCC located on the back, trunk and extremities. It is too sensitive and painful to be used on the face. The procedure is always done by a physician. There are no incisions and the skin remains intact. Crusting of the lesion may occur after the treatment.



Radiation therapy: Sometimes the cancer may be in an area where surgery may be difficult and thus radiation may have to be used. Most individuals require numerous sessions of radiation treatment spaced over 4-6 weeks. If the BCC is very localized, one may also use specially designed needles or implanted seeds which emit radiation. These implants or seeds can deliver high levels of radiation to a localized area.

Photodynamic therapy has also been used to treat basal cell carcinoma. Prior to the phototherapy, the patient is administered a drug intravenously which will localize where the tumor it. Then light therapy can be given which will only react with the drug at the site of the cancer. The higher concentration of the light will destroy the cancer. This technique is more useful for tumors which are deeper inside the body.

Surgery: In some cases, the location of the tumor may best be removed by surgery. Surgery basically requires removing the entire lesion. The procedure is done under local anesthesia. The entire lesion is usually removed with a good margin of normal tissue. If the lesion is small, the skin can be closed with sutures. If the lesion is large, it may require skin grafting or some complex plastic surgery.

Cryotherapy: In some cases, the BCC can be destroyed by freezing therapy. The Cryotherapy is best for lesions on the delicate areas of the body such as the eyelids, ears or nose. The skin lesion is repeatedly treated with a Q tip containing liquid nitrogen. It takes numerous treatments to destroy the tumor. Over a period of weeks to months, the tumor slowly sloughs off. The treatments are not painful and the treatment can be used to treat multiple skin lesions at the same time. After Cryotherapy, the skin lesion becomes dry and scars are rare.

Mohs' surgery: This procedure is ideal for the removal of large skin lesions from the face but can be done anywhere on the body. It basically requires removing the tumor layer by layer and examining the cells until all abnormal cells have been removed. Moh's surgery requires technical experience and is not performed by all physicians. The procedure is painless and can be performed in an office setting.This is an effective treatment for recurring basal cell carcinomas and those that are large, deep, fast-growing lesions on your face.

Laser has recently been introduced for the treatment of BCC; it is only used for the most superficial skin lesions. It vaporizes the tumor cells. In a few cases, stronger lasers can be used which act as a sharp blade and removes the tumor. There is little bleeding because the laser also coagulates (gels) up the blood. However, deep and strong lasers are only used under general anesthesia because of the pain.

Chemotherapy, which uses toxic drugs to destroy cancer cells, may be used to treat basal cell carcinoma. In most cases, the chemotherapy drugs are applied directly to the skin as a cream or a lotion. Various drugs including Vitamin A derived drugs like Tazarotene (Tazorac) can be used to treat the very flat superficial BCC. Other topical drugs include the use of fluorouracil (5-FU) and imiquimod. These drugs are strong skin irritants and physician monitoring of these drugs is essential to prevent side effects.

These drugs are applied on the body part for 5-6 times a week for 4-6 weeks. The drugs are left on the skin for at least 8 hours and then the skin is thoroughly washed off.

Common side effects of these drugs include:

- redness

- swelling

- pain or burning

- flaking

- itching

Because there are so many treatments for BCC, your physician will determine what is the best treatment for you after the first consultation.

After treatment, it is imperative that one follow up regularly with the dermatologist. BCC are notorious for recurring and almost 30% of individuals have a recurrence in the next 5 years. Efforts to avoid the sun and wear sunscreen are a must once a skin cancer has been diagnosed.