Alternate Names: Rodent ulcer; Skin cancer - basal cell; Cancer - skin - basal cell; Basal cell carcinoma

Causes and Risks:

A new skin growth that ulcerates, bleeds easily, or does not heal well could indicate development of basal cell skin cancer. Skin cancer has a high cure rate if treated early, but neglect can allow the cancer to spread, causing disability or death.

Basal cell skin cancer is the most common form of cancer in the United States. It accounts for about 75% of all skin cancers. The incidence of skin cancer has increased greatly. In 1990, 600,000 Americans were diagnosed with either basal cell cancer or squamous cell cancer, up from 400,000 in 1980.

Over 90% of basal cell skin cancers occur on areas of skin that are regularly exposed to sunlight or other ultraviolet radiation. They may also occur on the scalp. The onset most commonly occurs after age 40. This is considered the primary cause of most skin cancers.

Other risks include a genetic predisposition (basal cell skin cancers are more common in those who have light colored skin, blue or green eyes, blond or red hair) and over-exposure to X-rays or other forms of radiation.

Basal cells are normal skin cells. They may develop cancerous changes, causing a patch or lump that is painless. The lump may grow slowly, ulcerate, and never heal completely.

It usually remains local and almost never spreads to other parts of the body, but it may continue to grow and invade nearby tissues and structures, including the nerves, bones, and brain. The tumor may begin very small, growing to 1 or 2 centimeters in diameter after several years of growth.

Prevention: Minimize sun exposure. In the sun, protect the skin: wear protective clothing such as hats, long-sleeved shirts, long skirts, or pants. Ultraviolet light is most intense at midday, so try to avoid exposure during these hours. Use high-quality sunscreens, preferably with SPF (sun protection factor) ratings of at least 15. Look for sunscreens that block both UVA and UVB light. Apply sunscreen at least a half hour before exposure, and reapply it frequently. Use sunscreen in winter, too.

Examine the skin regularly for development of suspicious growths or changes in an existing skin lesion. A new growth that ulcerates, bleeds easily, or is slow to heal is suspicious. Suspicious changes in existing growths include change in color, size, texture, appearance, or the development of pain, inflammation, bleeding or itching.

Symptoms:

• A skin lesion, growth, or bump located on the face, ear, neck, chest, back, or scalp
• Pearly or waxy appearance
• White or light pink, flesh colored, or brown
• Flat or slightly raised
• Visible blood vessels in the lesion or adjacent skin
• Appearance of a scar-like lesion without a history of injury to the skin in that area
• A sore that will not heal

Signs and Tests: A biopsy of a suspicious skin lesion is needed to prove the diagnosis of basal cell carcinoma.

Treatment: Treatment varies depending on the size, depth, and location of the cancer.

The carcinoma is removed through one of these procedures:

• Scraping
• Cauterization (burning)
• Surgical removal, including microscopic shaving (Mohs’ surgery)
• Cryosurgery (freezing)
• Radiation

Prognosis: Early treatment by a dermatologist may result in a cure rate of more than 95%. New sites of basal cell cancer can occur, so prevention should be diligent. Regular examination by a health care provider is required.

Complications:

A complication of basal cell cancer is an invasion of adjacent tissues or structures, causing damage to their appearance and function. This is most worrisome around the nose, eyes, and ears.

Call for an appointment with your health care provider if any change occurs in the color, size, texture, or appearance of a skin lesion.

Call for an appointment with your health care provider if pain, inflammation, bleeding, or itching occur in an existing skin lesion.