The Most Common Kind of Skin Cancer

Basal cell carcinoma (BCC) is the most common form of skin cancer. It rarely spreads to nearby lymph nodes or other organs.

Skin cancer forms in the epidermis, which is made up of three kinds of cells:

• Squamous cells: thin, flat cells that form the top layer
• Basal cells: round cells under the squamous cells
• Melanocytes: cells that make pigment that gives the skin its color

An estimated 4.3 million cases of BCC are diagnosed in the U.S. each year.

The best way to prevent any type of skin cancer is to protect your skin from the sun. Use sunscreen with a sun protection factor (SPF) of at least 15 when you go outside, even if it’s cloudy. Seek shelter in the shade, and don’t use tanning beds or sunlamps. Even if you tan easily or have darker skin, you’re still at risk of getting skin cancer. If you have fair skin, your risk is even higher.

Have your doctor check any lesions, moles or changes on your skin. It’s a good idea to have your skin checked by a doctor every year.

Symptoms, Diagnosis & Outlook

Skin cancer symptoms can vary depending on the type of skin cancer and its location on the skin. In general, any new or changing spots on your skin that persist for two weeks or more should be brought to your doctor’s attention.

The most common location for certain kinds of skin cancer is on sun-exposed skin, such as the face, neck, arms and legs. Skin cancer often has no symptoms in its early stages, though symptoms can appear at any point. In general, watch for any new spot on the skin or an existing spot that changes in size, shape or color. These changes can vary greatly so there is no one way to describe how a skin cancer looks.

Basil cell carcinoma may appear as: 

• A spot that is itchy or painful
• A nonhealing sore that bleeds or develops a crust
• A red, pink or shiny bump on the top of the skin
• A red rough or crusty spot that you can feel
• A growth with a rolled edge or indentation in the center
• Irregular or indistinct borders, including a scar-like growth that is slightly raised, without a well-defined border

Doctors who specialize in the treatment of skin are called dermatologists. Your Penn State Health dermatologist will ask you to answer in-depth questions about your personal and family medical history and will examine your skin using dermoscopy, which is a microscopic examination of the lesions.

When detected early, most BCCs can be treated and cured. Prompt treatment is vital, because as the tumor grows, it becomes more dangerous and potentially disfiguring, requiring more extensive treatment. Certain rare, aggressive forms can be fatal if not treated promptly.

If you’ve been diagnosed with a small or early BCC, a number of effective treatments can usually be performed on an outpatient basis, using a local anesthetic with minimal pain.

Treatment options depend on how many lesions you have, where they are, your age and overall health. They include:

• Curettage and electrodesiccation (electrosurgery): the dermatologist scrapes or shaves off the BCC using a curette (a sharp instrument with a ring-shaped tip), then uses heat or a chemical agent to destroy remaining cancer cells, stop the bleeding and seal off the wound. Your physician may repeat the procedure a few times during the same session until no cancer cells remain. Typically, the procedure leaves a round, whitish scar resembling a healed burn at the surgery site.
• Mohs surgery: Mohs surgery is performed during a single visit, in stages. The dermatologist removes the visible tumor and a very small margin of tissue around and beneath the tumor site. He or she color-codes the tissue, draws a map correlated to the surgical site and examines the tissue under a microscope to see if any cancer cells remain. If they do, your dermatologist removes more tissue exactly where the cancer cells are, repeating this process until there is no evidence of cancer. The wound may be closed or, in some cases, allowed to heal on its own.
• Excisional surgery: using a scalpel, the surgeon removes the entire tumor along with a “safety margin” of surrounding tissue and sends it to an off-site lab for analysis. The margin of skin removed depends on the thickness and location of the tumor. If the lab finds cancer cells beyond the margins, you may have more surgery at a later date until margins are cancer-free.
• Radiation therapy: the physician uses low-energy X-ray beams to destroy the tumor, with no need for cutting or anesthesia. Destruction of the tumor may require several treatments over a few weeks or daily treatments for a specified time. With radiation therapy, there is no way of knowing that all of the tumor was destroyed. Since the procedure is less precise and produces cure rates of only 90%, it is primarily used for BCCs that are hard to treat with surgery, and in elderly patients or people in poor health for whom surgery is not advised. For some cases of advanced BCC, especially those involving surrounding nerves, radiation may be used after surgery or in combination with other treatments.
• Photodynamic therapy (PDT): the dermatologist applies a topical agent to make the lesion sensitive to light or injects the agent into the tumor. After allowing a short period of time for absorption, the dermatologist uses a blue light or pulsed-dye laser (or sometimes controlled natural sunlight), which causes a reaction that destroys the BCC. After the procedure, patients must strictly avoid sunlight for at least 48 hours, as UV exposure will increase activation of the medication and may cause severe sunburns. PDT can be used for some superficial (not invasive) BCCs on the face and scalp, but is not recommended for invasive BCC.
• Cryosurgery: the dermatologist uses a spray device to apply liquid nitrogen to freeze and destroy the tumor. Later, the lesion and surrounding skin may blister or become crusted and fall off, allowing healthy skin to emerge. Cryosurgery is effective for smaller, superficial BCCs. It is especially useful for patients with bleeding disorders or problems tolerating anesthesia.
• Laser surgery: the dermatologist directs a beam of intense light at the tumor to target superficial BCCs. Some lasers vaporize (ablate) the skin cancer, while others (nonablative lasers) convert the beam of light to heat, which destroys the tumor without injuring the surface of the skin. Laser surgery is not FDA-approved for superficial BCCs, but is sometimes used as a secondary therapy, especially when other techniques have been unsuccessful.
• Topical medications: these are creams or gels applied directly to affected areas of the skin to treat superficial BCCs with minimal risk of scarring. Approved medications are imiquimod (Aldara®, Zyclara®) and 5-fluorouracil (5-FU – Efudex®, Carac®, Fluoroplex®, Tolak®). Imiquimod activates the immune system to attack cancerous cells, while 5-FU is a topical chemotherapy that kills cancerous cells. Often, tumors diagnosed on biopsy to be superficial will have other invasive areas within the same lesion, making appropriate tumor selection for this treatment difficult. When weighing the pros and cons of treatment options, it’s important to consider that radiation, cryosurgery and topical medications all have one significant drawback in common – no tissue is examined under the microscope, so there is no way to determine how completely the tumor was removed.

Advanced BCC is treated with oral medications. Vismodegib (Erivedge®) and sonidegib (Odomzo®) are FDA-approved for treating adults with BCCs that are large or have penetrated the skin deeply, spread to other parts of the body or resisted multiple treatments and recurred. Both medications are targeted drugs taken by mouth.

Why Choose Penn State Health for Care

Comprehensive, Compassionate Care

Penn State Health provides specialized testing, treatment and management for cancerous skin lesions. Our medical team is consistently recognized nationally through Best Doctors in America and America’s Top Doctors awards. Our specialists also participate in worldwide conferences and speaking engagements in countries including India, Korea, Germany, Japan and others.

Leading-Edge Clinical Trials

The skin cancer experts at Penn State Health Milton S. Hershey Medical Center and Penn State Cancer Institute are committed to offering their patients the latest treatment options, including access to leading-edge clinical trials. Our superb clinical research team includes dedicated research nurses, clinical trial coordinators and data analysts and gives patients the opportunity to participate in the latest clinical trials. Learn more about new Penn State Health clinical trials at StudyFinder.

Support Groups

Support groups provide an opportunity to share your feelings and connect with other patients and caregivers who are experiencing similar struggles.

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