Basal Cell Carcinoma and Superficial Basal Cell Carcinoma

1.    What are basal cell carcinoma and superficial basal cell carcinoma?  

Basal cell carcinoma is the most common type of cancer in humans and the most common skin cancer.  A basal cell carcinoma typically begins as a painless “pimple-like” bump that can be pink or skin-colored.  This lesion will grow very slowly over time until a point when it may suddenly grow more quickly.  Often the lesion will be very fragile and will bleed easily.  It may appear to heal, but never entirely resolves. Basal cell carcinoma can arise in all skin types, although is most common in fair-skinned individuals who have had a great amount of sun / ultraviolet exposure throughout their lifetime.  Although basal cell carcinoma rarely spreads to lymph nodes or other areas of the body, it can spread locally and destroy soft tissue and cartilage, resulting in significant disfigurement and possible infection.  Very few cases of death due to basal carcinoma are reported.

2.    What do basal cell carcinoma and superficial basal cell carcinoma look like?

Basal cell carcinomas may take on a number of forms.  They may appear as bleeding, oozing, open sores that persistently crust yet remain unhealed for over three weeks.  This is a very common, early sign of basal cell carcinomas.  They may also appear as red patches on the arms, legs, shoulders, or chest, which may have either itchiness, pain, or may not feel irritated at all.  The latter are typically the superficial basal cell carcinoma type.  Other types of basal cell carcinomas appear as pearly, shiny bumps or nodules of white, tan, black, or brown coloration.  These may be confused with nevi, especially in darker-skinned individuals.  Another form of basal cell carcinoma may appear as a pinkish growth with raised outer borders and depressed crusted or eroded centers.  These may grow larger and begin to show tiny blood vessels just underneath the pearly surface.  Finally, a less common form of basal cell carcinoma may appear as a whitish scar-like growth with very undefined borders.  These types of cancer may be very aggressive.  Any growth resembling a basal cell carcinoma should be evaluated by a dermatologist to determine its identity and determine the best treatment plan.  If left unchecked, basal cell carcinomas that arise near the eyes, nose, or ears are capable of invading deeply and causing significant damage, even extending into important blood vessels and tissues of the brain.    

3.    Who gets basal cell carcinoma and superficial basal cell carcinoma?

Basal cell carcinomas are extremely common, generally affecting adults over age 40, although they may occur earlier in individuals who have had extensive sun / ultraviolet exposure (tanning beds) or in those with a lowered immune system.  These cancers are especially prevalent among fair-skinned, outdoor workers or sportspersons in the sunniest areas of the United States, and in adults with a history of heavy sun exposure before age 18.  They can also arise in darker-skinned individuals.  Albinos of all races are especially susceptible to basal cell carcinomas.

4.    What causes basal cell carcinoma and superficial basal cell carcinoma?

Basal cell carcinomas are caused by chronic exposure to the sun and other sources of ultraviolet and / or x-ray radiation.

5.    What triggers basal cell carcinoma and superficial basal cell carcinoma? / What can make them worse?

Prolonged sun exposure among individuals with poor tanning capacity increases the risk for acquiring basal cell carcinomas.  Other factors contributing to a higher risk for basal cell carcinoma include previous x-ray therapy for facial acne, or having some history of ingestion of arsenic-containing substances during childhood.

6.    How can my basal cell carcinoma and superficial basal cell carcinoma be treated?

Superficial basal cell carcinomas may resolve with topical chemotherapy cream or scraping and electrocautery. Basal cell carcinomas of the head and neck area, especially near the eye, nose, lips and ears or on areas where there is minimal excessive normal skin, can be treated with either Mohs micrographic surgery or by a non-surgical, approach called electronic brachytherapy (Ebx, see below), both offered in our offices. For more information on basal cell carcinoma treatments or to schedule a skin check, please call and speak with a representative at the Berman Skin Institute.

WHO IS SUITED FOR ELECTRONIC BRACHYTHERAPY (EBX)?
With a number of excellent options, patients can choose according to their individual preferences for treatment. Considerations include comfort, pain, treatment time, effectiveness, and appearance post treatment.

EBX may be the treatment of choice when:

  • Looking for a painless, nonsurgical therapy
  • Scarring needs to be minimal as the tumor is in a visible area (face or nose)
  • The tumor is in an uncomfortable position (shin)
  • Surgery is not advised due to a health condition or medication (blood thinners)
  • It is vital to preserve the structure and use of the area being treated (hand or ear)
  • The margins are positive after initial surgical excision
  • Radiation Treatment Options for NMSC:

    OLDER, MORE TRADITIONAL External Beam Radiotherapy (EBRT) uses low-dose x-rays or electrons accurately directed to the area of the tumor within a specialized treatment facility. It is used for the vast majority of cancer types and is delivered daily over several weeks. Also, the older HDR Brachytherapy works via a precise, radioactive seed that delivers high dose radiation within specialized catheters to a targeted area within a shielded room. It is also commonly used for breast, lung, prostate and gynecologic cancers.

    NEWER, INNOVATIVE Electronic Brachytherapy (Ebx) is a highly focused therapy that uses low-energy x-rays without using a radioactive isotope. The treatment thus maximally spares healthy tissues and can be delivered safely and conveniently in an unshielded room.

    The Ebx Procedure: The simple outpatient treatment takes place twice a week for approximately 4 weeks. The number of sessions required will vary based on the tumor size, depth, and location. An individualized treatment plan with custom shielding is developed for each patient. During treatment, a small surface applicator is applied to the skin thru which radiation is delivered for just a few minutes. The therapy is non-invasive and painless.

    The patients are able to drive themselves home and immediately return to normal activities. As a superficial skin treatment localized to the skin cancer, there is no radiation exposure to other areas of your body or to anyone else.

    A radiation therapist and physicist work under the direct supervision of a radiation oncologist who specializes in radiation treatment of skin cancer.

    Proven effective:
    Cure rates are similar to surgery and EBRT; most people receiving brachytherapy remain cancer-free.

    Painless Procedure:
    Pain-free, knife-free and needle-free, no anesthesia or sedation is needed.

    Minimal or no scarring:
    Outstanding appearance of treatment site.

    Minimal loss of use:
    Little or no healthy tissue affected so loss of use is minimal compared to surgery.

    Minimal side effects:
    Accurate delivery of radiation directly to tumor reduces the risk of side effects.

    Convenience of short treatment:
    Brachytherapy is often given over a few days compared to weeks of EBRT and unlike surgery, no recovery time is needed.

    State-of-the-art therapy:
    Established therapy; continued technological advances providing even more effective treatment. Advances in treatment planning and applicator design facilitate even greater precision in dose delivery and minimizes harmful radiation to surrounding healthy tissues. Excellent efficacy, cosmetic and functional outcomes, combined with reduced risk of side effects, short outpatient treatment times and improved quality of life indicate that brachytherapy is a patient-centered treatment choice. The shorter treatment duration of surface brachytherapy also lowers the total treatment costs.

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