Among the different types of skin cancer, basal cell carcinoma (BCC) is the most common in the UK and the one we see most frequently at the London Skin Cancer Clinic clinic on Harley Street. There are many different subtypes of BCC but the classic appearance is a raised red lesion with tiny blood vessels (telangectasia) radiating from the centre of the lesion which is pearly in appearance. Basal cell carcinomas are also known as 'rodent ulcers' and can be very destructive locally where they grow but typically do not spread (metastasise) to other areas of the body.
How is it treated?
Once a lesion is confirmed as a basal cell carcinoma - either through a biopsy or because it has the classic appearances of a BCC, the next step is to remove or destroy the tumour. There are many treatment options available and the decision as to which option is best depends upon the size, location and which sub type of BCC you may have. We will also consider the patient's age
, health status and medical history when deciding the plan of action to take.
At the London Skin Caner Clinic we normally treat basal cell carcinomas on an outpatient basis, the procedure is carried out with local anaesthetic and involves only minimal discomfort.
Surgical Excision
The basal cell carcinoma is removed with a cuff of surrounding normal skin to ensure the tumour is completely removed. The amount of normal skin removed and resulting size of the scar depends on the size and subtype of basal cell carcinoma. The wound is then carefully closed with sutures and the specimen sent to the laboratory for histological analysis. Recurrence rates following surgical excision are under 5%.
Cryosurgery
Some superficial basal cell carcinomas can be treated using cryosurgery which involves the application of liquid nitrogen to the tumour. Extreme cold destroys the tumour cells and this treatment can be suitable for certain patients, avoiding the need for a surgical procedure. Occasionally the treatment may need to be repeated to ensure the cancerous tissue is completely destroyed. There is minimal discomfort associated with cryosurgery and after treatment the area can blister and scab, which then falls off leaving a red mark and ultimately a small circular scar.
Curretage and cautery
Superficial tumours respond well to curettage and cautery. The surgeon scrapes off the tumour with a curette and stops the bleeding with electrocautery. In the right hands and with the right type of basal cell carcinoma it can be as effective as excision. As with any surgical procedure there will be a red mark left on the skin which will fade to a small scar with time.
Mohs Micrographic Surgery
This is a surgical treatment usually reserved for recurrent basal cell carcinomas, those which are particularly aggressive and those that arise in cosmetically sensitive areas. Mohs surgery is an involved procedure whereby the basal cell carcinoma is debulked then thin shavings of the surrounding skin are taken sequentially and examined under the microscope in real time until no further tumour is seen. Recurrence rates following Mohs surgery are less than 1% however it is a time consuming procedure and can leave fairly extensive soft tissue defects requiring plastic surgical reconstruction, sometimes under general anaesthetic.
Topical Creams
Some superficial BCCs may respond to Imiquimod. Cure rates are good and no surgery is needed. The patient only needs to rub the cream on the lesion 5 times a week for 6 weeks or more depending on doctor’s specifications.
Another topical cream for used for BCCs is 5-Fluorouracil. It has similar effectiveness to Imiquimod. The cream is applied to the tumour twice a day for 3 - 4 weeks. Both creams cause inflammation and irritation of the area treated.