Basal cell carcinoma (BCC) is the most common type of skin cancer. Over 4 million cases are diagnosed in the United States each year. BCC rarely spreads to other parts of the body, but it can grow into surrounding areas and cause serious damage if left untreated. If caught and treated early, BCC has a cure rate of over 95%. Knowing what to expect if you are diagnosed with BCC can help you seek prompt treatment and have the best possible outcome.
What are the first steps after a BCC diagnosis?
If a biopsy confirms you have BCC, the first step is to get the tumor fully removed with a procedure called excision. This involves numbing the area with local anesthesia and cutting out the tumor along with a margin of healthy skin around it to ensure all cancerous cells are eliminated.
Your doctor will examine the excision site to determine if they got all of the cancerous tissue. They may do one of two procedures:
Mohs surgery
Mohs surgery is considered the gold standard treatment for BCC removal. Here’s how it works:
- The visible tumor is removed along with a thin layer of surrounding tissue.
- That tissue is immediately examined under a microscope while you wait.
- If cancer cells are still present at the edges, another thin layer is removed from that spot.
- This process is repeated until no more cancer cells are seen under the microscope.
Mohs allows the most precise removal of cancerous tissue while sparing as much healthy skin as possible. It has the highest cure rate – up to 99% for early stage tumors.
Wide local excision
In this technique, the tumor is cut out along with a wide margin of normal skin around it. The width of the margin depends on factors like where the tumor is located and how large it is.
The excised tissue is then sent to a lab to be examined under a microscope to ensure all cancerous cells have been removed. If any remain at the edges, additional tissue may need to be cut out.
Wide local excision is faster than Mohs surgery but may sometimes require removing more healthy skin around the tumor.
What happens after excision?
After the cancerous tissue is fully excised, the treatment depends on the specifics of your case:
For simple tumors:
If the BCC was small and easily removed with clear margins, you may need no additional treatment. But you will need regular skin exams to watch for recurrence or new tumors.
For high-risk tumors:
In certain cases, your doctor may recommend additional steps after excision to lower the risk of recurrence:
- Radiation therapy: This uses X-rays to kill any cancer cells that may remain around the excision site.
- Advanced treatments: For tumors in high-risk areas like the nose or ears, special treatments like curettage and electrodesiccation or topical chemotherapy creams may be used after excision.
- Clinical trials: If available, your doctor may suggest enrollment in clinical trials studying new treatments to lower recurrence risk.
Reconstructive surgery
If the BCC or its removal resulted in a large defect or scar, you may benefit from reconstructive surgery. This can involve:
- Skin grafts to replace lost tissue
- Skin flaps to cover the wound
- Mohs reconstructive surgery to minimize scarring
A plastic surgeon can help restore function and appearance after excision.
What follow-up care is needed?
Lifelong follow-up care is crucial after any skin cancer diagnosis. You will need regular exams to check the original treatment site and screen the rest of your skin for new tumors. Your doctor will tell you how often you need follow-up visits based on your specific situation.
The National Comprehensive Cancer Network recommends the following BCC monitoring:
| Risk Level | Follow-up Recommendations |
|---|---|
| Low | Exams every 6-12 months for first 5 years, then annually |
| Medium | Exams every 6-12 months indefinitely |
| High | Exams every 3-6 months for first 2 years, then every 6-12 months |
Your doctor may take photos of suspicious spots to monitor for changes over time. Any new nodules or suspicious lesions will be biopsied. If additional BCCs or other skin cancers are detected, they will need prompt treatment.
You play an important role in follow-up care by performing regular thorough self-exams of your skin. Let your doctor know immediately if you notice any new bumps or changes. Avoiding excessive sun exposure and protecting your skin also help limit your risk of developing another skin cancer.
What is the long-term outlook for BCC?
With appropriate treatment, most basal cell carcinomas are fully cured. The 5-year survival rate for people with localized BCC is over 99%. While serious complications are rare, some things to be aware of include:
- Recurrence: Even with treatment, BCCs can sometimes come back. The recurrence rate is about 10% over 5 years. Vigilant follow-up care helps detect recurrences early.
- Metastasis: Less than 0.1% of BCCs spread to other parts of the body. This occurs more often in cases where treatment is delayed or inadequate.
- Locally advanced disease: Neglected BCCs can erode deep into tissues, destroying bone and cartilage. Treatment gets more complex in these cases.
- New skin cancers: A history of BCC increases your risk of developing other skin cancers in the future, so lifelong sun protection is essential.
The key to a good prognosis is seeking appropriate treatment right away and staying on top of follow-up care. With expert care and vigilant monitoring, most people diagnosed with BCC can enjoy long-term cure and good quality of life.
What questions should you ask your doctor after a BCC diagnosis?
Some important questions to ask your dermatologist or treatment team after a BCC diagnosis include:
- What BCC treatments do you recommend for me and why?
- What is the likelihood that the BCC has spread or metastasized?
- Will I need additional treatments like radiation or chemotherapy?
- How large of a margin will be removed around the tumor?
- Should I get a second opinion on my treatment options?
- Will I have a scar after treatment? How can we minimize scarring?
- How often will I need follow-up appointments and what will they entail?
- How can I reduce my risk for developing another BCC or other skin cancer?
- Are my family members at higher risk for BCC based on my diagnosis?
Don’t hesitate to voice any other questions or concerns you have about your diagnosis, treatment options, and outlook. Your doctor is there to educate and guide you through this process. Discussing your concerns together leads to the best possible care and outcomes.
Conclusion
A basal cell carcinoma diagnosis can be frightening, but the condition is highly treatable in most cases, especially when detected early. Treatment involves surgical excision of the tumor, with Mohs surgery or wide local excision allowing clear removal of all cancerous cells. Ongoing long-term monitoring and sun protection are imperative after treatment. While recurrences are possible down the road, they can also be effectively treated if caught early through skin self-exams and follow-up visits with your dermatologist. With appropriate treatment and vigilant follow-up care, most people with BCC can enjoy a positive prognosis and healthy, active lives. Staying informed about what to expect at every stage allows you to be an informed, empowered patient and get the best possible care.