Basal cell carcinoma (BCC) is the most common type of skin cancer. It starts in the basal cells of the skin, which are round cells found in the top layer of the epidermis (outer layer of the skin). As BCC grows, it tends to grow along the skin surface and outward. Early stage BCCs are highly treatable and curable. But if left untreated, BCC can grow deeper into the skin, invade bones and other tissues under the skin, spread to lymph nodes, and metastasize (spread) to other parts of the body.
What are the stages of BCC?
Doctors use a staging system to describe the extent of BCC growth. Staging helps doctors plan treatment and determine prognosis. The American Joint Committee on Cancer (AJCC) staging system for BCC is:
- Stage 0: Also called carcinoma in situ. Abnormal cells are only present in the epidermis (outer layer of the skin) and have not grown deeper into the dermis (inner layer of the skin).
- Stage I: The tumor is 2 cm across or smaller, and has not grown below the dermis.
- Stage II: The tumor is larger than 2 cm across, but has not grown below the dermis or into nearby tissues.
- Stage III: The tumor has grown into facial bones or 1 or more lymph nodes, but has not metastasized to distant sites.
- Stage IV: The cancer has spread to distant organs beyond the regional lymph nodes, such as the lungs, liver, or bones.
What is stage 4 basal cell carcinoma?
Stage 4 is the most advanced stage of BCC. In stage 4:
- The primary tumor can be any size and may have grown deeply into facial bones or other areas under the skin.
- Cancer has spread to 1 or more lymph nodes in the region. This is called nodal involvement.
- Cancer has metastasized to distant sites beyond the regional lymph nodes, most often the lungs, liver, or bones.
What are the signs and symptoms of stage 4 BCC?
Signs and symptoms of stage 4 BCC may include:
- An open sore that bleeds or scabs and won’t heal
- A reddish patch or irritated area that may crust or itch
- A shiny bump or nodule that may be translucent or pearly
- A scar-like area that is flat, white, yellow, or waxy
- Asymmetrical growth or irregular borders of a lesion
- Growths that appear in sites of previous radiation treatment
- Lymph nodes near the tumor that feel firm or enlarged
- Bone pain if cancer has spread to bones
- Shortness of breath, cough, or chest pain if cancer has spread to lungs
- Abdominal pain or jaundice if cancer has spread to liver
How do doctors diagnose stage 4 basal cell carcinoma?
Doctors may use the following tests to diagnose stage 4 BCC and check for metastasis:
- Biopsy: The suspected tumor is removed and examined under a microscope to confirm cancer cells. A biopsy can determine if the cancer has spread into the lower layers of skin.
- Imaging tests: CT, MRI, PET scan, X-ray, and ultrasound can detect tumors in lymph nodes or metastasis to other organs.
- Blood tests: Blood chemistry tests and tumor marker tests may detect abnormalities if cancer has spread to liver or bones.
- Lymph node biopsy: Removal and examination of lymph nodes near the primary tumor can detect cancer spread.
- Bone scan: Radioactive material is injected into the bloodstream and collects in areas of abnormal bone growth. A scanner detects cancer spread to bones.
What is the treatment for stage 4 basal cell carcinoma?
Treatment options for stage 4 BCC depend on the size and location of the primary tumor, whether the cancer has spread to lymph nodes, and whether it has metastasized to distant sites. Treatments may include:
- Surgery to remove the primary tumor and affected lymph nodes.
- Radiation therapy to kill cancer cells using high-energy beams.
- Chemotherapy drugs to kill cancer cells throughout the body.
- Targeted therapy drugs that attack specific abnormalities in cancer cells.
- Immunotherapy drugs that help the immune system destroy cancer cells.
Treatment also focuses on managing cancer symptoms and side effects. A team approach with medical, surgical, and radiation oncologists offers the best outcome.
What is the prognosis and survival rate for stage 4 basal cell carcinoma?
The prognosis and survival rates for stage 4 BCC depend on many factors, including:
- Age and overall health of the patient
- Primary tumor size, location, and extent of invasion
- Whether cancer has spread to lymph nodes or metastasized
- How well treatment works to eradicate cancer cells
Overall, BCC has a high cure rate when detected and treated early. But stage 4 indicates advanced disease. Some key survival statistics include:
- The 5-year survival rate for localized BCC is over 95%. The 5-year survival rate for BCC with regional spread is about 85%.
- The 5-year survival rate for stage 4 BCC with distant metastasis is estimated between 20% and 40%.
- Median survival time after diagnosis of metastatic BCC is 8 months to 3.6 years.
Early diagnosis and prompt treatment provide the best chance for long-term remission and survival.
What are the risk factors for developing stage 4 basal cell carcinoma?
Risk factors that make someone more likely to develop advanced BCC include:
- Sun exposure & UV radiation – Chronic sun exposure and repeated sunburns early in life increase risk.
- Fair skin, light eyes, blonde/red hair – Lower melanin levels increase susceptibility to UV damage.
- Immune suppression – Medications after organ transplant or diseases like HIV/AIDS.
- Prior radiation therapy – Radiation to treat other conditions can cause DNA damage.
- Genetics & family history – Abnormalities in genes that control cell growth, like PTCH and TP53.
- Advancing age – Risk increases significantly after age 50.
- Male gender – BCC is more common in men than women.
How can I reduce my risk of developing advanced basal cell carcinoma?
Preventing BCC from progressing starts with protecting yourself from UV radiation and detecting skin changes early. Tips include:
- Use broad spectrum sunscreen with SPF 30 or higher daily.
- Wear protective clothing like hats, long sleeves, and sunglasses outside.
- Avoid the sun during peak hours between 10am and 4pm.
- Don’t use tanning beds or sunbathe.
- Examine your skin monthly and note changes in moles or new growths.
- See a dermatologist annually for a full body skin exam.
- Get any new or changing skin growths biopsied promptly.
- Follow up as directed if you’ve been treated for BCC in the past.
Catching BCC in the early stages offers the best prognosis. Public education and screening those at high risk can improve early detection.
In conclusion…
Stage 4 basal cell carcinoma is advanced disease with cancer spread beyond the primary site. Treatment is aimed at destroying cancer cells and controlling progression and symptoms. While stage 4 BCC survival rates are lower than earlier stages, treatment can provide remission. Prevention through UV protection and early detection of skin changes is key to finding BCC when it is most curable.