Basal cell cancer, also called rodent ulcer, is caused by exposure to the sun.
There are five clinical types – noduloulcerative, superficial, pigmented, morpheaform and keratotic.
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The most common form – noduloulcerative – consists of a raised, round lesion with small blood vessels concentrated around it and often a central ulcer.
Treatment is by scraping the tumour out, full surgical excision, sometimes x-ray treatment or imiquimod (aldara).
After incomplete removal, basal cell cancer can recur in the same place up to 10 years after treatment.
Basal cell cancer (BCC) is a type of skin cancer caused by exposure to the sun. It is also called a rodent ulcer.
It usually consists of a single lesion on sun-exposed skin. There are five clinical types:
Noduloulcerative BCC (most common)
Superficial BCC
Pigmented BCC
Morpheaform BCC
Keratotic BCC
What causes basal cell cancer?
Sun exposure is the single most important cause of this skin cancer.
However, basal cell cancer can also arise in areas of skin with chronic scarring or x-ray damage.
Symptoms and signs of basal cell cancer
Noduloulcerative BCC is usually seen as a raised, round lesion with transparent borders. There may be ulceration in the centre and small blood vessels that appear to lead away from the lesion. Recurrent crusting and bleeding are common and the lesion continues to enlarge slowly.
Superficial BCC can look like chronic eczema – red and scaly with a sharply demarcated border.
Pigmented BCC can have a smooth, somewhat transparent border with deep pigmentation. This sometimes looks like, and is mistaken for, malignant melanoma (another type of pigmented skin tumour).
The morpheaform BCC is more serious and difficult to treat. This often appears as a yellowish to white lesion with a localised collection of small capillaries visible around the lesion. This and the keratotic (wartlike) BCC are aggressive tumours that infiltrate surrounding tissues.
How is basal cell cancer diagnosed?
Diagnosis is made on the clinical appearance of the lesion, but also by taking a sample of the tumour (biopsy) and looking at it under the microscope. This is the only way in which a definitive diagnosis can be made.
Can basal cell cancer be prevented?
Lessening exposure to the sun will help prevent any skin cancer, including BCC.
How is basal cell cancer treated?
The type of BCC, its size, the site and the clinical appearance will determine the choice of treatment.
The tumour may be curetted out – effectively scraped off the surface of the skin. It may also be dried out using electrodesiccation – destruction with electricity.
Surgical excision is used for larger and more aggressive tumours. Occasionally, x-ray therapy is used.
Recurrent tumours are treated by excising the tissue under a microscope so that all the tissue, including the edges, is removed. This is called Moh’s surgery.
What is the outcome of basal cell cancer?
BCC can recur up to 10 years after treatment, and there is a higher incidence of nonmelanoma skin cancers in people who have had BCC than in those who have not. Nonmelanoma includes all the other skin cancers such as squamous carcinoma. Therefore, long-term follow-up examination of the skin is important.
BCC can recur within scar tissue, at the edge of a scar or skin graft, or as a mass under a scar or skin transplant.
The natural history of BCC is of a slow-growing and locally invasive cancer. It rarely spreads to other areas of the body (metastases). Metastases occurs in less that 0.5% of cases.
The morpheaform and keratotic BCC are the most troublesome types, infiltrating surrounding tissue further.
When to call the doctor
Any kind of skin lesion which starts to change shape or colour, bleed or grow in size should be seen by a doctor as soon as possible.
Reviewed by Prof H.F. Jordaan, MBChB, MMed (Derm).
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