Basal Cell Carcinoma Treatment in Mumbai, India

Basal Cell Carcinoma is the least risky type of skin cancer, which appears on parts of your skin that are exposed to the sun a lot. Basal cells present in the skin produce new skin cells to replace the old ones. They are found in the lower part of the epidermis, which is the outermost layer of the skin. It is also called Basal Cell Skin Cancer.

Basal Cell Carcinoma Symptoms

Basal Cell Carcinoma typically appears on sun-exposed body parts like your face, shoulders, arms, and neck. Sometimes, it can also spread to other parts of the body protected from the sun, like the genitals. Symptoms include:

• Shiny bumps that could be mistaken for warts
• Spots that are lighter in one area of the skin and darker in another
• Open sores with dried-up blood that take a very long time to heal
• Small areas of white scars, different from your actual skin colour
• Irritated skin patches that resemble a rash
• Extreme sensitivity
• Numbness

The lesions can be in the form of sores, patches, bumps, and pink growths that can be slightly elevated or have smooth edges. In patients with dark skin, at least half the Basal Cell Carcinomas are pigmented (brown or black). The carcinoma cells look different on different people and may bleed or itch or be crusty in nature.

Basal Cell Carcinoma Causes

This type of carcinoma occurs when there is a mutation in the DNA of the skin’s basal cells. The DNA is responsible for giving instructions to a cell about its growth. When a mutation enters this system, it tells the older basal cells to continuously grow and multiply rapidly, instead of dying. This leads to an accumulation of abnormal cells that could result in the formation of a cancerous tumor.

Basal Cell Carcinoma Diagnosis & Test

To assess the changes in your skin, a dermatologist (skin specialist) will first conduct a general physical exam and ask you about your medical history, changes in the skin, and any other signs you may be experiencing. This could range from when you first noticed the lesions to the precautions you take to stay safe in the sun. The rest of your body will also need to be checked for other abnormal growths.

Post this, a skin biopsy is conducted, which involves taking your skin sample and examining it in a laboratory. This helps the doctor ascertain whether you have skin cancer and, if yes, what type it could be.

Basal Cell Carcinoma Treatment

The type of treatment depends on the location, type, and size of the cancer present. Your overall health and biopsy results will also influence the main treatment plan. It can also change if it is a recurring Basal Cell Carcinoma. The various treatment methods are:

• Surgical: This is the most common solution that could either be a surgical excision (where the cancerous lesions and a surrounding margin of healthy skin are cut out) or Mohs surgery (where the doctor removes skin layer by layer and examines it until no cancerous cells remain).
  Another method is the C and E (Curettage and Electrodesiccation) which involves removing the cancerous skin surface with a curette (scraping instrument) and then burning the base of the cancer with an electric needle.
• Non-surgical: When surgery isn’t an option, special creams and ointments may be prescribed. For superficial lesions, liquid nitrogen is used to freeze and remove them (Cryosurgery). Photodynamic Therapy (PDT) is a two-part procedure where a solution is created to make it more sensitive to blue or red light to help destroy the cancer cells.

In some rare cases, Basal Cell Carcinoma can spread to nearby lymph nodes as well as other parts of the body. Additional treatment options include Chemotherapy (aggressive use of drugs to destroy cancer cells) and Targeted Drug Therapy (specific drugs are used to block the molecular signals that instruct the cancers to keep growing). Newer treatments for deep Basal Cell Carcinoma are being studied in clinical trials.

Basal Cell Carcinoma Preventions

To reduce the risk of contracting Basal Cell Carcinoma, you should:

• Apply sunscreen generously throughout the year.
• Wear protective clothing (like hats, scarves, long sleeves, and full pants) to reduce exposure to the sun.
• Go to your dermatologist annually for a skin exam and ask about warning signs to look out for.

Basal Cell Carcinoma is the least risky type of skin cancer and can be cured easily if caught early. It rarely spreads to other parts of the body.

Basal Cell Carcinoma Risk Factors

Individuals could be at a higher risk for Basal Cell Carcinoma if:

• They live in a sunny location or are constantly exposed to the sun's UV rays.
• They have a personal or family history of skin cancers.
• They are above the age of 50 as these carcinomas take decades to develop.
• They regularly visit commercial tanning salons and are exposed to harsh UVA and UVB rays.
• They have a weak immune system or are on medication that suppresses their immunity.
• They are undergoing radiation therapy to treat another condition.
• They are male.
• They are exposed to the toxic metal, Arsenic, through their food or water.
• They have a history of blistering sunburns.
• They have some pre-existing medical conditions like Xeroderma pigmentosum.

Basal Cell Carcinoma Complications

Some complications include:

• Spreading beyond the skin (like to the bones and lungs)
• Increasing the risk for other types of skin cancers
• Recurrence (most Basal Cell Carcinomas reappear)

1. What are the treatment options available for basal cell carcinoma?

The treatment approach for basal cell carcinoma (BCC) can vary based on the tumour’s size, location, and specific subtype.

Mohs surgery: A specialised surgical procedure that removes the tumour layer by layer until no cancer cells remain.

Excisional surgery: Surgical removal of the tumour along with a surrounding margin of healthy tissue.

Curettage and electrodesiccation: Removing the tumor by scraping it with a curette, followed by the application of an electric current to eliminate any remaining cancer cells.

Radiation therapy: Treatment that uses high-energy X-rays to destroy cancer cells.

Topical treatments: Topical treatments (imiquimod 5% or 5-fluorouracil 5%) are primarily for superficial BCC (and in select cases small nodular BCC in low-risk sites when surgery isn’t suitable)

Photodynamic therapy: Photodynamic therapy is mainly for superficial BCC; while cosmetic outcomes can be good, long-term control is generally lower than surgery, especially for nodular disease.

Targeted therapy: Systemic therapy for advanced BCC includes hedgehog pathway inhibitors (vismodegib, sonidegib) for locally advanced or metastatic BCC when surgery/RT aren’t appropriate; if these are not tolerated or fail, PD-1 immunotherapy (cemiplimab) is an option.

2. How effective are the different treatment options for basal cell carcinoma?

The effectiveness of treatment options for basal cell carcinoma is generally high. Mohs surgery is the most effective treatment, achieving a success rate of around 98-99% for primary BCCs. Other surgical procedures, such as excisional surgery, also have high success rates. Radiation therapy is effective, particularly for tumours in difficult-to-treat areas or for patients who cannot undergo surgery.

3. Are there any side effects associated with basal cell carcinoma treatment?

The effects vary depending on the treatment method. Common side effects may include pain, swelling, bleeding, scarring, infection, and alterations in skin colour or texture. Some treatments, such as radiation therapy, can also lead to fatigue, skin irritation, or potential long-term effects on nearby tissues.

4. How long does the treatment of basal cell carcinoma typically take?

The length of treatment for basal cell carcinoma can vary based on factors such as the treatment method, the tumour’s size and location, and individual patient characteristics. Excisional surgery is usually a single outpatient visit; Mohs surgery is completed the same day in multiple stages; radiation therapy is delivered over multiple sessions (fractions), often 5–30 treatments over days to weeks, depending on the regimen.

5. Will basal cell carcinoma treatment leave a scar?

It is common for basal cell carcinoma treatment to result in some degree of scarring. The extent of scarring can vary based on factors, including the size and location of the tumour, the treatment method used, and individual healing factors. Surgical procedures, including Mohs surgery and excisional surgery, aim to minimise scarring by removing as little healthy tissue as possible.

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