Basal Cell Carcinoma (BCC):
Information for adults

If your physician suspects a basal cell carcinoma, he or she will first want to establish the correct diagnosis by performing a biopsy of the lesion. The procedure involves:

1. Numbing the skin with an injectable anesthetic.
2. Sampling a small piece of skin by using a flexible razor blade, a scalpel, or a tiny cookie cutter (called a "punch biopsy"). If a punch biopsy is taken, stitches (sutures) may be placed and will need to be removed 6–14 days later.
3. Having the skin sample examined under the microscope by a specially trained physician (dermatopathologist).

Treatment of a biopsy-proven basal cell carcinoma depends upon many factors, including the subtype of basal cell carcinoma, its size, its location on the face or body, and the general health of the patient.

Nodular basal cell carcinomas:

• Freezing (cryosurgery) with liquid nitrogen – Very cold liquid nitrogen is sprayed onto the basal cell carcinoma, freezing it and destroying it in the process.
• Electrodesiccation and curettage, also known as "scrape and burn" – After numbing the lesion, the doctor uses a curette to "scrape" the skin cancer cells away, followed by an electric needle to "burn," or cauterize, the tissue. The electrodesiccation helps to kill the cancer cells and also to staunch any bleeding of the site.
• Excision – The basal cell carcinoma is cut out with a scalpel, and sutures are usually placed to bring the wound edges together.
• Mohs micrographic surgery – In this technique, the physician takes tiny slivers of skin from the cancer site until it is completely removed. This technique is particularly useful for basal cell carcinomas located on the nose, the ears, and the lips.
• Radiation treatment – X-ray therapy is often useful for patients who are not good surgical candidates because of other health issues.

Infiltrating or morpheaform basal cell carcinomas:
Infiltrating basal cell carcinomas can be more aggressive and locally destructive than other types of basal cell carcinoma. They can invade more deeply and widely than may first be evident by the superficial appearance of the skin cancer. For this reason, it is more important to treat them early and with slightly more aggressive techniques.

• Excision – The basal cell carcinoma is cut out with a scalpel, and sutures are usually placed to bring the wound edges together.
• Mohs micrographic surgery – In this technique, the physician takes tiny slivers of skin from the cancer site until it is completely removed. This technique is particularly useful for basal cell carcinomas located on the nose, the ears, and the lips.
• Radiation treatment – X-ray therapy is often useful for patients who are not good surgical candidates because of other health issues.

Superficial basal cell carcinomas:
Superficial basal cell carcinomas tend to be slow-growing and, as the name implies, very thin. Therefore, they do not necessarily need the more aggressive forms of treatment. In fact, some research indicates that superficial basal cell carcinomas may be treated without surgery.

• Cryosurgery with liquid nitrogen – Very cold liquid nitrogen is sprayed on the basal cell carcinoma, freezing it and destroying it in the process.
• Electrodesiccation and curettage, also known as "scrape and burn" – After numbing the lesion, the doctor uses a curette to "scrape" the skin cancer cells away, followed by an electric needle to "burn," or cauterize, the tissue. The electrodesiccation helps to kill the cancer cells and also to staunch any bleeding of the site.
• Radiation treatment – X-ray therapy is often useful for patients who are not good surgical candidates because of other health issues.
• Imiquimod – This cream encourages the body's immune system to attack and eradicate the superficial basal cell carcinoma. It is usually applied several times per week for 6–12 weeks.
• Photodynamic therapy – In this relatively new technique, a photosensitizing substance (a chemical that is activated when it is exposed to light) is applied to the superficial basal cell carcinoma. After an incubation period in which the chemical is preferentially absorbed by the skin cancer cells, the superficial basal cell carcinoma is exposed to a particular wavelength of light in the physician's office. The special light activates the chemical, causing destruction of the superficial basal cell carcinoma.
• Laser – For superficial basal cell carcinomas, some physicians are using carbon dioxide and other lasers to destroy the skin cancer.