Basal Cell Carcinoma and Squamous Cell Carcinoma

General Information

Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the two most common forms of skin cancer. BCC is the most common type of skin cancer accounting for about 80 percent of all skin cancers. SCC is responsible for about 15 percent of all skin cancers. Both of these types of skin cancer are associated with sun exposure and a light complexion. Fortunately, both types can usually be treated successfully if identified early and treated appropriately.

What happens if BCC or SCC are not treated?

BCC is a slow growing cancer with very little ability to spread to other parts of the body. However, it can be locally invasive, growing into and destroying nearby structures such as the nose, ear or eye. When located on the body, the cancer can grow large and invade down to muscle or bone and create an open wound. Usually this type of destruction takes several years to occur.

SCC is a more aggressive skin cancer than BCC. It usually grows more quickly and can cause greater destruction than BCC. In addition to being locally invasive, SCC can spread to lymph nodes or other parts of the body. This type of spread occurs most often in SCC's that are present on the lips, ears, hand and fingers and in patients whose immune systems do not work well. In the vast majority of cases, SCC remains only in the skin.

What treatments are available for BCC and SCC?

The first step in treatment of BCC and SCC is to take a biopsy of the suspected skin cancer to be checked under the microscope to make a definite diagnosis. Once this is done, a treatment for skin cancer can be chosen.

Several treatments are available for BCC and SCC and each treatment has its own advantages and disadvantages. Common treatments include destruction of the cancer and surgical removal of the cancer - either with Mohs surgery or traditional surgery. Less common treatments include radiation treatment and creams that can remove skin cancer. Sometimes more than one treatment is used in combination. Your dermatologist will recommend the treatment that he or she feels is most appropriate for your skin cancer. If you have questions about treatments other than the ones recommended, ask your doctor for more details.

What do I need to do now that I have skin cancer?

The first step is to treat the melanoma. After the treatment for the skin cancer is completed, you should see your dermatologist regularly for follow-up exams. Your dermatologist will examine the area where the skin cancer was treated to make sure that it is not growing back and will also check your skin for new skin cancers. Once you have been diagnosed with BCC or SCC, you have a 50 percent chance of having another skin cancer within the next 5 years.

You should also examine your own skin thoroughly each month. Use a will lit room and the combination of a full length mirror and a hand held mirror to check all of the areas that are hard to see. A spouse, parent or friend can also help you. Notify your dermatologist of any new growths, any spots that are changing and any spots that look funny. Also, pay attention to any spot that bleeds for no good reason or gets a scab that will not heal. Most skin cancers are discovered by a patient or spouse and then brought to the attention of the doctor. Carefully examining your own skin is the best defense against a future skin cancer.

It is also important to protect your skin from the sun. Regular sun protection can decrease your chances for developing future skin cancers. The following steps should be taken for sun protection.

1. Do not intentionally expose your skin to natural or artificial sunlight.
2. Avoid sun exposure when possible, especially in the middle part of the day when the sun is most directly overhead.
3. Protect your skin from the sun with clothing. Wear a hat with a broad brim, sunglasses, a long sleeved shirt and pants when outdoors.
4. Apply sunscreen with an SPF of 15 or higher to all skin surfaces that cannot be covered with clothes. Be sure to reapply this sunscreen regularly.

The above steps for sun protection are listed in the order of importance. When used together, these steps will reduce your chances of developing more skin cancers.

Where can I learn more about skin cancer?

Your dermatologist can answer many of your questions about skin cancer. Other good sources for information include the following websites:

1. The American Academy of Dermatology www.aad.org
2. The National Cancer Institute www.nci.nih.gov
3. The American Cancer Society www.cancer.org
4. The Skin Cancer Foundation www.skincancer.org

Treatment Options

General Treatment Information

Several treatments are available for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), the two most common forms of skin cancer. Each treatment has its own advantages and disadvantages. Treatments include destruction, Mohs surgery, traditional surgery, radiation, creams and home remedies. Sometimes more than one treatment is used in combination. Your dermatologist will recommend the treatment that he or she feels is most appropriate for skin cancer. If you have questions about any of the treatments that are covered on this webpage, ask your doctor for more details.

Destruction of Skin Cancer

Destruction of the skin cancer is the most widely used treatment for BCC and SCC. The skin is numbed with a shot of local anesthetic and a sharp surgical instrument, called a curette, is used to scrape away the skin cancer. Then, the base is cauterized to stop the bleeding. This leaves an open wound that looks like a scrape, and it heals in about four to six weeks. The healed wound usually leaves a flat white scare about as large as the skin cancer. The advantages of this method are that it is quick to perform, does not require stitches, is less expensive than other treatments and has a cure rate of about 85 percent. The disadvantages are that the failure rate is about 15 percent and there is a prolonged healing time. This treatment is most often recommended for small skin cancers located on the body.

Mohs Surgery

In Mohs surgery, the visible part of the skin cancer is outlined with a pen. Then, the skin is numbed with a shot of local anesthesia and the outlined area is surgically removed. After this, the wound is bandaged and the removed skin is taken to the lab to be processed into microscope slides. While the patient waits, all of the edges and the base of the removed skin are checked under the microscope to be certain that the cancer has been completely removed. If the cancer is not completely removed, then a map of where the cancer is located is made and the patient has another piece of skin removed just in that area and checked under the microscope again. This process is repeated until the cancer is completely removed.

The advantages of Mohs surgery are that it has the highest cure rate of any available treatments for BCC and SCC. Cure rates range from 95 to 99 percent depending on the type of cancer being treated. The cure rate is so high because all of the edges and base of the cancer are checked under the microscope at the time of surgery and no roots are left behind. The other advantage is that only the cancerous skin is removed and no extra skin around the cancer has to be taken. This means that the wound from the surgery and the associated scar are as small as possible. The disadvantages are that it takes several hours to complete the treatment and it is more expensive than most other treatments for skin cancer. Mohs surgery is most often recommended for skin cancers on the head and neck, for large or aggressive skin cancers and for skin cancers that have grown back after previous treatment.

Traditional Surgery

In traditional surgery, the skin cancer is outlined with a pen and then a safety margin of normal skin around the cancer is removed in addition to the visible cancer. After the cancer is removed, the wound is repaired with stitches and the patient is sent home. The removed skin cancer is sent to a pathologist and the edges are sampled to see if the cancer has been completely removed or not. The advantages of traditional surgical excision are a cure rate of 90 to 95 percent and a cost that is between Mohs surgery and destruction. The disadvantages are that extra skin has to be removed to make sure the cancer is adequately treated and that the pathology results are no available until after the surgery has been completed. This means that if the cancer was not completely removed a second surgery would have to be performed. Traditional surgical excision is most commonly recommended as an alternative to destruction of skin cancer for small and medium sized skin cancers located on the body.

Radiation

Radiation treatment is an option for skin cancer. The patient is referred to a radiation oncologist, a doctor who specializes in radiation treatment of cancers. The radiation oncologist decides on the particulars of the treatment including how many radiation treatments are needed and how frequently the patient needs to have the treatments. Commonly, the patient will have treatments several times a week for several weeks. The main advantage of radiation is that no surgery is needed. The disadvantages are the time and expense involved in radiation treatment and the lower cure rate as compared with surgical treatments. Radiation treatment is most commonly recommended for patients who are unwilling to undergo surgery or as a treatment in addition to surgery for patients with aggressive skin cancer.

Creams

There are two creams that are approved by the Food and Drug Administration for the treatment of superficial skin cancers - Aldara and Efudex. These creams are applied once or twice a day to the skin cancer for several weeks. They often create a superficial wound around the skin cancer. The advantages of the creams are that they are non-surgical treatments and can be completed at home rather than in the doctors office. The main disadvantage is that they are only effective for selected small skin cancers and the cure rate is much lower than with traditional treatments ranging up to 75 percent for some skin cancers but my be lower than 50 percent for other types. These treatments are usually recommended for patients who cannot or will not have surgical treatments.

Home Remedies

A variety of home remedies exist for the treatment of skin cancer. These treatments are sold over the internet and through other avenues. Most of these remedies are escharotics, creams that are applied to the skin cancer to destroy it. They may be derived from plants such as Bloodroot or from chemicals. These creams have not been carefully studied and are not recommended for the treatment of skin cancer. Please advise your doctor if you intend to use one of these treatments so that he or she can discuss with you the associated risks.