Basal Cell Carcinoma
These superficial skin cancers can be treated in a number of different ways, and your doctor will advise you on the most suitable treatment. Surgical removal enables the lesion to be assessed by a pathologist to see if it has been adequately treated. Other treatments may require a sample (biopsy) to confirm the type of skin cancer before starting treatment.
Your surgeon will most often do this under a local anaesthetic (stay awake) as a daycase procedure. The aim of surgery is to completely remove the affected area with a margin of safety. Once removed, the wound will often be simply stitched together, but sometimes a skin graft or skin flap is needed to mend the wound.
There are times when it is very difficult for your surgeon to see the edge of the affected area to reliably remove it first time. Mohs Surgery allows the surgeon to check the edges of the tissue down a microscope in the next room whilst you remain in the day surgery unit and take a further sample if abnormal cells are still present in your skin. This process can be repeated until all tumour cells are removed. The wound can be closed at the same time, or commonly the following day.
With very early sun damage your doctor can scrape away the damaged cells in the top layers of the skin (curettage) and leave things to heal naturally with a simple dressing.
Your doctors may suggest you use an ointment (Efudix or Aldara) to treat areas of sun damage or basal cell carcinoma, particularly superficial BCC. These ointments are designed to make the affected area inflamed (hot and red) so that your body’s own defence cells (immune system) can enter and destroy any abnormal tumour cells. Treatment is normally applied for 3–6 weeks and can take up to 12 weeks to fully settle down. Your doctor will then check if this has been successful.
Occasionally your doctor will recommend a combination of ointment to the affected area before you sit beneath a specially designed light that activates the treatment to destroy abnormal cells in the skin. The treatment is carried out as a single outpatient visit and can take a number of weeks to settle down. Your doctor will assess its effects and can repeat it if necessary.
Some patients are not suitable for surgery because they have numerous medical problems, or have a large area of tumour that cannot be easily removed and rebuilt (reconstructed). Also, radiotherapy can be used after surgery to ‘mop up’ any remaining tiny tumour cells around the treated area. This involves a number of visits to your local radiotherapy unit often over a short period of time. Radiotherapy does not result in scars in the short term but can lead to scarring and tissue damage in the future.
In some special circumstances patients are offered a new chemotherapy medicine (vismodegib) to treat advanced basal cell carcinomas. This treatment is usually only used for very aggressive disease that cannot be treated by an operation.
Skin anatomy and types of skin cancer
Squamous cell carcinoma
Surgery and reconstruction
Lymph node surgery