Features of Basal Cell Carcinoma

A Basal Cell Carcinoma initially forms as a small lesion, which slowly enlarges. Patients often report the presence of a “scab” that does not heal. Involved skin can become a salmon-pink colour, fine red blood vessels can be visible on the surface of the involved skin, the edge of the lesion can become elevated (this can give the appearance of a rolled edge around a central crater.) Some Basal Cell Carcinomas can become lumpy.

Making the diagnosis

For many patients the diagnosis can be made by clinical examination, and by inspection of the lesion using a dermatoscope (which magnifies the skin approximately 10x). If there is any doubt: diagnosis can be confirmed by a small biopsy carried out under local anaesthetic. It usually takes two weeks to get the results.

Treatment

Surgery is successful at treating Basal Call Carcinoma. Lesions are usually removed using local anaesthetic. A margin of about 3mm around the lesion is associated with a 97% likelihood of complete removal of the tumour.

Flat superficial (biopsy confirmed) Basal Cell Carcinoma can be treated with a cream (5 fluorouracil or imiquimod) or photodynamic therapy. Lesions near the eye can benefit from the involvement of an oculoplastic surgeon. Lesions in critical sites (for example near the tear duct) can benefit from real-time histological analysis of the excised tissue (Moh’s microsurgery) in order to minimise the amount of tissue removed at surgery. 

The risks of surgery for Basal Cell Carcinoma

All surgery is associated with a small risk of bleeding, and infection. Please let me know if you are regularly taking Aspirin, Plavix, or Warfarin. If the wound becomes red, or discharges after surgery, then contact my office or the hospital. Your general practitioner may also be able to provide advice. Sepsis after minor surgery is extremely rare: a patient who feels unwell with a temperature should seek urgent advice.