Basal Cell Mohs Frequently Asked Questions!


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 WHAT CAUSES SKIN CANCER?

It has been well established that exposure to sun greatly increases the risk of basal cell skin cancer. People with fair skin who burn instead of tan are more susceptible to skin cancer. Skin ageing and skin cancer relate to total sun exposure over one's entire life.

 Will I HAVE EARLY WARNING SIGNS?

Most people receive thousands of hours of lifetime exposure to the sun. When this exposure reaches a critical point, like when you get a severe sunburn, many people start noticing precancerous and cancerous lesions. This can happen many years later and these indications should not be ignored.

 WHAT IS THE MOST COMMON TYPE OF SKIN CANCER?

Basal cell carcinoma is the most common type of skin cancer. It rarely metastasizes or kills, but it is still considered malignant because it can cause significant destruction and disfigurement by invading surrounding tissues. Statistically, approximately 3 out of 10 Caucasians develop a basal cell cancer within their lifetime. In 80 percent of all cases, basal cell cancers are found on the head and neck.

 WHAT SHOULD I LOOK FOR?

The face, neck, tops of the hands and arms are most frequently exposed to ultraviolet light from the sun. 90% of all skin cancers (except melanoma) occur in these areas. These are the areas that patients should watch most carefully, although all skin should be checked monthly at home. The following signs of skin cancer (basal and squamous cell) should be closely looked for:

  • An open sore or pimple that bleeds, oozes or crusts and remains for one month or more. A persistent non healing pimple should be checked.
  • A reddish patch or irritated area, especially on sun exposed skin. It may or may not be symptomatic.
  • A shiny bump that can be a pearly color or pinkish-red color.

 HOW IS SKIN CANCER DIAGNOSED?

When an area of skin does not look normal, the doctor will perform a biopsy (removal of all or part of growth). The tissue is examined under the microscope to determine if it is cancerous.

Doctors generally divide skin cancer into two stages: local (affecting only the skin) or metastatic (spreading beyond the skin). Because skin cancer rarely spreads, a biopsy often is the only test needed to determine the stage. In cases where the growth is very large or has been present for a long time, the doctor will check the lymph nodes in the area. You also may need additional tests, such as special x-rays, to find out whether the cancer has spread to other parts of the body. Knowing the stage of a skin cancer helps the doctor to plan your best treatment.

 WHAT ARE THE DIFFERENT TYPES OF BASAL CELL?

Basal cell carcinomas may be divided into the following types:

  • Nodular basal cell carcinoma (Classic basal cell carcinoma)
  • Cystic basal cell carcinoma
  • Cicatricial basal cell carcinoma (Morpheaform basal cell carcinoma, Morphoeic basal cell carcinoma)
  • Infiltrative basal cell carcinoma
  • Micronodular basal cell carcinoma
  • Superficial basal cell carcinoma (Superficial multicentric basal cell carcinoma)
  • Pigmented basal cell carcinoma
  • Rodent ulcer (Jacobi ulcer)
  • Fibroepithelioma of Pinkus
  • Polypoid basal cell carcinoma
  • Pore-like basal cell carcinoma
  • Aberrant basal cell carcinoma

 HOW IS BASAL CELL CARCINOMA TREATED?

The following methods are employed in the treatment of basal cell carcinoma (BCC):
  • Standard surgical excision with either frozen section histology, or parafin embedded fixed tissue pathology. This is the preferred method for removal of most BCCs.
  • Mohs surgery: Mohs surgery (or Mohs micrographic surgery) is an outpatient procedure in which the tumor is surgically excised and then immediately examined under a microscope. It is claimed to have the highest cure rate of 97% to 99.8%.
  • Chemotherapy: Some superficial cancers respond to local therapy with 5-fluorouracil, a chemotherapy agent. Topical treatment with 5% Imiquimod cream, with five applications per week for six weeks has a reported 70-90% success rate at reducing, even removing, the BCC (basal cell carcinoma).
  • Immunotherapy: Immunotherapy research suggests that treatment using Euphorbia peplus, a common garden weed, may be effective.
  • Radiation: Radiation therapy is appropriate for all forms of BCC as adequate doses will eradicate the disease. Although radiotherapy is generally used in older patients who are not candidates for surgery, it is also used in cases where surgical excision will be disfiguring or difficult to reconstruct (especially on the tip of the nose, and the nostril rims).
  • Photodynamic Therapy: Photodynamic therapy is a new modality for treatment of basal-cell carcinoma, which is administrated by application of photosensitizers to the target area.
  • Cryosurgery: Cryosurgery is an old modality for the treatment of many skin cancers. When accurately utilized with a temperature probe and cryotherapy instruments, it can result in very good cure rate.
  • Electrodessication and curettage: or EDC is accomplished by using a round knife, or curette, to scrape away the soft cancer.

 WHAT IS APPROPRIATE FOLLOW-UP CARE AFTER TREATMENT FOR BASAL CELL?

Studies have shown that if you've had skin cancer once then there's a 35-50% incidence of an additional skin cancer (basal and squamous cell types) within 3 years after treatment of the first cancer.

If you have had prolonged sun exposure or already have had a skin cancer then you should be making regular visits to your dermatologist. Every 3 to 6 months if you've had basal cell, 1 year checkups if you consider yourself to be at risk.

 SHOULD I BE USING SUNSCREEN?

If you have light skin or have had one of the lesions mentioned above, avoidance of excess sun exposure by using hats and other protective clothing. The use of sunscreen should become a habit that you do every time you have sun exposure. Sunscreen lotions with a sun protection factor (SPF) of 30 or greater should be used. Apply to the skin regularly about 15-30 minutes before and 15-30 minutes after exposure, after swimming and every 2 hours or so if out for a prolonged period of time. Even products that are supposedly water proof should be reapplied to the skin after being in water. New research finds markedly better results with 2 closely-spaced applications to ensure adequate amounts are applied and skipped areas are covered.

Even five and ten minutes of sun continues to add to the total lifetime dosage. It does not require a sunburn to develop chronic sun damage. During the very sunny seasons or when in sunnier climates, daily morning use of sunscreen is advised. Those with very light skin or skin cancer are urged to use sunscreen daily year round.