Basal cell carcinoma is a form of skin cancer that is largely related to sun exposure. There are different types of skin cancer with different treatment approaches and long-term outcomes. Basal cell carcinoma is regarded as a skin cancer or tumour but if recognised and treated early has an excellent prognosis. It grows slowly and locally causing localised tissue destruction but does very rarely spread to other sites or organs. It therefore has the best prognosis of all skin cancer forms.
Basal cell carcinoma often appears on the sun-exposed areas of the skin hence it is mostly found in the head and neck area. It often presents as a small lesion or lump that can appear a bit shiny with some small visible blood vessels within it. There are different variants and subtypes of basal cell carcinoma and these include: nodular, superficial, morpheic and micronodular. These largely relate to how the skin tumour appears under the microscope but clinically an experienced dermatologist can often determine the subtype too. Once basal cell carcinoma is suspected the diagnosis should be confirmed histologically; that is a small piece of the suspected lesion is taken and sent for analysis under the microscope. This small piece of skin is called a biopsy and it is important in confirming the diagnosis and establishing the subtype of the tumour as this will have implications for subsequent treatment.
There are different treatments available depending on size, subtype, anatomic location, patient’s general health condition and underlying illnesses and clinical experience of the treating dermatologist. Surgical removal of the basal cell carcinoma remains the most effective and used method in particular for the more aggressive subtypes such as micronodular and morpheic. Other treatments available and used where appropriate are cryotherapy, curettage, topical therapy with imiquimod cream and photodynamic therapy.
Mohs micrographic surgery is a highly specialised and sophisticated form of skin surgery that offers the highest cure rate and the lowest chance for tumour recurrence – that is the chance of the tumour to return once treated. Mohs micrographic surgery is a day procedure performed in clinic under local anaesthesia by a dermatologic surgeon. Dr Firas Al-Niaimi is a fellowship trained Mohs and dermatologic surgeon trained at Guy’s and St. Thomas’ hospital and has performed hundreds of Mohs surgery cases.