Basal cell carcinoma (BCC) is the most common type of skin cancer, accounting for around 80% of all skin cancer cases. Over 4 million cases of BCC are diagnosed in the United States each year. While BCC grows slowly and rarely spreads to other parts of the body, it is still important to treat it early to prevent complications. Many people wonder – what are the chances of dying from BCC?
What is basal cell carcinoma?
Basal cell carcinoma arises from abnormal and uncontrolled growth of basal cells in the outermost layer of the skin (epidermis). It often appears as a raised, smooth, pearly bump on sun-exposed areas like the head and neck. Other signs include a flat reddish patch, a white, waxy scar-like lesion, or a sore that heals and then re-opens.
While BCC is locally invasive, it rarely metastasizes or spreads to distant organs. However, without treatment, the lesions can grow deep into the skin and damage nearby tissue, requiring extensive surgery and resulting in scarring or disfigurement.
What causes basal cell carcinoma?
The major cause of BCC is exposure to ultraviolet (UV) radiation from sunlight or tanning beds. People with fair skin, light hair and eye color have a higher risk. BCCs most often occur in areas frequently exposed to the sun like the head, neck, and back of hands.
Other risk factors include:
– Increasing age
– Male gender
– Chronic sun exposure
– Previous skin cancer
– Exposure to radiation or arsenic
– Genetic conditions like nevoid basal cell carcinoma syndrome
– Immunosuppression
– Scarring from previous skin injuries
How common is basal cell carcinoma?
BCC is very common, affecting over 3 million Americans every year. It makes up around 80% of all nonmelanoma skin cancers diagnosed in the United States.
The incidence of BCC has been increasing over the past few decades. This is likely due to a combination of increased sun exposure, longer life expectancy, and earlier detection by physicians.
What are the different types of BCC?
There are several subtypes of basal cell carcinoma:
Nodular BCC: Appears as a pearly, dome-shaped bump with visible blood vessels on the surface. It is the most common subtype.
Superficial BCC: Manifests as a red, scaly patch on the skin surface. It is flat and spreads along the top layer of skin.
Morpheaform or sclerosing BCC: Forms as a white scar-like lesion with poorly defined borders. This subtype is aggressive and infiltrates deep into the skin.
Pigmented BCC: Appears as a brown, black or blue lesion due to deposits of melanin pigment.
Basosquamous carcinoma: Exhibits features of both BCC and squamous cell carcinoma. More aggressive than typical BCC.
Infiltrative BCC: Grows down into the deeper layers of the skin without causing much surface change, making it hard to detect.
What are the chances of dying from BCC?
The short answer is that dying from basal cell carcinoma is extremely rare. BCC rarely spreads beyond the original tumor site, so it seldom metastasizes to internal organs where it can become fatal.
According to published statistics:
- The 5-year survival rate for patients with localized BCC is estimated to be over 99%
- The overall 5-year survival rate of metastatic BCC is only about 34%
- Even in advanced cases, the 10-year disease-specific mortality rate is less than 0.5%
This means that out of every 100 people who develop a basal cell carcinoma, less than 1 person will die from BCC within 10 years.
Compared to other types of cancers, the risk of dying from basal cell carcinoma is extremely low. However, this does not mean BCC should be ignored. Without treatment, it can increase in size and severity, requiring extensive surgery and increasing chances of recurrence.
What determines the prognosis of BCC?
The prognosis or outlook for BCC largely depends on the following factors:
- Type of BCC: Infiltrative, morpheaform and basosquamous subtypes are more aggressive.
- Location: Tumors on the central face, eyes, ears and genitalia have a higher risk of recurrence.
- Size: Larger tumors penetrating deeper into the skin are harder to treat.
- Treatment: Incomplete excision leads to recurrence and increased complications.
- Immune status: Immunosuppressed patients have higher recurrence rates.
- Metastasis: Spread to distant organs like lungs, bones and liver carries a poor prognosis.
Early diagnosis and proper treatment of basal cell carcinoma results in an excellent outcome in almost all cases.
What complications can arise from basal cell carcinoma?
If left untreated, basal cell carcinomas can cause the following complications:
Local tissue damage
BCC can grow deeper into the skin over time, damaging surrounding healthy tissue. This requires surgical excision and leads to scarring. Tumors around the eyes, nose or ears can invade cartilage and bone, affecting function. Genital BCCs may erode into sensitive areas.
Recurrence
Recurrence rates after standard excision range from 1-5% for primary BCC. Improper removal and aggressive tumor subtypes increase the risk. Recurrent tumors grow larger and penetrate deeper, causing more destruction.
Metastasis
While rare, BCC can metastasize from the original site to distant lymph nodes, lungs, bones and liver in advanced cases. Metastatic basal cell carcinoma has a poor prognosis with a 5-year survival rate of about 34%.
Bleeding, infection and pain
Larger, long-standing tumors may bleed, ulcerate or get infected. They can be painful if pressing on nerves. Bleeding risk is higher in anti-coagulated patients.
Disfigurement
BCCs on the face may require extensive excision and reconstructive surgery if allowed to enlarge, leading to potential disfigurement. Early diagnosis minimizes tissue loss.
How is basal cell carcinoma diagnosed?
Basal cell carcinoma is typically diagnosed by clinical examination, dermoscopy and biopsy.
Clinical examination: The suspicious lesion is visually inspected for characteristic BCC features like a pearly appearance, telangiectasias, rolled border and central ulceration. Dermatoscopy can enhance the evaluation.
Dermoscopy: A special microscope evaluates subsurface structures not seen by the naked eye. Features like spoke wheel areas, leaf-like areas and blue-gray globules are suggestive of BCC.
Skin biopsy: The most reliable method is a biopsy where the suspicious area is excised or shaved and sent for microscopic analysis. A pathologist examines the histological appearance of the cells to confirm BCC.
Additional imaging like MRI may be done to assess tumor depth and spread in select cases. Metastatic workup involves CT scan, nuclear bone scan, and chest X-ray.
How is basal cell carcinoma treated?
There are many effective treatment options for basal cell carcinoma:
Surgical Excision
Surgical removal is the gold standard treatment for BCC. The tumor is excised with a margin of healthy tissue to ensure full eradication. Margin size depends on tumor type, site and size. Mohs surgery involves histologic margin assessment for maximal preservation of healthy tissue.
Curettage and Electrodesiccation
The cancerous tissue is scooped out (curettage) and the base is treated with electric current to control bleeding and kill remaining tumor cells (electrodesiccation). Repeat cycles are done to ensure complete removal.
Cryosurgery
Liquid nitrogen is used to freeze and destroy cancerous cells. Freezing cycles are repeated to achieve greater depth of treatment.
Topical Medications
Medications like imiquimod, 5-fluorouracil, ingenol mebutate can treat superficial BCCs. They stimulate the immune system and kill cancer cells over weeks of application.
Photodynamic Therapy
A photosensitizing agent and light source are used to selectively destroy cancer cells. Ideal for large superficial BCCs.
Radiation Therapy
High energy X-rays are targeted at the tumor to kill cancer cells and shrink the lesion. Useful when surgery is difficult.
How can the risk of developing BCC be reduced?
While basal cell carcinoma cannot always be prevented, the following practices can help reduce your risk:
- Minimize sun exposure by seeking shade and avoiding midday sun
- Generously apply broad spectrum, high SPF sunscreen when outdoors
- Wear wide-brimmed hats, long sleeves and UV-blocking sunglasses
- Avoid indoor tanning beds
- Get annual skin exams to screen for suspicious growths
- Treat precancerous lesions like actinic keratoses to prevent progression
- Take extra care if you are at high genetic risk for skin cancer
- Practice sun safety with children to instill lifelong habits
Early detection and treatment of BCC provides the best opportunity for a cure and good cosmetic outcome. See your dermatologist at the first sign of any persistent, non-healing skin lesion.
Conclusion
In summary, dying from basal cell carcinoma is extremely uncommon, with well over a 99% five-year survival rate. However, BCC can be locally destructive if neglected. Metastatic spread to distant sites also remains a possibility, albeit small. Early diagnosis and proper treatment are imperative to obtain an excellent prognosis. Most cases of BCC are completely curable if managed appropriately. With vigilant sun protection and regular skin exams, the risk of BCC can be greatly reduced.