The Skin Cancer Guide: Part 1
What It Is
About a million cases of this most common type of skin cancer are diagnosed each year. It starts in the deepest layer of the epidermis.
Is It Dangerous?
It seldom metastasizes and is almost never fatal, but it's serious just the same. Some basal-cell cancers spread along the surface of the skin, while others can go deep. "It can grow under the skin like tentacles," says Julie Karen, MD, a New York City dermatologist. If a cancer has progressed that far, surgery to remove it can lead to serious scarring or disfigurement; unlucky patients have lost an ear, a nose -- even an eye. Fortunately, basal-cell cancer takes years, maybe decades, to do that kind of damage and can usually be cured if you find it early.
The major cause is exposure to UV radiation from sunlight. Tanning salons greatly increase your risk, too. Arsenic, found in contaminated meat, poultry, or water, may cause it, and patients on immunosuppressant drugs after transplant surgery also are at higher risk.
Where You Get It
Most frequently on any part of the body exposed to the sun, but it can show up elsewhere. Behind the ears is common, according to Dr. Spencer. And up to 10 percent of all skin cancers occur on the eyelids, most of which turn out to be basal.
Sometimes the biopsy alone will get rid of the cancer. Doctors can also scrape or burn off superficial cancers or use photodynamic therapy. This involves treating the skin with a chemical that lets a certain wavelength of light destroy cancerous cells without seriously harming healthy cells. (Your skin may turn pink and flake, so you'll have to avoid sunlight for 48 hours.) Deeper basal-cell tumors usually need surgery. If the cancer is large, growing fast, is in a visible spot like your face, or has been previously treated and has recurred, it may be a candidate for Mohs surgery, followed by plastic surgery or laser treatment, if needed.
Chemotherapy creams (5-fluorouracil and imiquimod) can kill basal-cell cancer on the skin's surface, leaving few or no scars. "It's a viable option for young people with a large but shallow lesion on the back or chest that would scar if you remove it surgically," says Sandra Read, MD, a dermatologist in Washington, D.C., who adds that chemo cream is only for patients willing to apply it three to five times a week for up to four months and put up with inflammation, soreness, and redness during treatment.
For any suspicious mole or bump, ask about high-frequency ultrasound with elastography, a noninvasive technique that's an accurate alternative to biopsy for all skin-cancer types.