Basal Cell Carcinoma: What it is, Causes, Treatment & More

What is Basal Cell Carcinoma?

Basal cells are located in the epidermis, which is the skin’s outermost layer. They continuously produce new skin cells by dividing and copying themselves. As new cells are created, the older ones are pushed upward toward the surface to shed.

Basal cell carcinoma occurs when this process is disrupted. UV radiation can alter the DNA in basal cells. Instead of following a controlled cycle, the affected cells start to grow and divide uncontrollably, forming a lump, bump, or flat lesion on the skin's surface.

What are the Types of Basal Cell Carcinoma?

Each type of basal cell carcinoma has unique appearances, locations, and levels of aggressiveness.

How Common is Basal Cell Carcinoma in India?

Detailed national data on basal cell carcinoma in India remains limited, as research in this area is still relatively sparse compared to Western countries where skin cancer has historically been more prevalent. However, recent trends suggest that the number of skin cancer cases is increasing in India. In 2022, the country ranked 8th globally in skin cancer-related deaths, indicating that the condition is not a low-priority concern anymore.

A hospital-based study from North India provides some clinical data. The majority of patients (81.9%) had a single BCC lesion. The head and neck were the most frequent site, accounting for 82.5% of cases, the cheek, nose and periorbital area being the most involved sites. The most common subtype was nodular BCC, and pigmentation was clinically evident in almost half of the cases, reflecting a higher prevalence of darker skin in the Indian population.

What are the Symptoms of Basal Cell Carcinoma?

The appearance of basal cell carcinoma can vary considerably depending on the type. Here is what to look out for with each:

What Causes Basal Cell Carcinoma?

BCC occurs when changes in the DNA of basal cells disrupt the normal process of skin cell growth, multiplication, and eventual death. The exact cause behind it is not known, but here are some possible causes:

• Genetic Mutations: When DNA is damaged, the genetic instructions that tell basal cells to stop dividing can become stuck in the "on" state, leading to an excessive buildup of cells. This accumulation is what leads to the formation of tumours.

• Ultraviolet Radiation: The most common cause of BCC is exposure to ultraviolet radiation, primarily from sunlight but also from tanning beds and lamps. UV rays damage DNA in basal cells, disrupting the instructions that regulate when cells divide and when they should stop dividing. Instead of following a controlled cycle, the affected cells begin to multiply uncontrollably, forming lesions and lumps.

• Gorlin Syndrome: In rare cases, Gorlin syndrome, also known as basal cell nevus syndrome, can cause basal cell carcinoma in children.

Risk Factors of Basal Cell Carcinoma

While UV exposure is the leading cause, several other factors can increase a person's likelihood of developing basal cell carcinoma:

• Excessive Sun Exposure: Spending prolonged time outdoors without proper skin protection is a major risk factor. UV damage builds up over the years, which is why BCC most often appears after decades of unprotected sun exposure. The risk is even greater for those living in sunny climates or at high altitudes (where UV is more intense).

• Use of Tanning Beds and Devices: Indoor tanning beds and devices give off UV light that can be similar to, and sometimes stronger than, sunlight. Studies have repeatedly shown that people who use tanning beds are far more likely to develop BCC.

• History of Sunburns: Having experienced sunburns, especially severe or blistering ones, during childhood or adolescence increases the risk of developing BCC later in life.

• Skin Tone and Complexion: People with very light skin, naturally blonde or red hair, light-coloured eyes, or skin that freckles or burns easily face a higher risk. That said, BCC can develop in people of all skin tones.

• Older Age: BCC typically develops over decades and is more likely to be diagnosed in people aged 50 and above.

• Inherited Genetic Conditions: Rare inherited conditions such as Gorlin syndrome, xeroderma pigmentosum, Rombo syndrome, and Bazex-Dupre-Christol syndrome can dramatically increase susceptibility to BCC, sometimes leading to hundreds of skin cancers over a person's lifetime.

• Weakened Immune System: People affected by diseases such as HIV have a weak immune system. Certain medicines, like drugs prescribed after an organ transplant or during chemotherapy, also suppress immunity. These reasons reduce the body's ability to detect and eliminate abnormal cells.

• Personal or Family History of Skin Cancer: Having previously had any type of skin cancer significantly raises the risk of developing another. A family history of skin cancer also indicates a higher individual risk.

What are the Complications of Basal Cell Carcinoma?

While basal cell carcinoma is rarely life-threatening, allowing it to go untreated or poorly managed can lead to several complications:

• Recurrence: Even after successful treatment, basal cell carcinoma has a tendency to return. People who have had it once need to remain careful and continue regular skin check-ups.

• Development of Other Skin Cancers: A history of BCC increases the likelihood of developing other forms of skin cancer, including squamous cell carcinoma.

• Deep Tissue Damage: If left untreated and allowed to grow, BCC can extend beyond the surface of the skin and cause significant damage to surrounding structures. This can include destruction of cartilage, compression or wrapping around nerves, and in more advanced cases, invasion of bone.

• Spread to Other Parts of the Body: In less than 1% of cases, BCC can affect nearby lymph nodes and, from there, spread to other areas of the body, such as the bones or lungs. When this happens, newer targeted medications such as vismodegib and sonidegib may be used as part of the treatment approach.

When Should I See My Healthcare Provider?

Any change in the skin that does not resolve on its own is worth getting checked by a doctor. This includes new growths or marks that appear unexpectedly, an existing mole or lesion that changes in size, shape, or colour, a sore that keeps returning after healing, or any lump on the skin that becomes itchy, painful, or uncomfortable.

Basal cell carcinoma can grow slowly and initially look like a minor skin issue, so it is always better to get it checked out right away. The sooner a suspicious change is examined, the better the chance of catching it at an early, very treatable stage.

How is Basal Cell Carcinoma Diagnosed?

Here is an overview of the process followed by doctors to diagnose basal cell carcinoma:

How is Basal Cell Carcinoma Treated?

The primary goal of BCC treatment is to destroy the cancerous cells, and the most suitable method depends on the type of cancer and the location of the lesion. Here are the methods used for treatment:

• Surgical Removal: Doctors cut out the cancerous lesion with a small margin of healthy surrounding tissue, which is then examined under a microscope to confirm the cancer has been fully removed.

• Mohs Surgery: This is a more precise surgical technique in which the cancer is removed in thin layers, with each layer examined under a microscope before proceeding. This allows the surgeon to remove only the cancerous tissue with minimal damage to healthy skin.

• Cryotherapy: In this procedure, liquid nitrogen is used to freeze cancerous cells, which are then destroyed. It may be suitable for small, thin lesions that have not grown deep into the skin and is usually considered when surgery is not an option.

• Radiation Therapy: In this therapy, high-energy beams are used to destroy cancer cells. Radiation is generally considered when surgical removal is not possible or suitable for the patient.

• Curettage and Electrodessication: This procedure involves scraping away the surface of the cancerous growth with a specialised instrument. Then doctors use an electric needle to kill any remaining cancer cells at the base. It is typically considered for small, superficial BCCs in lower-risk locations.

• Laser Therapy: High-energy laser beams can be used to remove cancerous tissue, offering an alternative to traditional surgical methods in some situations.

• Photodynamic Therapy: This two-stage treatment involves applying a light-sensitive agent to the skin, which is then activated by a specific light source to destroy cancer cells. It may be considered as an alternative to surgery in certain cases.

Can Basal Cell Carcinoma be Prevented?

Prevention of basal cell carcinoma cannot be guaranteed, as its root cause is not known. But you can do the following things to reduce the chances of getting this cancer:

• Limit Sun Exposure In Peak Hours: UV radiation is most intense between about 10 a.m. and 4 p.m. If you can, plan outdoor activities for outside these hours and seek shade when the sun is at its hottest.

• Use Sun Protection Daily: Apply sunscreen every day, ideally with SPF 30 or higher, including on cloudy days. Cover exposed skin with tightly woven, dark clothing that covers the arms and legs if you will be in the sun for a long time.

• Avoid Tanning Beds: Indoor tanning devices emit UV radiation that is comparable to, and sometimes stronger than, sunlight. Avoiding them entirely is one of the most effective steps toward reducing BCC risk.

• Consider Vitamin B3 Supplementation: Taking nicotinamide, a form of vitamin B3, at a dose of 500 milligrams twice daily has been shown to reduce the risk of developing new BCC and squamous cell carcinoma. However, supplements should be taken as per a doctor’s advice.

• See a Dermatologist Annually: A professional skin examination once a year can help detect any suspicious changes early, before they develop into something more serious.

What is the Prognosis of Basal Cell Carcinoma?

Basal cell carcinoma is a highly treatable type of cancer, and the outlook for most people diagnosed with it is excellent. It very rarely spreads to other parts of the body, and fatalities are extremely uncommon as a result. When detected early and treated appropriately, the tumour can be fully removed, and most people go on to live normal, healthy lives.

Even after successful treatment, it is important to have regular follow-ups with a dermatologist. Any new lesion that appears near a previously treated lesion should be promptly examined by a health care provider.

Does Health Insurance Cover Basal Cell Carcinoma?

Yes, health insurance policies cover the treatment of skin cancers like basal cell carcinoma. Standard coverage includes hospitalisation, surgery, prescribed medicines, diagnostic tests, ambulance charges, and eligible pre- and post-hospitalisation expenses.

Many insurance companies also offer specialised cancer insurance plans. Depending on the insurer and policy terms, some of these plans may also provide coverage for pre-existing cancer after the predetermined waiting period is over.

Critical illness insurance policies also cover skin cancer. You can get a lump-sum compensation for treatment costs after diagnosis. A waiting period of 90 to 180 days and a survival period of 7 to 30 days is mandatory for coverage.

You should thoroughly read the policy documents to know the exact scope of your health insurance policy.

How Much Health Insurance is Required for Basal Cell Carcinoma?

Cancer treatment can be expensive, especially if it includes lesion removal surgery, radiation therapy, chemotherapy, and long-term follow-up care. It is advisable to have a health insurance cover of at least ₹10 lakh to ₹20 lakh to manage these expenses.

Elderly people, those with a family history of cancer and those who have other cancer-related risk factors can opt for higher coverage to safeguard themselves.