What is the average size of a basal cell carcinoma

Making an educated treatment decision begins with the stage, or progression, of the disease. The stage of skin cancer is one of the most important factors in evaluating treatment options. Non-melanoma skin cancers, such as basal cell carcinomas rarely spread and may not be staged.

The chance that squamous cell carcinomas will spread is slightly higher. The American Joint Committee on Cancer has developed a uniform system for describing the stages of skin cancer.

This system allows doctors to determine how advanced a skin cancer is, and to share that information with each other in a meaningful way. This system, known as the TNM system, is composed of three key pieces of information:.

N node : This indicates whether or not cancer cells have spread to nearby lymph nodes, or the channels connecting the lymph nodes. M metastasis : This refers to whether the cancer cells have spread to distant organs. There are certain features that are considered to make the cancer at higher risk for spreading or recurrence, and these may also be used to stage basal cell carcinomas.

These include:. After the TNM components and risk factors have been established, the cancer is given a stage. For basal cell carcinoma staging, the factors are grouped and labeled 0 to 4.

The characteristics and stages of basal cell carcinoma are:. Once again there may be more tumour present than is indicated by the appearance. The tumour grows with widespread fine rootlets which are invisible from the skin surface. Other variants of this subtype include morphoea form or sclerosing basal cell carcinoma where the appearance may be somewhat scar-like due to the presence of increased collagen within the tumour and metaplastic or basosquamous cell carcinoma which has an appearance intermediate between that of basal cell carcinoma and squamous cell carcinoma.

Sometimes infiltrative types of basal cell carcinoma show a tendency to spread down nerves. This can make their removal by standard treatment methods very difficult.

In reality basal cell carcinomas often show a mixed pattern. Unsuccessful previous treatment of basal cell carcinoma tends to select a more aggressive element of the basal cell carcinoma and a tumour which first appeared nodular may after several inadequate treatments develop a substantially infiltrative growth pattern.

Basal cell carcinoma tends to be a slow growing cancer. It tends to follow the "path of least resistance". It is for this reason that involvement of bone cartilage and muscle is not so common but tends to be a later phenomena. This may partially explain the difficulty in the management of basal cell carcinoma in areas like the eyelid, ear, nose and scalp. In such areas, basal cell carcinomas, when they reach muscle, cartilage of bone planes, tend to spread sideways and their true extent may be masked by the appearance of normal looking overlying skin.

It is very clear from the medical literature that treatment of basal cell carcinoma should be carried out with the intention to cure. The first time you treat a basal cell carcinoma is also the best opportunity to completely eradicate it as subsequent treatments have a lower chance of success.

The four principles that we use at the Skin Centre in the management of basal cell carcinoma are used widely by Dermatologists:. The most important aim is to rid the patient of the tumour. If this goal is not achieved then ultimately the others will not be met.

Cosmetic result should not come at the risk of failure to cure the patient. Basal cell carcinomas grow slowly and rarely metastasize so they are sometimes not treated with the respect that they deserve. When discussing the treatment options with your dermatologist it is important to be aware of the likely recurrence rate for any given modality of treatment for your particular type of basal cell carcinoma in its individual location.

Cryosurgery is probably one of the most common modalities used to treat basal cell carcinoma. However, in order to be effective this treatment needs to be carried out in the right manner.

Appropriate margins should be used, e. This treatment in our clinic is done under local anaesthetic and the area treated usually subsequently blisters, scabs and heals over weeks, ultimately leaving a stellate white slightly indented scar.

This is the most common method we use for superficial basal cell carcinomas on the back. This is not a good treatment for recurrent basal cell carcinomas.

In basal cell carcinomas greater than 1. This is a simple procedure practised by Dermatologists and involves scraping out the bulk of the tumour with a small sharp spoon like instrument called a curette. This is then followed by treatment of the tumour bed with electric current producing burning of the surrounding tissue to approximately 1mm in diameter. This is then repeated in 3 cycles to give an effective mm margin on the tumour. This is the best practiced for small nodular tumours, not on the face.

It is not an appropriate treatment for morphoeic or recurrent basal cell carcinomas because of poor cure rates. This is probably the most common treatment for basal cell carcinoma. A margin of normal skin is taken around the cancer to ensure eradication of unsuspected subclinical invisible spread. This treatment modality offers the advantage of eventual pathological analysis providing an estimate of whether the cancer has been completely removed.

Mohs Micrographic Surgery offers the gold standard of treatment for basal cell carcinoma, and is well established for this in the medical literature. Watch Video Mohs Micrographic Surgery see Mohs Micrographic Surgery page offers the highest documented cure rates as well as tissue conservation of any modality for the treatment of basal cell carcinoma.

It is however, a very time consuming and expensive modality. Therefore its use is reserved in our clinic for tumours on the face, ears, scalp and neck where tissue conservation is of the most importance and where strict histological control is most paramount.

To achieve the high cure rates claimed Mohs Micrographic Surgery requires an extensively trained sub specialised Dermatologist and an on-site laboratory. The Dermatologist removes the tissue, colour codes it, the tissue is then mapped out and frozen sectioned on a cryostat.

Microscope sections are then stained to enable identification of residual basal cell carcinoma. The slides are then examined under the microscope. Residual tumour can be identified and traced to its location in the defect using the map. The residual tumour can then be resected and checked again and so on, until all the tumour has been removed.

Standard histological processing is completely adequate in the vast majority of circumstances, particularly for nodular tumours but may fail to provide an accurate indication of complete excision of recurrent tumours or primary infiltrative, morphoeic or micronodular subtypes. Mohs Micrographic Surgery provides the most effective modality also for treating tumours that show spread down nerves.

The limitations of Mohs surgery include lesions with multiple foci of recurrence, tumours so invasive as to need removal of bone or deeper organs where general anaesthesia is necessary. Mohs Micrographic Surgery is almost always carried out under local anaesthesia as it is too unwieldy to provide this procedure under general anaesthesia.

Radiation therapy can be an effective modality for most types of basal cell carcinomas excluding morphoeic basal cell carcinoma. It is generally not recommended for those under the age of 65 because of the long term risk of further basal cell carcinoma developing in the irradiated skin and because of the poor cosmetic results in the long term.

Multiple visits are necessary for eradication of tumours, typically visits over a week period. For the very elderly with multiple basal cell carcinomas this can be an effective modality allowing treatment of multiple tumours in the same treatment schedule. Recurrent tumours, large tumours, tumours in high risk areas and basal cell carcinomas of the aggressive histological growth pattern are less likely to be treated well with radiation therapy.

However this may be traded off against being able to treat multiple tumours at the same time without the need for reconstructive surgery. Carbon dioxide laser has been used most often in place of curettage and electrodesiccation as a destructive modality to treat patients with multiple basal cell carcinomas.

The disadvantage of this technique, as with all destructive modalities, no specimen is available for histological analysis to determine adequate treatment of the specimen, and in addition carries the added disadvantage over curettage of being less likely to give an accurate indication of the depth of the original tumour. Photodynamic Therapy is an evolving method for the treatment of basal cell carcinoma. Its place in our practice is principally in the treatment of superficial basal cell carcinoma in the lower leg, which might otherwise have to be treated with wide excision and skin grafting.

It may also be a useful treatment for superficial basal cell carcinomas in other modalities. A photosensitizing cream is placed over the repaired tumour site. Swelling and sometimes crusting ensues over the following week. Imiquimod is a relatively new treatment for basal cell carcinoma. Once again it has shown good results in studies of treatment of superficial basal cell carcinoma. Unfortunately the medical literature is confounded by the fact that the vast majority of studies for the use of Imiquimod in the treatment of superficial basal cell carcinoma were sponsored by the company making the product and further research by independent organisations is awaited.

The medical literature reports badly recurrent basal cell carcinomas following treatment with 5-Fluorouracil. The lesion should be first curetted then 5-Fluorouracil applied under occlusion.

It should be applied twice daily for no less than 6 weeks, probably for 3 months. It should be reserved for patients with superficial basal cell carcinomas where no other treatment is practical. Your dermatologist considers the following variables when assessing and discussing with you the best treatment for your basal cell carcinoma.

A patient who is not concerned about the cosmetic appearance may be happy with modalities such as cryosurgery or curettage and electrodesiccation. However younger individuals tend to prefer an all but invisible scar that only excision can give. The vast majority of basal cell carcinomas can be quickly excised without the need for general anaesthesia.

Klumb, C. Girard et al. View at: Google Scholar H. Breuninger and K. View at: Google Scholar J. Hendrix and H. Lo, S. Snow, G.

Reizner, F. Mohs, P. Larson, and G. View at: Google Scholar P. Ting, R. Kasper, and J. Karagas and E. Mukhtar, Ed. View at: Google Scholar V. Madan, J. Lear, and R. Gulleth, N. Goldberg, R. Silverman, and B. View at: Google Scholar N. Smeets, D. Kuijpers, P. Nelemans et al. Ceilley and J. Bath-Hextall, W.

Perkins, J. Bong, and H. Housman, S. Feldman, P. Williford et al. Kyrgidis, K. Vahtsevanos, T. Tzellos et al. Babaye-Nazhad, M. Amirnia, H. Alikhah, E. Khodaeyani, and N. Ridley, J. Whiteside, T. McMillan, and S. Lear, A. Smith, R.