What is Basal Cell Carcinoma?
Basal cell carcinoma (BCC) is the most common form of skin cancer. It is usually caused by sun exposure. In rare cases it is caused by a genetic defect such as in Gorlins Syndrome or by exposure to certain carcinogens such as Arsenic in childhood.
The name Basal Cell refers to the cell type within the skin where the cancer originates.
There are a number of subtypes of BCC based on their microscopic appearance. These include multifocal superficial, nodular, cystic, sclerosing and micronodular. These latter two can be more aggressive BCCs. It is not usually possible to determine the subtype by clincal examination alone.
Once a diagnosis of BCC has been made on clincial examination or by biopsy, the majority of BCC will require surgical excision and reconstruction as necessary.
Some subtypes of BCC such as 'multifocal superficial BCC' can be treated by non surgical methods in certain circumstances. This is best discussed with a Dermatologist who performs these treatments rather then a Plastic Surgeon, and Dr O'Mahony will be happy to refer her patients to a Dermatologist if they wish to pursue this course of treatment.
The benefits of surgery for all BCCs include microscopic examination of the lesion by a pathologist after removal to ensure complete clearance has been achieved.
Fortunately it would be extremely rare for a BCC to break away and metastasise (spread) to other parts of the body, but left untreated they can certainly enlarge and erode the local tissues, causing significant tissue destruction and deformity. Indeed in years gone by they were sometimes referred to as 'rodent ulcers'. In more serious cases the lesions can spread directly along the pathway of local nerves and cause more tissue damage. This is termed 'perineural invasion' and may require additional treatment by radiotherapy after surgery.
Happily the majority of BCCs, if treated appropriately when they are first found will be cleared by surgery and have a low risk of recurrence.
The two goals of surgery to treat BCC, or any skin cancer, are primarily to clear the cancer and secondarily to recontruct the defect to minimise any cosmetic deficit.
Depending on the site of the cancer this may be as simple as a direct suture of the wound, or may require a flap or skin graft to reconstruct the wound. On facial sites such as the nose, ear, eyelid or lip these more complex reconstructive techniques are often required. Dr O'Mahony frequently performs skin cancer surgery of the face and can advise you as to the best options for reconstruction in your particular case.
Skin cancer surgery is often performed under general anaesthetic or twilight sedation, but if the procedure is not too lengthy or complex, and it can be performed under local anaesthetic.
Surgery under general anaesthetic or sedation require admission to hospital, usually only for day surgery, where a Specialist Anaesthetist can perform the anaesthetic for Dr O'Mahony.
Local Anaesthetic Procedures can be undertaken in the fully equipped theatre in Dr O'Mahony's rooms, usually on a different day from your initial consultation unless booked simultaneously by prior arrangement. Please contact Dr O'Mahony's office to discuss the options for timings of surgery. It is important to note that the Health Funds do not rebate for out of hospital procedures, although a partial rebate is available through Medicare for surgery undertaken in her rooms.
Dr O'Mahony can advise the most appropriate approach for the surgical treatment of your skin cancer when she first consults with you regarding your BCC diagnosis.
If surgery is undertaken and clearance proven by microscopic examination it is not common for a BCC to recur. If the BCC is a sclerosing or micronodular subtype this risk is slightly increased. Having one BCC is more likely to be a risk factor for the development of other new BCCs in sun exposed skin, due to the previous sun damage that most likely caused the first BCC.
The best course of action after clearance of the BCC and healing of the surgical wounds is regular skin surveillance under the care of a Dermatologist or your GP.
If you have any other questions regarding BCC please do not hesitate to ask Dr O'Mahony via the contact page or contact her office for an appointment.