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Basal cell carcinoma is the most common of all cancers. In direct correlation with sun exposure, it usually manifests itself in the most exposed areas of the skin (nose, forehead, hands, etc.).

Basal cell carcinoma is diagnosed through a histologic exam (biopsy) which is performed whenever there is the slightest doubt. This type of skin cancer always remains local and never metastasise. However, depending on where it is located, it can be mutilating (basal cell carcinoma on the nose, on the eyelid, etc.) and tends to be recurrent.

What Is Basal Cell Carcinoma?

Basal cell carcinoma is a type of skin cancer. It owes its name to the cells which make up the basal layer – which is the deepest layer of the epidermis – it spreads from. Quite frequent, it is a less serious form of the disease than melanoma. Contrary to melanoma – which develops from melanocytes – carcinoma develops from epidermis cells, the keratinocytes.

There exist many clinical forms of basal cell carcinoma:

  • micronodular basal cell carcinoma,
  • superficial basal cell carcinoma,
  • nodular basal cell carcinoma,
  • infiltrated basal cell carcinoma,
  • sclerodermiform basal cell carcinoma, etc.

The various clinical forms for this type of cancer all have different medical prognoses. While a superficial basal cell carcinoma shows an encouraging prognosis, nodular basal cell carcinomas constitute an intermediate level of risk. Without treatment, nodular basal cell carcinoma may indeed make its way down and become an infiltrated basal cell carcinoma.

What Is the Difference Between Melanoma and Carcinoma?

For starters, carcinomas (squamous cell and basal cell) are different from melanomas by how common they are. Carcinomas are the most frequent form of skin cancer. Often appearing after a certain age, they are especially exacerbated by sun exposure. Melanomas, on the other hand, can appear anywhere on the body including in areas that were not exposed to the sun (nail, scalp, foot soles, etc.). Contrary to popular thinking, most melanomas do not spread from moles. Another difference is the severity of these two types of skin cancer. Carcinoma is much less concerning than melanoma. Melanoma can spread to the neighbouring tissue and destroy it. It can also metastasise, which means that it may spread to other areas of the body.

What Is the Difference Between Squamous Cell Carcinoma and Basal Cell Carcinoma?

Both types of skin cancer develop from the spinous, or prickle cell layer where keratin is produced. Basal cell carcinoma, contrary to squamous cell carcinoma, is more likely to develop in cases where sun exposure was sudden and repeated. Four times less common on average than basal cell carcinoma, squamous cell carcinoma my cause lymph node, and sometimes pulmonary metastases.

Both types of skin cancer develop with age, usually starting from 50 for the basal cell form, and from 60 to 65 for squamous cell carcinoma.

What Are the Risk Factors for Basal Cell Carcinoma?

Basal cell carcinoma can have many causes. Some factors may increase the risk of developing this type of symptoms:

  • Repeated sun exposure varying in intensity, from a young age and into adulthood.
  • The risk of developing basal cell carcinoma increases in people who, from an early age and then routinely, use tanning beds.
  • The patient’s phototype. Complexion, as well as the colour of their hair and eyes are factors of sensitivity to the harmful effects of the sun.
  • A weakened immune system, which can be due to medical treatment (anti-rejection drugs, diseases such as AIDS, etc.).
  • Some genetic diseases, such as Gorlin syndrome, may cause a very large number of basal cell carcinomas to develop.
  • Tobacco is an important factor which stimulates the emergence of basal cell carcinoma on the lips.

How to Identify Basal Cell Carcinoma?

Basal cell carcinoma has very specific symptoms. In 80% of cases, basal cell carcinoma develops on the face and neck. The first symptom which may raise concern as to this form of cancer is the manifestation of a new skin protrusion or changes in the appearance of a pre-existing one. The presence of a sore which never seems to heal could be another early sign. A connection has also been established between basal cell carcinoma and fatigue. Fatigue is indeed a very common side effect of this cancer and may occur at various stages of treatment.

Depending on its type, carcinoma may take different shapes:

  • Superficial: It is characterised by the presence of scaly-looking, squamous patches on the skin.
  • Nodular: It takes the form of a tough lesion with visible vascularisation. The nodules are shiny, firm, almost translucent, or with a beaded aspect. Ulceration and scabs are common.
  • Sclerodermiform: It looks like hardened scar tissue, which can take on a lighter colour than the rest of the skin.

Even if advanced forms of the disease are more concerning, the complications associated with basal cell carcinoma are rarely life-threatening. However, it is crucial to seek medical attention (GP and dermatologist).

Basal Cell Carcinoma: Which Exams?

Basal cell carcinoma diagnoses in Paris are usually made early. When cutaneous symptoms are observed, a clinical examination of the epidermis will reveal the shape, size, and colour of the growth. A dermatologist will also examine the skin and suspicious cutaneous changes using a dermatoscope (a magnifying optical tool). This exam allows the health professional to check the smaller lesions, along with any potential changes that would not be visible to the naked eye.

A biopsy is another reference examination used for basal cell carcinoma screening. This exam consists in extracting a skin sample under local anaesthesia to analyse it at an anatomic-pathology lab. The sample may be a superficial layer of skin obtained through curettage, or the entirety of the suspicious tissue extracted through excision. A biopsy is essential in order to make a reliable diagnosis. In some cases, imaging tests such as scans or MRIs may be performed to determine the exact size and extent of the tumour.

Basal Cell Carcinoma: How Does It Evolve?

Basal cell carcinoma can be very destructive as it invades normal tissue. In the absence of treatment, the tumour can spread quickly and cover a wide area of the skin. This expansion towards underlying tissue and bones is likely to cause serious damage, particularly when located around the eyes or mouth.

Recurrence of basal cell carcinoma may occur in the same area. The appearance of a new skin cancer within 5 years is not uncommon.

How to Treat Basal Cell Carcinoma?

Treatment is mainly surgical. Many techniques are available and always consist in:

  1. Removing the tumour, including safety margins to minimise the risk of recurrence. The surgical margin is usually 1 mm for a conveniently located, well-defined nodular lesion, and 10 mm for a poorly located, undefined, infiltrating lesion. Usually, this operation is performed at the doctor’s office under local anaesthesia.
  2. Compensating for the loss of tissue resulting from the excision.

Radiotherapy is another form of treatment which may be considered in some cases. Radiotherapy treatment consists in exposing very specific areas of the skin to rays in order to damage the cancerous cells and induce their destruction. Painless and non-invasive, radiotherapy can treat basal cell carcinoma effectively when a surgical procedure is impossible for aesthetic or functional reasons.

What Should I Know About Post-Treatment Reconstruction?

In the case of surgical treatment, the role of the plastic surgeon becomes fundamental. Reconstruction relies on suture removal when the lesion is small, all the way to skin grafts, and sometimes skin flaps if the loss of tissue is important. As a plastic surgery, reconstructive surgery, aesthetic surgery, and aesthetic medicine specialist, Doctor Vincent Masson performs operations on patients himself and is responsible for their postoperative follow-up for basal cell carcinoma in Paris.

After treatment, regular monitoring is essential to prevent any recurrence, or more similar breakouts in other areas of the body.

Natural Treatment for Basal Cell Carcinoma

The best natural treatment for basal cell carcinoma and potential relapses remains prevention. Basal cell carcinoma prevention mainly relies on the application of effective protection when exposing your skin to the sun. Use suitable sunscreen for your skin type and avoid sun exposure during the hottest hours of the day.


Dr Vincent Masson is a plastic surgeon with a post-graduate diploma in plastic, reconstructive and aesthetic surgery and a gold medal in surgery from the Paris Hospitals. He is a former senior registrar and attaché at the Hôpital Saint Louis.

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