Understanding Advanced Basal Cell Carcinoma: Causes, Symptoms, and Treatment

Causes and Risk Factors of Advanced Basal Cell Carcinoma BCC

Several factors can contribute to advanced BCC, including:

• Excessive Sun Exposure – Spending too much time in the sun without sunscreen increases your risk.
• Environmental and Lifestyle Factors – Pollution, tanning beds, or exposure to harmful chemicals can play a role.
• Certain Medications – Some drugs may weaken your immune system, making it harder for your body to fight cancer cells.
• Genetics – If a close family member has had BCC, your risk may be higher.

Why Is It Important to Treat It Early?

If left untreated, advanced BCC can cause serious damage. It may affect surrounding tissues, bones, or even vital organs. In rare cases, it can spread to other parts of the body, making treatment more difficult.

What Makes It Advanced?

Experts don’t have one exact definition, but a BCC is generally considered advanced when:

• It is too large to be treated easily.
• The edges are not clearly defined, making surgery difficult.
• Standard treatments, like radiation or surgery, have not worked.
• The tumor is growing rapidly or keeps coming back.
• It is located near a vital organ, like the eyes or brain, where surgery is risky.

Types of Advanced BCC

There are two main types:

1. Locally Advanced BCC – This occurs when the cancer spreads to nearby tissues but has not moved to distant parts of the body. This is the most common type.
2. Metastatic BCC – This is rare but serious. It happens when cancer cells spread to organs like the lungs, liver, bones, or lymph nodes.

If you notice an unusual skin growth that won’t heal, don’t wait. The sooner you seek medical help, the better your chances of successful treatment.

Read More: What is Mucinous Carcinoma?

Stages of Basal Cell Carcinoma

Unlike other cancers, BCC is rarely staged because it usually doesn’t spread. However, doctors may stage it using the TNM system, which considers tumor size (T), lymph node involvement (N), and metastasis (M). The stages range from 0 to 4:

Stage 0 (Early stage basal cell carcinoma)

• Cancer cells are only in the top skin layer (epidermis) and haven’t spread.
• Highly treatable with topical treatments, cryotherapy, or minor surgery.
• Also known as carcinoma in situ.

Stage 1

• Tumor is 2 cm or smaller.
• No spread to lymph nodes or other tissues.
• Usually treated with surgical excision or Mohs surgery.

Stage 2

• Tumor is between 2-4 cm.
• Hasn’t spread but may have high-risk features, like deeper skin invasion.
• Treatment includes surgery with a wide margin or radiation for hard-to-reach areas.

Stage 3

• Tumor is larger than 4 cm, has invaded bones or nerves, or spread to one nearby lymph node.
• Requires extensive surgery, Mohs surgery, and possibly radiation therapy.

Stage 4

• In stage 4 basal cell carcinoma, the cancer has spread to distant lymph nodes, bones, or other organs.
• Tumor may be deeply invasive, affecting critical structures.
• Treatment involves surgery to remove tumors, followed by radiation to manage symptoms.
• A complete cure is difficult, but treatment can help control the disease.

Furthermore Read: Understanding Giant Cell Tumors

Signs and Symptoms of Advanced Basal Cell Carcinoma

Advanced basal cell carcinoma (BCC) develops from an untreated or recurring cancerous lesion. It most often appears in areas frequently exposed to sunlight, such as:

• Face
• Ears
• Scalp
• Neck
• Shoulders or upper back

Common Signs of Advanced BCC:

BCC can take on various appearances, making it important to recognize potential warning signs, such as:

• Persistent, scaly patch: A slightly raised, irritated area that doesn’t heal.
• Non-healing sore: A pimple-like lesion that oozes, bleeds, or refuses to heal.
• Shiny, skin-toned bump: Resembling a mole, it may be clear, pink, red, or darker in color.
• Depressed area: Pink or reddish area that dips in at the center.
• Flat, waxy scar-like patch: A smooth, pale, or slightly shiny area that resembles a scar.

If you notice any of these signs, it’s crucial to seek medical attention promptly. Early diagnosis and treatment can help prevent the cancer from progressing.

How Is Basal Cell Carcinoma Diagnosed?

Doctors typically diagnose basal cell carcinoma (BCC) based on the appearance of a slow-growing skin lesion. A clinical evaluation helps identify BCC, but confirmation requires a biopsy or tissue examination after removal.

In some cases, particularly with superficial BCCs on the trunk and limbs, a diagnosis may be made based on clinical signs alone. These cases might be treated with non-surgical methods without the need for a biopsy. However, when necessary, a diagnostic biopsy helps determine the histological subtype and guides the most effective treatment approach.

Also Read: Understanding Large Cell Lung Carcinoma

How Is Advanced Basal Cell Carcinoma Treated?

Treatment for advanced basal cell carcinoma (BCC) depends on factors like tumor size, location, and how far it has spread. Common treatment options include:

Surgery and Radiation Therapy

• These are the most common treatments for BCC.
• They may also be used for some advanced cases.
• However, they may not be an option if the tumor is too large, in a difficult location, or has spread extensively.

Systemic Treatments

When surgery or radiation isn’t possible, systemic treatments—those that work throughout the entire body—are needed. The FDA has approved three systemic treatments for advanced BCC:

1. Targeted Therapy

Targeted therapy uses drugs that attack specific features of cancer cells. The two targeted drugs for advanced BCC are:

• Vismodegib
• Sonidegib

Both drugs block the hedgehog pathway, which plays a key role in BCC growth.

2. Immunotherapy

Immunotherapy boosts the body’s immune system to help fight cancer. Cemiplimab was FDA-approved in 2021 for advanced BCC.

Cemiplimab is a PD-1 inhibitor, which blocks immune checkpoints that prevent the immune system from attacking cancer cells. Once these checkpoints are blocked, immune cells can better detect and destroy cancer.

Also Read: Understanding Immunotherapy vs Chemotherapy

How Clinical Trials Are Shaping Cancer Treatment

Cancer research plays a crucial role in developing innovative treatments and improving patient outcomes. Scientists and medical experts continuously explore new therapies to target various cancer types.

For example, ongoing solid tumor clinical trials provide patients with access to cutting-edge treatments, aiming to evaluate their effectiveness and improve future cancer care.