Basal Cell Carcinoma

The experienced skin cancer specialists at UT Southwestern Medical Center deliver expert care to patients with all types and stages of basal cell carcinoma. Our patients have access to the most advanced treatments and clinical trials that aren't available at every hospital.

UT Southwestern is home to the only National Cancer Institute-designated comprehensive cancer center in North Texas. Our specialized team offers an exceptional level of skill and expertise – as well as innovative, science-based therapies – to people with basal cell carcinoma.

Specialized Care for the Most Common Skin Cancer

Basal cell carcinoma – also called basal cell cancer – is the most common type of skin cancer, accounting for approximately 80 percent of all skin cancer cases.

One of the three primary types of cells that make up the skin (epidermis), basal cells are located at the bottom of the epidermis.

Although basal cell carcinomas usually grow slowly and rarely spread to other parts of the body, if left untreated, they can grow deeply into the skin and bone.

It’s important that they are entirely removed to prevent recurrence in the same area.

Program Highlights

UT Southwestern’s Comprehensive Melanoma and Skin Cancer Program specialists offer patients a unique level of expertise and experience and the most innovative and advanced therapies.

Our experts diagnose and treat all types of skin cancer – from the most common to the very rare – and deliver the advanced screening, precise diagnostics, and pioneering treatments that are leading to better-than-ever patient outcomes. UT Southwestern’s team works closely with patients to develop tailored care plans that are based on each person’s unique condition, overall health, and treatment goals and preferences.

Highlights of our program include:

• An integrated, multidisciplinary team that includes dermatologists, surgical and radiation oncologists, medical oncologists, pathologists, and radiologists – all of whom take a personalized, evidence-based approach to skin cancer diagnosis and care
• A focus on screening, early detection, and accurate diagnoses – all key to successful skin cancer treatment
• The most sophisticated diagnostic tools available, including highly specialized dermatopathology testing and in-house molecular profiling
• Expertise in all types of surgery to remove all types of skin cancer, including Mohs surgery, tumor excision, and regional lymph-node dissection 
• Leadership in the use of stereotactic radiosurgery – including tools such as the Gamma Knife and CyberKnife – to treat some cases of skin cancer
• Immunotherapies, such as immune checkpoint inhibitors, which stimulate the immune system to target and kill skin cancer cells
• Targeted therapies, which use drugs to target abnormal proteins in tumor cells
• Opportunities for patients to enroll in clinical trials aimed at improving the diagnosis and treatment of skin cancer via promising new protocols that are not yet available to the public
• A comprehensive variety of cancer support services

Symptoms

Basal cell carcinomas often arise on skin that gets UV light exposure – particularly on the head and neck. They can appear as:

• Flat, firm, pale or yellow areas, similar to scars
• Raised reddish patches that might itch
• Small, pink or red, translucent, shiny, pearly bumps that might have areas of blue, brown, or black
• Pink growths with raised edges and a lower area in their centers
• Open sores with oozing or crusted areas that don’t heal or that heal and return

Risk Factors

As with all types of skin cancer, sunlight and tanning-bed exposure are key risk factors for basal cell carcinomas. Other risk factors for basal cell carcinoma include:

• Fair skin: Caucasians – particularly those with skin that tends to freckle or burn – are at significantly higher risk of developing skin cancer than African-American and Hispanic people.
• Gender: Men are at greater risk than women for developing basal cell carcinoma.
• Advancing age: People are at higher risk for developing basal cell carcinoma as they get older.
• Prior skin cancer: People who have previously had basal cell carcinomas or other types of skin cancer are at higher risk for developing new ones in other areas.
• Weakened immune system: Certain medical conditions and drugs weaken the immune system, increasing people’s risk for developing cancer.
• Radiation exposure: People who have undergone cancer radiation treatment are at elevated risk for developing skin cancer in the exposed area.
• Psoralens and ultraviolet light (PUVA) therapies: Used to treat psoriasis, these therapies can increase patients’ risk of skin cancer.
• Xeroderma pigmentosum (XP): People with this very rare inherited condition frequently develop many skin cancers.

Diagnosing Basal Cell Carcinoma

UT Southwestern’s skin cancer specialists offer the following tests to evaluate and diagnose basal cell carcinoma. All diagnostic tests help us determine the most appropriate, evidence-based course of treatment. Tests include:

• Skin biopsy: If a spot on the skin appears to be cancerous or precancerous, a small sample of the suspicious tissue is removed for microscopic evaluation by a dermatopathologist.
• Lymph node biopsy: In the rare cases that basal cell carcinoma spreads beyond the skin, it typically goes first to nearby lymph nodes. If this is suspected, a small sample of the nearest lymph node might be removed for microscopic evaluation.

Because basal cell carcinomas are virtually always cured before they spread (metastasize) to other parts of the body, they are not typically staged.

Treatments

UT Southwestern offers a range of advanced therapies for patients with basal cell carcinoma. They include surgery, nonsurgical local therapies, radiation therapy, and targeted therapies.

Surgery

Surgery is often the first line of treatment for basal cell carcinoma, and it might be performed in conjunction with other therapies.

The incision and scar size, patient recovery time, and whether the surgery is performed as an inpatient or outpatient procedure all depend upon the cancer’s size, depth, and location.

UT Southwestern offers basal cell carcinoma surgeries that include:

• Traditional tumor excision: This surgery involves removal of the tumor and a bit of normal surrounding tissue to check for carcinoma cells.
• Mohs surgery: Used most often in non-melanoma skin cancers, this outpatient procedure removes skin cancer one layer at a time and can be used as an alternative to traditional tumor excision. As each layer is removed, it’s examined under a microscope. If the margins are cancer free, the surgery is completed. This process allows surgeons to spare as much tissue as possible.
• Reconstructive surgery: UT Southwestern surgeons can sometimes use reconstructive surgery to prevent or treat scarring or disfigurement after skin cancer treatment, especially when a tumor is large. We also offer immediate local tissue reconstruction after Mohs surgery.

Nonsurgical Local Therapies

• Cryotherapy (cryosurgery): Nitrogen applied to the basal cell carcinoma freezes and kills the cancer cells. The procedure frequently is performed more than once.
• Photodynamic therapy (PDT): A liquid drug applied to the basal cell carcinoma turns into a chemical that makes the tumor cells highly sensitive to certain kinds of light. A special light focused on the tumor then destroys the cancer cells.
• Topical chemotherapy: Chemotherapy drugs such as 5-fluorouracil (5-FU) are applied directly to the skin, killing the basal cell carcinoma cells.
• Immune response modifiers: Drugs such as topical imiquimod are sometimes used to help bolster the body’s anti-cancer immune response.
• Laser treatment: Sometimes used to treat superficial basal cell carcinomas, a beam of laser light is used to target and destroy the cancer cells.
• Chemical peel: Used sometimes to treat superficial basal cell carcinomas, a bit of trichloracetic acid applied directly to the tumor kills the basal cell carcinoma cells.

Radiation Therapy

Radiation therapy uses external radiation – delivered by beams of high-energy X-rays – to target and destroy basal cell carcinoma cells and prevent them from growing.

UT Southwestern offers both traditional radiation therapy and stereotactic radiosurgery to treat basal cell carcinoma that has spread to other organs that can’t be treated with surgery or when a patient isn’t healthy enough for surgery. It might also be used after surgery to kill tumor cells left behind.

UT Southwestern physicians and physicists are recognized as worldwide leaders in these sophisticated treatments.

Targeted Therapies

Targeted therapies are drugs that target and destroy abnormal characteristics of basal cell carcinoma cells without harming noncancerous cells. UT Southwestern offers vismodegib and sonidegib, both taken orally for advanced basal cell cancer.

Support Services

UT Southwestern’s Harold C. Simmons Comprehensive Cancer Center offers a comprehensive range of support services to help our patients and their loved ones through skin cancer treatment and beyond.