BCC and SCC
Skin is the largest organ of the human body. Among all cancers, skin cancer is considered the most common cancer developed in humans.
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Cancer means abnormal growth and transformation of cells without having normal controls. As the cells multiply they form a tumor. Tumor means mass. They are called cancerous only when they are malignant – which means they invade neighboring tissues and lymph nodes. When abnormal growth of skin cells occurs, it is called skin cancer. Areas that are exposed to the sun are more prone to skin cancer. But it can also develop in places where usually sun exposure doesn’t occurÂ
Demographics
In the United States, skin cancer is considered the most common cancer. The most common type of skin cancer is basal cell carcinoma. Approximately eighty percent of people suffering from skin cancer are diagnosed with basal cell carcinoma. In the United States, each year 5.4 million people are diagnosed with squamous skin cell carcinoma and basal cell carcinoma.
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- In the USA annually two thousand people die from non-melanoma skin cancer. In 2020, it is estimated that more than 100 thousand people will be diagnosed with skin cancer.
- Basal cell carcinoma can be seen in all types of races and skin types. But statistics show light skin individuals are most often affected by this. On the contrary, dark-skinned people are seldom affected. About thirty-three to thirty-nine percent of White men have a lifetime risk of developing basal cell carcinoma. About twenty-three to twenty-five percent of white people have a lifetime risk of developing basal cell carcinoma.
Types of skin cancer
- Basal cell carcinoma (BCC): These are slow-growing masses. They are usually locally malignant tumors. The common site of developing basal cell carcinoma is the neck and head. It is considered the most common form of skin cancer. Approximately 90% of all types of skin cancer.
- Squamous cell carcinoma (SCC): This type of skin cancer is more aggressive than other types of skin cancer. It generally develops on the outer layers of skin. It looks like scaly, red lesions on your skin.
- Melanoma: Melanoma forms in the melanocytes of the skin. The function of melanocytes in skin pigment (color) production. It is considered the most dangerous type of skin cancer. Usually, this type of skin cancer is very rare. It accounts for merely one percent of skin cancers, but the sad part is most skin cancer-related deaths are caused by melanoma.
General signs of skin cancer
Any type of unusual changes in your skin is a warning sign of cancerous lesions. It may not produce too many signs or symptoms.Â
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Skin lesions: A skin lesion can be an unusual growth in the skin, a scaly patch, dark spot, new sore or bump, skin color or texture change, or a mole that doesn’t easily go off. Following characteristics in a skin lesion can be suggestive of skin cancer –Â
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- Asymmetry: Any type of asymmetry in your mole or lesions is an indication of a cancerous lesion.
- Border: Uneven edges; ragged lesions are considered cancerous lesions.
- Evolving skin lesions: Any type of wart or mole changing its shape, color, or size may turn out to be a cancerous or precancerous lesion.
- Diameter: The skin lesion is larger in diameter – it may be larger than one-quarter inch.
- Color of the lesion: Any type of spot having unusual color (black, pink, blue, red) or showing any type of color changes can be cancerous.
This article talks about two common types of skin cancers – Basal cell carcinoma & Squamous cell carcinoma.
Basal cell carcinoma
Basal cell carcinoma arises from basal cells of the skin. Basal cells are small round cells found in the lower layer of the epidermis. Basal cell carcinoma is one type of non-melanocytic skin cancer.Â
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Basal cell carcinoma may appear as a small, firm, flat sometimes raised area. The lesion may also look shiny, translucent, waxy, pearly. These features are considered the hallmark sign of basal cell carcinoma. Generally, this lesion has a raised border and the presence of central ulceration. Typically these types of skin tumors are slow-growing. Usually, It occurs on the sun-exposed areas of skin. This type of skin cancer doesn’t metastasize usually.Â
Demographics of basal cell carcinoma
- The possibility to develop basal cell carcinoma is much higher in people aged fifty-five to seventy years than in younger people.
- Though it can affect teenagers and people having comparatively fair skin. The sad part is the aggressive form of basal cell carcinoma is noticed in younger people than the older generation.
- Men are more affected than women. The most probable cause is occupational exposure to the sun.
Causes of basal cell carcinoma (BCC)
- Long-term exposure to ultraviolet radiation from the sun is considered the main cause of basal cell carcinoma. It occurs when chronic exposure to ultraviolet rays causes mutation of DNA. DNA is responsible for coding the way of cell growth. But unfortunately, the mutated DNA fails to stop the abnormal growth of skin cells – as a result, abnormal cell growth occurs in the basal cell of the skin. In addition, commercial tanning and some other risk factors are equally responsible for this carcinoma.
- A person suffering from any form of immunosuppression has a good risk of developing cancerous lesions.
- People who are exposed to X-rays or any type of high-energy radiation are also in the risk zone.
- Exposure to certain chemicals such as hydrocarbon, arsenic. People working in mines, ships, or involved in farming have a great risk of developing skin cancer.
- People with certain genetic disorders eg: xeroderma pigmentosum, albinism carries a high risk of developing carcinoma. In xeroderma pigmentosum, there is a faulty DNA repair mechanism present. In response to ultraviolet rays, DNA causes mutation thus leads to skin damage.
- A person having severe sunburn during his early years of life.
- A person whose close relative has any kind of skin cancer.
- People having unusual or several moles present from birth.
- People with any type of burn, not just only sunburn are also prone to develop basal cell carcinoma.
Sites of basal cell carcinoma
- Around eighty-five percent of basal cell carcinoma occurs in the neck, head, scalp, and face.
- A very few of them may develop in the trunks and extremities.
- Periocular basal cell carcinoma is also present mostly in the lower eyelid, upper eyelid, medial canthus, and lateral canthus.
Features of basal cell carcinoma
- Basal cell carcinoma may resemble shiny bumps, pink growths, red patches, or any type of sore which bleeds after any kind of trauma. Sometimes it may look like a non-cancerous lesion such as eczema or psoriasis. Another important sign is hard skin growth and a waxy appearance. This lesion has uncontrollable growth. It rarely metastasized- that means it usually doesn’t go beyond the original tumor location. Ulceration (mostly central ulceration) or erosion may present. It may be pigmented. Â
- In the case of large basal cell carcinoma, there may be the presence of crusting and oozing.
- Some surfaces may have telangiectasia.
- Some lesions have waxy papules and some form of central depression.
- It is a slow-growing tumor which means it takes a longer period to develop this lesion.
- Pearly appearances or translucency is a common feature in this type of carcinoma.
- Presence of rolled or slightly raised area.
- Some areas may show color discoloration such as blue or black.
Types of basal cell carcinoma (Clinicopathological)
- Superficial type: Mostly present in the shoulders or trunk areas. Plaque, patch (well-circumscribed); erythematous lesion. Sometimes scaling is also present.
- Micronodular type: May have a well-defined border. During stretching, white or yellow color nodules are firm to touch. Less prone to ulcer development.
- Nodular type: It is the most common type. It may be pigmented, keratotic, or cystic. Sometimes appear as pearly white flesh-colored papules. The presence of telangiectasia is also common.
- Morpheaform type: Yellow or white-colored sclerotic plaque or wax formation occurs in this type. The firm, flat and fibrotic lesion is the hallmark of this type.
- Infiltrative type: In this type, the margin of the tumor is not prominent. These types of tumors infiltrate the dermis in between the collagen fibers.
Prevention of basal cell carcinoma
- Avoid direct sun exposure.
- Staying indoor during strong sunlight exposure.
- Application of good quality sunscreen at least thirty minutes before going outdoors.
- Apply lip balm having a skin protector factor of thirty or higher to avoid skin burn.
- Wearing sunglasses that can give you protection from ultraviolet A and B.
- Wearing a dark and tight dress and hat during daylight hours.
Treatment of basal cell carcinoma
Non-surgicalÂ
- Superficial radiotherapy
SurgicalÂ
- Cryosurgery
- Excisional surgery
- Electrocauterization
- Mohs microscopic surgery
- laser treatment is available nowadays
- In some cases, you may need a cosmetic surgeon’s help with the surgical reconstruction of your skin.
Prognosis of basal cell carcinoma
- Basal cell carcinoma is a malignant neoplasm but it rarely metastasizes. People with basal cell carcinoma show an excellent prognosis if it is detected early and has not already spread to other sites.
- If basal cell carcinoma is not treated early there is a possibility for morbidity. Some people may face cosmetic disfigurement which can cause mental trauma to the patient.
- Very few people approximately point one percent are estimated to develop metastasis. Usual sites for metastasis are the lungs, lymph nodes, bones.
Squamous cell carcinoma
This type of cancer initially occurs in the squamous cell. Squamous cells made the outermost layer of skin. Some internal organs such as the lungs, urinary tract, the mucous membrane also have a squamous lining.
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It is the second most common cancer among all types of skin cancers. It is caused by certain DNA changes. This type of change leads to the uncontrolled cell’s normal growth and development.
Causes of squamous cell carcinoma
- Long-term exposure to certain chemicals such as hydrocarbon or tannin is responsible for damage to the skin layer and causes the formation of cancerous lesions.
- Body parts exposed to Ultraviolet radiation are often seen to develop squamous cell carcinoma.
- Some viruses such as human papillomavirus are also responsible for this type of cancer.
- Some ulcers or burns can also turn into squamous cell carcinoma.
Features of squamous cell carcinoma
- Initially, squamous cell carcinoma appears as a red, scaly patch of skin. After some time it may continue to grow and may even turn into bumps. There may also be crust formation. In some cases, ulcers may form inside the mouth. Sometimes the lesion tends to bleed or may take the form of a white patch.
- Any time of pre-existing scar, mole, sore which refuses to heal is also indicative of squamous cell carcinoma.
Risk factors of squamous cell carcinoma
- History of exposure with arsenic or hydrocarbon chemicals.
- Having fair skin increases the risk quotient.
- Having chronic exposure to ultraviolet radiation.
- Living in hot sunny areas.
- A person having AIDS, HIV, or blood cancer carries a greater risk than any normal individual.
Diagnosis of basal and squamous cell carcinoma
- Taking a patient’s personal and medical history helps to diagnose.
- Ask about the mole or spot initially where it started.
- Physical examination of the lesion specially shape, size, color, texture.
- History of sun exposure, ultraviolet ray exposure, or chemical contacts.
- Taking a biopsy of the lesion to see the presence of cancer cells.
Treatment of squamous cell carcinoma
In most cases treatment depends on the patient’s age, overall physical condition, the severity of cancer, and how far cancer has extended.Â
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If the SCC is detected early, the success rate of treatment increases. Some treatment procedure is discussed below:
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- Cryosurgery: In this form of surgery liquid form of nitrogen is used to destroy the cancerous lesion by freezing it.
- Excisional surgery: In this form of surgery cancerous lesion is removed and part of healthy skin is also removed. Then your doctor will close the wound and a sample of the cell is sent to the laboratory to know if the cancerous lesion is removed fully or not.
- Mohs micrographic surgery: In this surgery, the doctor removes the abnormal growth using a scalpel and takes it under a microscope. If any cancer cell is seen the procedure is repeated until the whole area is clear from the cancerous lesion.
- Electrosurgery: Done by scraping a cancer cell and burning the skin to destroy it.
- Using radiation therapy: Using high-energy X-rays in the affected area can kill cancer cells. But it takes time to do this process.
- Using topical medications such as imiquimod or five- fluorouracil.Â
- Using reconstructive surgery to correct cosmetic disfigurement.
- Using laser technology to remove the abnormal growth.Â
You have to keep in mind that all these procedures must be done by a qualified registered doctor who is skilled in the treatment of cancer patients otherwise this thing may backfire.
Prognosis
People with squamous eyes usually have a good survival tendency. It is observed that ninety-nine percent of patients have a five years survival rate. If cancer has already spread to the bone, lymph nodes then it may lower the survival rates. Nowadays various extensive surgery is available to treat advanced cancer.
A brief table comparing BCC vs SCC
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Traits | Basal Cell Carcinoma  | Squamous Cell Carcinoma |
Layer | It develops from the basal layer of the epidermis. | It arises from the squamous layer     (outermost) layer of the skin. |
Site | Commonly in the face, trunk extremities, any sun-exposed areas | Skin, esophagus, oral cavity, urinary bladder, lungs, cervix, etc. |
Metastasis | Locally malignant tumors rarely metastasize. | It is a tumor in situ, and has a higher possibility of metastasis. |
Cause | UV radiation, chronic sun exposure,         some precancerous conditions such as basal cell nevus syndrome, xeroderma pigmentosum, etc. | Exposure to chemicals such as arsenic, hydrocarbon, exposure to sunlight and ionizing radiation, human papillomavirus, some precancerous condition such as xeroderma pigmentosum. |
Demographics | Mostly affect people with lighter skin  | Mostly affects man |
Appearance | It may have a nodular/papular appearance. Sometimes central ulceration present; the edge may Be raised or rolled. Some lesions show a pearly appearance, some may have translucency. | It may have a red, scaly plaque-like appearance. Some may show skin thickening, some may have a modular appearance. |
Growth | Slow | Faster |
Psychological counseling (BCC vs SCC article)
After getting diagnosed with cancer you may feel disheartened and hopeless all of a sudden. You need to remember that proper treatment at an appropriate time may recover you completely. Besides, most cancer carries a good prognosis. Regular follow-up will help you to prevent the recurrence of tumors and help you to lead a healthy life.
Let us know in the comment section what did you think about our BCC vs SCC article.Â
