Most basal cell carcinoma occur on the sun-exposed areas of the skin, for example the head and neck area, the back of the hand, or other places, but rarely on the mid-section. In the initial stage, basal cell carcinoma usually look like a scab, or like a glassy nodule on the skin. Typically, they do not cause any discomfort and often only noticed when they develop a small, bleeding ulcer.
Basal cell carcinoma grows very slowly, usually over years, and can also grow into and destroy surrounding tissue (e.g., muscles, bones). The basal cell carcinoma grows aggressively, a sign of malignancy. Notably, a basal cell carcinoma usually can not metastasize (spread), e.g. form settlements in lymph nodes or internal organs. This information is important to you, because in most cases, after complete local removal of the basal cell carcinoma, the healing process begins.
A patient diagnosed with a basal cell carcinoma has a significantly increased risk of getting a second basal cell carcinoma. Therefore, careful physical examination prior to the operation (to detect any additional basal cell mass) and periodic follow-up / control treatment is required from the treating dermatologist. Since basal cell carcinoma can look very different, and are usually not recognizable as such for the patient, you should show every skin change you notice to your dermatologist.
Preconditions for basal cell surgery
• Diagnosis by a dermatologist (skin doctor)
• A general physical examination
You are diagnosed with basal cell carcinoma, either because of the typical symptoms, or through a tissue sample.
The safest treatment of basal cell carcinoma is surgical removal including a ‘safe radius’ removal around the afflicted tissue. In some cases, alternative treatment options may be presented to you by the treating specialist.
Typically, surgical removal is done in two steps:
- Step 1: Removal of the basal cell carcinoma: All parts of the tumor must be removed. The complete removal is ensured by the microscopic examination of the removed tissue by the pathologist, who usually gives us the result after 24 hours. The first operation may not succeed to remove all parts of the basal cell carcinoma, in which case, a follow-up operation must be done. Removal of the basal cell carcinoma may not protect the muscles, nerves and vessels.
- Step 2: Closure of the wound defect: This is done in a second operation by stretching or shifting of the surrounding skin (flap-plasty) or skin grafting. The appropriate surgical technique in each case is discussed in detail with you before the operation.
Smaller basal cell carcinomas are operated on an outpatient basis with local anesthesia, possibly supplemented by cardiovascular monitoring and / or the administration of tranquilizers; larger basal cell carcinomas may be removed under general anesthesia.
Advantages of the operation
• histologically proven removal of the tumor
• histological diagnosis of the tumor is quite possible
Immediately after surgery, the wound area is swollen, bruising may occur and the wound dressings are conspicuous. This changes quickly within a short time. The wound care takes place at regular intervals, because after discharge, the referring doctor can (partially) take care of the wound. The same applies to the removal of any necessary wound drainage, or stitches.
The scars resulting from the surgery become more and more inconspicuous in the course of time, in the ideal case you hardly see anything after a few months. If unsightly scars remain, a corrective surgery may be useful. The decision about this is usually possible but only after 6-12 months.
The costs for a basal cell surgery are usually covered by your health care plan following appropriate diagnostics.
