Is Basal Cell Carcinoma on Your Radar?
Published on the 31 January 2016
Published on the 31 January 2016
The Cancer Council of Australia names non-melanoma skin cancer (NMSC) as Australia’s most common cancer, and basal cell carcinoma (BCC) leads the way. Two out of three people in your care may be diagnosed with skin cancer. As a nurse, do you feel confident that you could identify abnormal skin lesions and organise a referral for your patient?
This slow growing tumour arises from damaged epidermal basal layer and hair follicle cells.
A BCC can present as one of several subtypes, each with specific characteristics of appearance, recurrence risk and aggressiveness. Unlike other skin cancers that can develop from a pre-existing lesion, BCCs arise on skin probably sun damaged, but otherwise appearing “normal”. Tumour appearance corresponds to the size, shape, location and growth habits of the tumour nests.
BCCs can also contain pigment, commonly appearing as black-blue or brown areas (pigmented BCC). It is important to differentiate a pigmented lesion from a melanoma.
Be alert to a lesion that:
The main cause of BCC is intense intermittent ultra violet radiation (UVR), resulting in:
Risk Factors: UVR from natural or artificial sources; exposure pattern (recreational or occupational), severity (sunburn and blistering) and age (childhood or adult), induce skin changes – increasing susceptibility to skin cancer.
Additional risk factors include:
A clinical examination can often be sufficient. However, it’s important to appreciate that mixed morphology lesions are common, recurrent lesions may be active and infiltrate before being clinically apparent, and some anatomical sites, especially the face, can challenge the cosmetic and treatment outcomes. It’s important to confirm the presence of a BCC through a biopsy (a punch biopsy provides full-thickness tissue) or dermoscopy (visualisation of the upper dermal architecture and colours, correlating to histologic features).
You can examine the lesion under a bright overhead light, optimally natural light. By applying gentle stretch to the surrounding skin the lesion borders may become visible.
BCCs respond to a range of treatments especially when identified and treated early. Well established tumours may extend deeply, invading nerves or cartilage (for example ear or nose) leading to local tissue destruction and, rarely, metastasis.
Treatments can be:
Skin cancer is a very real threat, especially with Australia’s intense sun and beach/outdoors culture. As such, the Cancer Council of Australia advocates for opportunistic screening. Health professionals are encouraged to understand the risks of developing skin cancer to more easily recognise the “at risk” individual. Whilst the individual themselves are ultimately responsible and are encouraged to request regular skin checks. Encouraging patients to follow up after skin cancer treatment is also important. It is recommended that patients become familiar with their skin as recurrence and new lesions are always a possibility. Finally, a full skin check may identify lesions not visible to the patient.
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Jan Riley is a specialist dermatology nurse based in regional New South Wales, Australia. Her postgraduate studies include a Certificate in Dermatology Nursing (USA), Master of Nursing (NP) and Certificates in Dermoscopy and Skin Cancer Medicine. Driven by a passion for “all things skin”, Jan is a staunch and passionate mentor and advocate, who is always ready and willing to share knowledge and inspire nurses to understand skin’s impact on daily lives. Her active participation in a range of professional activities has greatly assisted to raise the profile of dermatology and skin disease in the community. Jan currently develops and presents skin education modules through a co-directed nurse education company (Dermatology Nurse Education Australia) for nurses across all areas of care delivery.