The most common symptom of BCCNS is the skin cancer called basal cell carcinoma (BCC). 95 percent of individuals with BCCNS will develop multiple BCCs over the course of their lives. This can range from just a handful every year, to new lesions appearing every month or week. The following advice on skin cancer treatments and their pros and cons is provided by The Skin Cancer Foundation.
First, a word about sun safety – The ultraviolet (UV) radiation from sun exposure is one of the main causes of BCCs. While a certain amount of sun exposure is necessary for the body to form Vitamin D, excessive sun exposure can cause an already vulnerable BCCNS patient’s skin to form even more lesions than it already would. For this reason, the BCCNS Life Support Network recommends the following precautions:
Limit your time outside between the hours of 10 a.m. and 4 p.m. This is when the sun is at its highest and hottest, and the UV rays are the strongest. During these hours, try to stay inside, or at least in the shade.
Block UV rays with an approved sunscreen. We recommend using a product that is at least SPF 30, and remember to reapply every two hours and after swimming or sweating. You should use two ounces (enough to fill a shot glass) every time you apply sunscreen such as Blue Lizard Sunscreen.
Wear sun-protective clothing. While long-sleeved shirts and broad-brimmed hats can help block UV rays, there are also companies like SunSafe, Coolibar, Tilley, and SunGrubbies which offer clothing with a high SPF/UPF rating.
With these tips in mind, here are the most common treatments for skin cancer.
The act of surgically removing the cancer lesion, this procedure may be performed by a dermatologist, otolaryngologist (ear-nose-throat specialist), plastic surgeon, or other specialist. If the lesion to be removed is large enough, a skin graft from another area of the body may be required. While this is the simplest way to deal with the skin cancer lesions, it has a higher rate of recurrence than some other treatments.
Also called “chemosurgery,” Mohs micrographic surgery is a more advanced form of excision. When the skin cancer lesion is removed, the surgeon marks its position. The edge of the lesion is examined for any cancerous cells, and any that are found are marked on a diagram of the lesion. The surgeon then goes back to remove more tissue from the area that was marked. This ensures a clean margin of healthy cells all the way around the lesion, so the procedure is more than 95% effective in making sure that the lesion is completely removed. Mohs surgery can be expensive, however, and it takes a longer time than simple excision. More information about Mohs surgery is available in this article from the Skin Cancer Foundation.
Electrodessication and curettage.
Called ED&C for short, this procedure involves using a light electric current to dry out and kill cancerous cells, which are scraped away using a round knife called a curette. This process is repeated until the entire lesion has been removed, along with a margin of healthy skin to ensure complete removal. ED&C involves little bleeding and requires no stitches, but it takes longer to heal and may not be suited for all skin cancers.
Almost the opposite of ED&C, cryosurgery freezes the skin cancer lesion with liquid nitrogen instead of burning it. The growth scabs over and generally falls off within a couple of weeks. Cryotherapy has a lower cure rate (85-90%) than other procedures, but it is the procedure of choice for people with bleeding disorders or trouble with anesthesia.
Chemotherapy uses various drugs to interrupt cellular processes that happen more quickly in cancer cells. This is done in order to kill off the cancer cells while leaving most of the healthy body cells intact. Topical chemotherapy involves applying the drug directly to the cancerous lesions as a cream. The cancerous cells absorb the drug and die off, forming scabs that can be removed. Patients complain of skin irritation, and the treatment may miss portions of some tumors that lie deeper under the skin, but topical chemotherapy tends to heal with the least scarring.
Often abbreviated as PDT, this procedure uses a drug that only becomes active under a certain wavelength of light. Cancerous cells absorb the drug more readily than healthy cells, so the cancerous cells are killed off while the healthy cells remain. The procedure can be made more accurate by using lasers to direct the light only at the cancerous cells. Patients sometimes complain of feeling “cigarette burns” or other irritation, and they must stay out of the sun for the next day or two, but PDT can be very useful for treating many BCCs at one time.
A warning about radiation: Radiation therapy for skin cancer is NOT recommended for people with BCCNS. The radiation may kill the original lesion, but at the expense of possibly creating multiple new lesions. BCCNS is caused by a loss of function in a tumor-suppression gene, so affected individuals are at much higher risk of forming new skin cancers after radiation exposure.