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Frequently Asked Questions (FAQ)

What is a basal cell carcinoma?

Basal cell carcinoma (BCC) is the most common type of cancer in humans.

Is it a malignant tumour?

Yes, basal cell carcinoma is a malignant tumour.

Who decides what is benign and what is malignant?

The most definitive way of diagnosing whether a tumour is benign or malignant is for a histopathologist to analyzing a fragment of the tumor under the microscope. To do this, the oculoplastic surgeon removes a piece of the tumor (incisional biopsy) and sends it to the pathologist. Using special tissue staining methods, the pathologist can tell whether the tumor is classified under a benign or malignant category.

Who gets basal cell carcinoma and why?

Basal cell carcinoma is associated with previous sun exposure and grows several years later, usually in older adults. However, in countries such as Australia, these tumours are increasingly being found in young adults affecting particularly the head and neck region of "sun-exposed" skin. In the UK we are also seeing young adults aged 30 years or younger with small BCCs on their face and around the eyelids.

Where on the body do basal cell carcinomas occur?

Approximately 80% occur on the head and neck, with the rest mainly on the trunk and lower limbs, particularly in women. Basal cell carcinoma on the backs of the hands is rare. The distribution of basal cell carcinoma is increasing on the trunk, perhaps as a result of increased sun-bathing amongst fair skinned people over the last 20 - 30 years.

What structure does basal cell carcinoma grow in?

It grows from the epidermis in the skin and gradually increases in size locally, invading deeper tissue.

Is it a threat to life?

Luckily, it is very rarely a threat to life. It can however cause unpleasant deformity, ulceration, bleeding, local orbital invasion and loss of the eye. Very rarely it can spread into the brain directly and cause death.

Why treat it?

It is important that Basal Cell Carcinoma on the face, particularly around the eyelids, is diagnosed early and excised completely or it may locally invade and destroy important tissue. This can cause aesthetic deformity, discharge, bleeding and local functional problems, such as eyelid incomplete closure, facial asymmetry and tightness.

What happens if a basal cell carcinoma is left untreated?

The larger the tumour is, the more normal tissue it will have invaded and so more tissue has to be excised. This leaves a bigger "hole" and makes the repair or reconstruction more difficult. On the face particularly around the eyelids, all the tissue is very important so a smaller defect is best for an optimum repair.

N.B. As mentioned above, it can spread deeply into the adjacent tissue and invades the orbit and even grows into the brain along the orbit wall if left untreated.

Why do Oculoplastic surgeons operate on patients with basal cell carcinoma?

Oculoplastic surgeons are trained to diagnose and treat skin cancer on the face, particularly on the forehead, eyelids, periocular region, the side of the nose, the cheeks and temporal areas. We work closely with out Dermatology colleagues, Mohs' surgery.

Can I have radiotherapy treatment instead of surgery?

Radiotherapy is a useful treatment that is generally reserved for elderly patients with extensive lesions when major surgery may not be appropriate. It is not recommended for young patients, as the late cosmetic results are inferior to those of surgery. Nor is it recommended for basal cell carcinomas on the central face, peri-ocular area or eyelids where function can be inpaired and full excision at primary surgery is desired. The five year cure rate for radiotherapy has been estimated at about 90% which is quite low compared to surgical excison with histopathological analysis of the margins, which is up to 98 - 100%.

What else could the tumour be?

Other malignant skin tumours are rarer and often more serious. They include squamous cell carcinoma and malignant melanoma. Deeper eyelid tumours such as meibomian cell or sebaceous cell carcinoma grow outwards from onto the skin.

N.B. Common things are common so common tumours are common

What are the eyelid tumors?

The most common benign eyelid tumours in adults are:

The most common precancerous skin tumours in adults are:

The most common malignant skin tumours in adults are: