Basal Cell Carcinoma Removal and Post-Operative Care
Basal cell carcinoma is a common cancer of the skin. Four out of five cases of the skin cancer are of the nodular form, which appears as a pink pimple with a pearly, translucent quality.1 While most basal cell carcinomas do not metastasize, they do have the potential to spread, so the cancer cells must be removed. Unfortunately, 70% of basal cell carcinomas occur on the face. This creates a tricky situation for patients and physicians: How to remove the basal cell carcinoma while leaving the smallest possible scar? The secret may be in choosing the right basal cell carcinoma treatment and proper pre- and post-operative care.
Surgical basal cell carcinoma removal is best, but not the only option
People with basal cell carcinoma generally have several treatment options—even more if the cancer is not likely to recur. The standard first-line procedure is to remove the basal cell carcinoma via surgical excision. Simply put, a surgeon uses a scalpel to remove the tumor and a bit of healthy skin all the way around it. While every effort is made to remove as little healthy tissue as is safe, standard surgical excision can leave patients with a relatively large surgical wound. This also means there is the potential for relatively large scar.
An alternate first-line approach for treating basal cell carcinoma is Mohs surgery. In Mohs surgery, the surgeon removes skin in a series thin of thin layers, so that each layer can be examined under a microscope. Once the diseased tissue has been removed and only healthy tissue remains, the surgeon stops removing additional tissue. While Mohs surgery takes considerably longer than standard surgical excision and can be more expensive, patients generally have smaller wounds and smaller scars than standard surgical excision.
Patients who are unable to undergo surgery or would simply like to avoid surgery may opt for topical treatment. In this approach, the physician applies a substance such as imiquimod or fluorouracil, which can destroy the cancer. As you may imagine, topical treatments are not always as effective as surgical treatments. As such, basal cell carcinoma is more likely to recur with topical treatment versus surgical treatment.2
For patients who are completely unconcerned about scars, curettage and electrodesiccation is another option. In this treatment, the surgeon scrapes away the visible basal cell carcinoma then uses electricity to destroy any remaining cancer cells. This approach almost certainly leaves a large scar over the treatment area. Some patients may be able to choose light/laser therapy, freezing, burning, or another alternative treatment. The effectiveness and scarring risk of these alternative basal cell carcinoma treatments varies.
Scars may happen after even after topical treatment
Some patients with basal cell carcinoma often want to explore topical and other alternative basal cell carcinoma treatments because they are worried about the risk of scarring that comes with surgery. Unfortunately, both imiquimod and fluorouracil may cause changes in the skin, and they can even lead to scars themselves. Virtually everyone treated with imiquimod experiences skin irritation including itching, redness, pain, and bleeding at the treatment site.2 While most patients ultimately have an excellent cosmetic outcome, topical treatment with imiquimod may permanently lighten the skin (hypopigmentation).3 Furthermore, as many as one in 10 patients treated with topical fluorouracil will develop scars.4
Minimizing the risk of basal cell carcinoma scars
While it may not be possible to entirely avoid basal cell carcinoma treatment scars, there may be ways to reduce your personal risk. A great place to start is to improve your ability to heal. Consuming adequate nutrition in the form of calories and vitamins and minerals gives your skin the building blocks it needs repair itself. Chronic diseases (e.g. diabetes) can interfere with the healing process, so is important to control chronic illnesses as much as possible prior to treatment. Smoking is particularly bad for wound healing. The longer you can stop smoking before your basal cell carcinoma removal procedure, the more likely you are to have a favorable outcome (as long as you do not smoke while you are healing!).
Caring for your wound after basal cell carcinoma treatment
How you care for your wound in the days to weeks after treatment can have a profound effect on the resulting scar. Your physician will provide you with detailed postoperative instructions—read these instructions and follow them. You may need to limit your physical activity for a certain time after the procedure. These temporary limitations are intended to protect the surgical wound and not put stresses and strains that could interfere with healing.
A moist wound is a healthy wound. Your skin needs to be well hydrated to heal and prevent infection. You can keep your wound moist by using high-quality dressings and medical tape. Too much moisture, on the other hand, can actually prevent proper healing. You can tell of the wound is producing too much moisture if it is weeping fluid, producing pus, or if you have to change dressings more frequently than recommended. Excessive moisture may mean your wound is infected. Notify your physician as soon as practical if you suspect a wound infection.
The new skin and scar tissue that grows inside of wounds is very fragile compared to mature skin. Scars are exquisitely sensitive to the sun. Sunlight can dramatically darken scars (hyperpigmentation), which is often permanent. That is why experts recommend protecting scars against the sun’s rays for at least six months after surgery. Large wounds can be protected by covering them with dressings and high-quality medical tape, while smaller wounds may only need to be covered with occlusive medical tape.
Silicone gel sheets may be able to keep surgical wounds appropriately moist and soften scar tissue. Unfortunately, most silicone gel sheets are transparent or translucent, which means they do not protect scars from UV radiation. In addition, silicone gel sheets often do not stick to skin very well. For these reasons, patients may want to consider covering the silicone gel sheet with occlusive dressing and high-quality medical tape.
Consider Hy-Tape for basal cell carcinoma removal and post-operative care
Hy-Tape is a high-quality medical tape that is perfect for use after basal cell carcinoma procedures. It can help secure dressings and silicone gel sheets good wound healing process. Because Hy-Tape has an SPF greater than 50, it provides excellent protection from the sun’s ultraviolet rays. So you can use Hy-Tape to cover basal cell carcinoma scars long after the initial wound has healed.
While you may not be able to limit your risk of developing a basal cell carcinoma scar, you can take steps to increase your chances of having a favorable cosmetic outcome.
Read More About Skin Cancer Scar Care.
1. Scrivener Y, Grosshans E, Cribier B. Variations of Basal Cell Carcinomas According to Gender, Age, Location and Histopathological Subtype. Br J Dermatol. 2002;147(1):41-47. doi:10.1046/j.1365-2133.2002.04804.x
2. Bath-Hextall F, Ozolins M, Armstrong SJ, et al. Surgical Excision Versus Imiquimod 5% Cream for Nodular and Superficial Basal-Cell Carcinoma (Sins): A Multicentre, Non-Inferiority, Randomised Controlled Trial. Lancet Oncol. 2014;15(1):96-105. doi:10.1016/s1470-2045(13)70530-8
3. Sriprakash K, Godbolt A. Vitiligo-Like Depigmentation Induced by Imiquimod Treatment of Superficial Basal Cell Carcinoma. Australas J Dermatol. 2009;50(3):211-213. doi:10.1111/j.1440-0960.2009.00541.x
4. Love WE, Bernhard JD, Bordeaux JS. Topical Imiquimod or Fluorouracil Therapy for Basal and Squamous Cell Carcinoma: A Systematic Review. Arch Dermatol. 2009;145(12):1431-1438. doi:10.1001/archdermatol.2009.291