I am going to have a lesion on my skin removed in the near future because it is possibly a BCC (Basel Cell Carcinoma). The excised tissue will then be sent to a pathology lab for examination. If it is identified as BCC then what should I expect by way of follow up. It seems to me that by removing the BCC, the cancer has been removed.Here was the response:
You're right to think that removing the BCC lesion usually means the cancer has been removed. Basal Cell Carcinoma (BCC) is the most common type of skin cancer, and it rarely spreads to other parts of the body. Surgical excision is a highly effective treatment, often leading to a complete cure.
However, a confirmed BCC diagnosis, even after successful removal, does typically warrant some follow-up. Here's what you should generally expect:
1. Pathology Report Review:
Your doctor will review the pathology report from the lab. This report is crucial because it confirms:
The diagnosis: That the lesion was indeed a BCC.
The type of BCC: There are different subtypes (e.g., nodular, superficial, infiltrative, micronodular). Some types, like infiltrative or micronodular, can be more aggressive and have a higher risk of recurrence if not completely removed.
The margins: This is very important. The pathologist examines the edges of the excised tissue (the "margins") to see if any cancer cells are present at the cut edges.
Clear/Negative Margins: This means no cancer cells were found at the edges, indicating the entire tumor was likely removed. This is the ideal outcome.
Positive/Incomplete Margins: This means cancer cells were found at the edges. If this happens, your doctor will likely recommend further treatment, such as another excision to ensure all remaining cancer cells are removed.
2. Follow-up Appointments:
Even with clear margins, regular follow-up appointments are recommended because:
Risk of new BCCs: People who have had one BCC are at a higher risk of developing new BCCs in different locations on their skin. This risk can be as high as 30-50% within 5 years.
Local recurrence: While less common with complete excision, there's a small chance of the BCC recurring in the same spot, especially if certain high-risk features were present (e.g., location on the face, certain subtypes, or larger/deeper tumors).
Frequency: The frequency of these check-ups can vary depending on your individual risk factors (e.g., number of previous skin cancers, type of BCC, sun exposure history, immune status). Common recommendations include:
Every 6-12 months for at least 5 years.
Some doctors may recommend lifelong annual checks, especially for those with multiple BCCs or other risk factors.
What happens during follow-up:
A thorough skin examination by your doctor (often a dermatologist), checking the original site and your entire body for new or suspicious lesions.
Discussion about sun protection and self-examination techniques.
3. Self-Examination and Sun Protection:
Monthly self-skin checks: Your doctor will likely advise you on how to perform regular self-examinations of your skin, looking for any new growths, changes in existing moles, or abnormalities at the excision site.
Sun Protection: This is crucial for preventing new skin cancers. You'll be strongly encouraged to:
Use broad-spectrum sunscreen with SPF 30+ daily.
Wear protective clothing (long sleeves, wide-brimmed hats).
Seek shade, especially during peak sun hours (10 AM to 4 PM).
In summary: While the excision often removes the cancer, the follow-up is about monitoring for recurrence at the original site and, more importantly, detecting new skin cancers early, as your risk significantly increases after a BCC diagnosis. It's about proactive surveillance and ongoing skin health management.
