Basal Cell Carcinoma Surgery, Body & Limbs

Basal Cell Carcinoma (BCC)

Basal cell carcinoma (BCC) is a skin cancer that begins in the basal cells at the base of the epidermis. It is the most common skin cancer in Australia. On the trunk and limbs it is often found on the back, shoulders, chest and lower legs, on skin that has had years of sun exposure.

A BCC on the body commonly presents as a pearly or shiny nodule with small blood vessels running across its surface, or as a flat, pink, slightly scaly plaque that can be mistaken for eczema or dry skin. Superficial BCCs on the trunk sometimes reach a few centimetres across before they are noticed, because a spot on the back is easy to miss.

BCC grows slowly and rarely spreads elsewhere in the body, but it continues to enlarge locally and can invade deeper tissue, so it is generally treated rather than watched. If you or a family member notices a spot on your back, chest, arm or leg that is growing, bleeding or not healing, see your GP or dermatologist. Any lesion that is changing quickly or looks pigmented should be assessed without delay.

Signs to look out for

• A shiny or pearly lump, sometimes with tiny visible blood vessels.
• A flat pink or pale patch that slowly widens and does not respond to moisturisers or creams.
• A spot that bleeds when caught by clothing, a towel or a strap, then scabs and bleeds again.
• An ulcer with a rolled edge that has been present for months.
• A lesion on your back or shoulder that a partner or hairdresser has pointed out to you.

How a BCC on the body is diagnosed

The lesion is examined with dermoscopy and the rest of your skin is checked, since people who develop one BCC often have others. Size, position and the amount of loose skin nearby are recorded, because they determine how the wound can be closed.

A biopsy confirms the diagnosis and histopathology reports the subtype. Nodular and superficial BCCs are usually well defined, while infiltrative and morphoeic subtypes extend further than the visible edge and call for a wider margin. After excision, the pathologist reports whether tumour reaches any margin.

How it is treated

Excision is the usual treatment for a BCC on the trunk or limbs, and body sites generally allow a wider margin than the face. Some superficial BCCs are managed non-surgically by a dermatologist. Mohs surgery is used less often on the body, and where it is, the Mohs surgeon performs the excision and Dr Maryam performs the reconstruction.

1. Planning. The margin is marked, the closure is planned and the anaesthetic is decided: local anaesthetic as a day procedure for smaller lesions, general anaesthetic for larger excisions, flaps or grafts.
2. Excision. The BCC is removed with a cuff of surrounding tissue, to a depth appropriate for the subtype and site, and the specimen is orientated for the pathologist.
3. Margin checking. Histopathology reports the margins. Results take several days, and a further excision is sometimes recommended.
4. Reconstruction. Many body wounds close directly in layers. Where skin is tight, as over the shoulder or shin, a local flap or a skin graft taken from another site may be used to rebuild the surface.

Recovery and follow up

Recovery depends on the size of the excision and where it sits. Wounds on the back and shoulders are under tension when you move, and wounds on the lower leg heal more slowly than those elsewhere.

• Dressings are kept dry and changed at planned intervals, and grafts are usually reviewed within the first week.
• Sutures on the trunk and limbs often stay in for about ten to fourteen days.
• Lifting, stretching and exercise are limited for a period to protect the wound.
• Elevation, and at times compression, is advised for leg wounds to limit oedema.
• Continue skin checks with your GP or dermatologist and daily sun protection, including clothing that covers the shoulders and arms, because further BCCs are common.

Your care with Dr Maryam

Dr Maryam Seyedabadi, MBBS FRACS, is a Specialist Plastic Surgeon consulting at 2c Heeley Street, Paddington in Sydney. Body excisions and reconstructions are carried out at East Sydney Private Hospital, St Luke’s Hospital in Potts Point, Sydney Day Hospital, Double Bay Day Hospital or The Skin Hospital in Darlinghurst. A referral allows a Medicare rebate to be claimed for these procedures.

The extent of surgery and the appearance of the scar depend on the type, size, site and stage of the lesion, and on what the pathology shows. Bring any biopsy report you already have to your appointment. Call 1300 067 668 to arrange a consultation.