When Basal Cells Come Early and in Numbers

What does it mean to have several basal cell carcinomas at a young age?

Having more than one basal cell carcinoma, particularly before your forties, is a reason to be evaluated thoroughly rather than a cause for alarm. Basal cell carcinoma is a skin cancer that is diagnosed by biopsy and usually treated by removing it, and most people do well 1Ref 1Kim JYS, Kozlow JH, Mittal B, et al. (2018).Guidelines of care for the management of basal cell carcinoma.That basal cell carcinoma is diagnosed by biopsy and treated with standard surgical excision (with clinical margins), Mohs micrographic surgery for high-risk/facial tumors, and a limited role for topical and photodynamic therapies.. What a young, repeated pattern adds is a question a dermatologist will want to explore: why so many, and why now?

This page cannot tell you the answer, and it will not try to reassure you that the pattern is nothing — that is exactly the kind of judgment that needs a person examining your skin and your history. Whether basal cell carcinoma is dangerous, and whether it can spread, are their own questions with their own answers; here, the point is narrower. Several basal cell cancers early is a signal to get a complete evaluation rather than treat each tumor as an isolated event.

The pattern — several, and young — is the finding worth a full evaluation, not just each individual tumor.

Why several, and why young, gets a closer look

A single basal cell carcinoma in someone with decades of sun exposure is a familiar story. Several of them in a young person is less typical, and that is what makes a dermatologist look beyond the individual tumors. The pattern itself is the clue: it can prompt questions about your family history, your sun and radiation history, and whether an inherited condition is contributing.

One such condition, sometimes called basal cell nevus syndrome, is an inherited pattern in which basal cell carcinomas tend to appear earlier and in greater numbers than usual. A clinician who sees a young, multiple-tumor pattern may consider it and ask about related features and about skin cancers in your relatives. That is a reason for a fuller evaluation, sometimes including a referral or genetic counseling — not a conclusion you or this page can reach. Neither the number of tumors nor your age settles it; they are what make the conversation worth having.

The useful move is the same regardless of the cause: a complete skin examination, an honest family history, and a plan for keeping watch.

How basal cell carcinoma is diagnosed and treated

Basal cell carcinoma is confirmed with a skin biopsy, where a sample of the spot is examined under a microscope 1Ref 1Kim JYS, Kozlow JH, Mittal B, et al. (2018).Guidelines of care for the management of basal cell carcinoma.That basal cell carcinoma is diagnosed by biopsy and treated with standard surgical excision (with clinical margins), Mohs micrographic surgery for high-risk/facial tumors, and a limited role for topical and photodynamic therapies.. Once diagnosed, the mainstay of treatment is removing the tumor. Standard surgical excision, taking a margin of normal-looking skin around the growth, is common for lower-risk tumors, while Mohs micrographic surgery is recommended for high-risk or facial tumors 1Ref 1Kim JYS, Kozlow JH, Mittal B, et al. (2018).Guidelines of care for the management of basal cell carcinoma.That basal cell carcinoma is diagnosed by biopsy and treated with standard surgical excision (with clinical margins), Mohs micrographic surgery for high-risk/facial tumors, and a limited role for topical and photodynamic therapies.. Topical creams and photodynamic therapy have a more limited role, generally reserved for certain superficial tumors 1Ref 1Kim JYS, Kozlow JH, Mittal B, et al. (2018).Guidelines of care for the management of basal cell carcinoma.That basal cell carcinoma is diagnosed by biopsy and treated with standard surgical excision (with clinical margins), Mohs micrographic surgery for high-risk/facial tumors, and a limited role for topical and photodynamic therapies..

When you have had several basal cell carcinomas, treatment is usually planned across all of them rather than one at a time, and the approach for each depends on where it is and how it looks under the microscope. It helps to know the range of appearances: basal cell carcinomas can show up as a pearly bump on the face that won't heal, and less commonly as a flat, scar-like patch that appeared on skin without a clear cause. Learning what basal cell carcinoma looks like is worth it if you are prone to them, so a new one gets flagged early.

Mohs micrographic surgery removes a tumor in stages, checking the edges under the microscope until they read clear.

The other skin cancers worth watching for

People who have had one kind of skin cancer often become more attentive to the others, and that is reasonable. The two to know alongside basal cell carcinoma are squamous cell carcinoma and melanoma. Squamous cell carcinoma, like basal cell, is diagnosed by biopsy and treated by removing it, with Mohs surgery reserved for higher-risk tumors 2Ref 2Kim JYS, Kozlow JH, Mittal B, et al. (2018).Guidelines of care for the management of cutaneous squamous cell carcinoma.That cutaneous squamous cell carcinoma is diagnosed by biopsy and managed by surgical excision, with Mohs micrographic surgery reserved for high-risk tumors.. Learning the squamous cell carcinoma symptoms — often a rough, scaly, or crusted spot that grows or won't heal — helps you bring the right things to a visit.

Melanoma is the skin cancer the ABCDE signs are built to catch. When you check your moles, the features that draw attention are Asymmetry, Border irregularity, more than one Color, a Diameter larger than about a pencil eraser, and Evolving — any change over time 3Ref 3Abbasi NR, Shaw HM, Rigel DS, et al. (2004).Early diagnosis of cutaneous melanoma: revisiting the ABCD criteria.The ABCDE mnemonic for melanoma, including the >6 mm diameter criterion and the addition of 'Evolving' for change over time, as features to use in self-examination of moles.. Any single feature can appear alone, and a mole does not have to meet all of them to be worth a look 4Ref 4Tsao H, Olazagasti JM, Cordoro KM, et al. (2015).Early detection of melanoma: reviewing the ABCDEs.That the ABCDE features are clinical signs supporting early melanoma detection and patient self-examination, and that any single feature may appear on its own.. A history of basal cell cancers is a good reason to fold a mole check into the same routine.

Surveillance from here — checks, self-exams, and what to bring

Because more skin cancers can appear over time, people with a history of several are usually placed on a schedule of regular full-skin exams with a dermatologist. Between visits, a monthly self-check helps you spot new or changing spots early. Use the ABCDE features for moles, and note anything that bleeds, will not heal, or looks different from before 3Ref 3Abbasi NR, Shaw HM, Rigel DS, et al. (2004).Early diagnosis of cutaneous melanoma: revisiting the ABCD criteria.The ABCDE mnemonic for melanoma, including the >6 mm diameter criterion and the addition of 'Evolving' for change over time, as features to use in self-examination of moles..

A little preparation makes the appointments count. Keep a simple record of your prior tumors and where they were. Photograph any new or changing spot with a coin or ruler beside it for scale, so a dermatologist sees change rather than relies on your memory. And if an inherited pattern is suspected, ask whether your close relatives should be checked too — that is often part of the plan when basal cells come early and in numbers.

Most basal cell carcinomas are removed in an office procedure, and finding them early keeps that simple.