Skin cancer, Calgary South
The most common skin cancer there is, and the most treatable when it is found early. It rarely spreads to the rest of the body, but it keeps growing into the tissue around it for as long as it is left alone. Dr. Paul Kuzel diagnoses it, biopsies it, and treats it surgically or with a lesion directed treatment when the pathology supports one.
What it is
Basal cell carcinoma grows from the cells that sit at the base of the outer layer of skin. It is driven mostly by cumulative ultraviolet exposure, which is why it turns up on the nose, ears, cheeks, forehead, scalp, neck, shoulders and forearms far more often than anywhere else.
It usually announces itself in one of a few ways. A small pearly or waxy papule with fine visible blood vessels running across the surface, called telangiectasia. A sore that scabs, comes off, bleeds a little and scabs again in the same spot, week after week. A flat pink or red scaly patch that behaves like eczema but never clears with cream. A firm pale area that looks like a scar in skin that was never cut. Some are pigmented and brown, which is why a spot that looks like a mole still needs proper assessment.
If a spot on your skin has bled and scabbed more than once, or a sore has not healed within about a month, book an appointment. Basal cell carcinoma is slow, but slow is not the same as harmless, and waiting only makes the procedure and the scar larger.
Subtypes, and why they change the plan
The biopsy does more than confirm cancer. It names the growth pattern, and the growth pattern decides what treatment is reasonable. Treating a deep tumour with a surface treatment is how cancer gets left behind under skin that looks healed.
The classic pearly bump with telangiectasia, often on the face. It grows as a defined mass into the dermis. Surgical excision is the usual answer.
A thin scaly pink patch, commonly on the trunk. It stays in the upper layers, so it is the one subtype where photodynamic therapy or cryotherapy is genuinely appropriate.
Thin strands of tumour spreading sideways under normal looking skin, often scar like on the surface. The true border is wider than the visible one, so it needs generous margins or Mohs surgery.
Small nests scattered through the dermis with indistinct edges. Higher rate of incomplete removal, so it is treated with wider margins than a nodular tumour of the same size.
Features of both basal cell and squamous cell carcinoma. It behaves more aggressively than ordinary basal cell and is treated more definitively.
A nodular or superficial tumour carrying brown pigment. It can be mistaken for a mole or for melanoma, and dermoscopy plus biopsy sorts it out.
Dr. Kuzel is a Royal College certified dermatologist and treats skin cancer as the core of his practice rather than a sideline. Diagnosis, surgery and follow up happen in the same place, with the same doctor. If you are not sure what you are looking at, that is what a full skin check is for.
Who it suits
There is no single best treatment for basal cell carcinoma. There is a best treatment for your tumour, at that site, with that growth pattern, on your skin. The options below are the ones Dr. Kuzel performs.
When he refers you elsewhere
What happens
Dr. Kuzel examines the lesion with dermoscopy and looks at the rest of your skin. People who grow one basal cell carcinoma often have others, and some are found before the patient has noticed them.
A small sample is taken under local anesthetic and sent to a pathologist. This confirms the diagnosis and names the subtype. Nothing that could be a skin cancer is destroyed without a diagnosis first, because destroying it means nothing can be examined.
Once the report is back, he explains what was found, what the options are, what each one would leave behind, and what he recommends. If Mohs surgery is the better operation, that is where the conversation goes.
Most treatments are done in the clinic under local anesthetic. Excision means freezing the area, removing the tumour with a marked margin, and closing the wound with sutures. Electrocautery, cryotherapy and photodynamic therapy are shorter and leave the skin to heal open.
Anything excised goes to pathology. The report says whether the tumour was removed completely. If a margin is involved, he tells you and arranges further treatment. Cryotherapy, cautery and photodynamic therapy do not produce a specimen, which is part of why they are reserved for low risk lesions.
Sutures come out, the site is checked as it heals, and you go on a skin check schedule. Surveillance is part of the treatment, not an add on.
Healing and risks
Every treatment that removes a skin cancer leaves a mark. The aim is a mark that settles quietly and a tumour that is completely gone, in that order.
After surgery
After cautery, cryotherapy or photodynamic therapy
Having had one basal cell carcinoma makes another more likely, because the ultraviolet exposure that caused it affected all of your skin, not just one spot. Daily sun protection and regular skin checks do more for you over the next ten years than any single procedure.
Questions
Book if a spot bleeds and scabs and then does it again in the same place, if a sore has not healed within about a month, if a bump is pearly, shiny or has fine blood vessels across it, or if a patch keeps coming back after creams. You do not need to be certain it is something. Sorting that out is the appointment.
It very rarely spreads to lymph nodes or other organs, and that part is genuinely reassuring. What it does do is destroy the tissue around it. Left alone on the face it can grow into cartilage, nerve and bone, and the repair then becomes far larger than it needed to be. It is treated, not watched.
No. Mohs micrographic surgery is the right choice for some tumours, particularly on the nose, eyelid, ear and lip, for recurrent tumours, and for aggressive subtypes with unclear borders. Dr. Kuzel does not perform Mohs. When your tumour is better treated that way, he says so and refers you to a Mohs surgeon.
Sometimes, and only for the right lesion. Superficial basal cell carcinoma sits in the upper layers of the skin and can respond to photodynamic therapy or cryotherapy. Nodular and infiltrative tumours grow deeper than light or freezing reach, and treating those with a surface treatment risks leaving cancer behind under skin that looks healed. The biopsy result decides, not the preference.
Surgery is done under local anesthetic. You feel the freezing going in, then pressure rather than pain, and most people manage afterwards with acetaminophen for a day or two. Cryotherapy stings sharply for a few seconds and aches afterwards. Photodynamic therapy is the least comfortable of the three: the light portion burns or stings while it runs, and the area is sore for several days.
Assessment and treatment of skin cancer are medically necessary care and are generally covered by the Alberta Health Care Insurance Plan for eligible residents. Purely cosmetic work, such as scar revision done for appearance alone, is not covered. There is no price list on this page because the plan depends on the lesion, the site and the pathology, and anything you would pay for is explained before it is booked.
A completely excised basal cell carcinoma usually does not come back at that site, and the pathology report is what confirms it was fully removed. The larger issue is that having had one makes a new one elsewhere more likely. Ongoing skin checks are part of the treatment.
Sutures come out at about 5 to 7 days on the face and 10 to 14 days on the body. The line stays pink and firm for several weeks, then softens and fades over 6 to 12 months. Sun protection over a healing scar makes a visible difference to how it ends up.
Book
A spot that is changing, bleeding or not healing is worth an appointment. Assessment takes minutes, and finding a basal cell carcinoma early is the difference between a small excision and a large reconstruction.
Book a consultation Call (403) 286-6888
Related reading: skin cancer treatments, skin checks, squamous cell carcinoma.
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