Can basal cell carcinoma spread with excision?

I had a small mole on my chest removed for biopsy a month ago which turn out to be basal cell carcinoma. In the meantime the wound was infected and is still oozing a little. Doctor said there might be a little BCC left at one of the edges. Can that make BCC to spread?

Doctor Answers 4

Can Cutting into a Basal Cell Carcinoma Cause it to Spread?

If I'm understanding your question, you are asking if cutting into a basal cell carcinoma can cause it to spread. The answer to that question is, "No." Best option is to follow up with your doctor and make sure that any residual skin cancer is removed and any infection treated.


Los Angeles Dermatologic Surgeon
4.7 out of 5 stars 14 reviews

Basal cell spread

Basal cell skin cancers are slow growing, locally destructive tumors. A "little BCC" on an edge should create no issues as long as once the infection clears a reexcision with margins free of tumor is performed.

Paul Buhrer, MD
Annapolis Plastic Surgeon
4.9 out of 5 stars 12 reviews

BCC

Thank you for your question. Basal cell carcinoma is a low grade skin cancer and the most common type of skin cancer. It sounds like the doctor took a biopsy of the lesion, which enables the specimen to be tested for the pathology of the lesion. In your case, it came back as a low grade skin cancer known as a BCC. In order to ensure that the cancer is completely removed, additional margins need to be taken until there are clear margins. This means that there is no more abnormal cells to the deeper edge or to the peripheral edge. There area various options for treatment, which include; MOHs procedure, Curettage and electrodessication, and chemotherapeutic creams depending on the type of basal cell carcinoma. The BCC needs to be completely removed in order to ensure the cancer will not continue to grow. BCC are at very low risk of metastasizing to other areas of your body and no risk of metastasizing when they are early and very small so there is no concern that it is spreading. You just need to have the lesion removed so it  won't continue to enlarge.  

Lenore Sikorski, MD
Orange County Dermatologist
4.3 out of 5 stars 24 reviews

BCC biopsy

There are a variety of ways in which a biopsy can be done.  


A shave excision involves shaving the bump/mole off and sending this for review at the lab (pathology).  The base/roots of the bump remain behind but this allows you to obtain a diagnosis with as minimal a cosmetic impact as possible.  It's usually done in areas that are very cosmetically sensitive (i.e. nose).  In some circumstances, the shave can go deep enough to eliminate the skin cancer completely but there is no way to know definitively as there are usually no "margins" to evaluate.  "Margins" are the areas of normal skin around the tumor that a pathologist would see when a formal excision is done - you would want to see a small cuff of normal skin around a tumor to know that the whole thing has been removed.  Never the less, its quite normal for this too ooze for 4-6 weeks until it heals completely - just like if you scraped your knee and had to have it heal in.

A punch biopsy involves a circular blade that is used to take a small circular biopsy of the mole/bump.  This can then be closed with a suture afterwards but can sometimes be left to heal on its own.  This type of biopsy rarely removes the entire mole unless the punch is quite large or the bump is very small.  In those circumstances margins can be evaluated to ensure that the bump has been completely removed.  In either case, wound healing will be quite quick if a suture is placed (i.e. 1-2 weeks).  If no suture is placed, healing  can take several weeks (i.e. 4-6) for things to heal.

Finally, when an excisional biopsy is done, the bump and a cuff of normal skin is removed (i.e. margins).  This is usually done in a diamond/fusiform shape to help bring the skin edges together.  Sutures are usually placed to help things heal.  The healing time for this is 1-2 weeks depending on the area where the bump was excised.  It is normal for these wounds to weep some blood tinged clear liquid for the first few days after the procedure.

Biopsies do not "cause" a skin cancer to spread.  A common scenario is that only a portion of the skin cancer has been biopsied with some of the residual cancer left behind (not biopsied).  If this occurs, then a formal excisional procedure should be done.  In some circumstances, the margins can be "close" - meaning that the the cuff of normal skin surrounding the removed or biopsied skin cancer was only a millimeter or so away.   In some circumstances it is acceptable to watch the area to see if something comes back as opposed to re-excising/removing the area again.  

I would strongly encourage you to meet with your doctor to have the area reviewed and discuss options going forward.  Removal for definitive cure of the cancer would help with your peace of mind but is a discussion best had with your physician.

Hope that helps.

Mike

Michael G. Brandt, MD
Toronto Facial Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.