Basal Cell Carcinoma (BCC) is the most common form of skin cancer, affecting millions of people globally, with a notably high incidence in Australia. BCC rarely spreads to other body parts because it is known for its high treatability when detected early. However, recent studies and reports suggest that there may be a rise in the incidence of BCC, especially in Australia. This blog explores the possible reasons behind this increase, the risk factors involved, and what can be done to prevent and treat this prevalent skin cancer in the Australian context.

Understanding Basal Cell Carcinoma

What is Basal Cell Carcinoma?

Basal Cell Carcinoma originates in the basal cells found in the outermost layer of the skin (the epidermis). These cells produce new skin cells as old ones die off. BCC typically appears as a slightly transparent bump on the skin, though it can take other forms. It’s most commonly found on skin areas frequently exposed to the sun, such as the face, ears, neck, scalp, shoulders, and back.

Symptoms and Identification

The signs of BCC can vary, but common symptoms include:

• A shiny, skin-coloured bump or growth
• A sore that bleeds, heals, and then returns
• A flat, scaly patch with a raised edge
• A white, waxy, scar-like lesion without a clear border

Early detection is crucial, as BCC grows slowly and can cause significant local damage if left untreated.

Rising Incidence: Statistical Insights

Global Trends

Over the past few decades, there has been a notable increase in the reported cases of BCC worldwide. Studies from the United States, Australia, and various European countries have documented a steady rise in BCC incidence. In the U.S., BCC cases have increased by more than 50% over the last 30 years.

The Australian Context

Australia has one of the highest rates of skin cancer in the world, including BCC. The country’s geographic location, with high levels of UV radiation year-round and a largely fair-skinned population, significantly contributes to this high incidence. Data from the Australian Institute of Health and Welfare indicate that BCC cases are on the rise, with thousands of Australians diagnosed each year.

Factors Contributing to the Increase

Several factors could be contributing to the rise in BCC cases:

1. Increased Sun Exposure
One of the most significant risk factors for BCC is exposure to sun ultraviolet (UV) radiation. In Australia, with its sunny climate and outdoor lifestyle, the cumulative exposure to UV radiation is exceptionally high. The popularity of sunbathing, outdoor sports, and beach activities further exacerbates this exposure.

2. Aging Population
The risk of developing BCC increases with age. As the Australian population ages, the number of older individuals at risk for BCC also rises. Older adults have had more years of UV exposure, contributing to the increased incidence.

3. Improved Detection and Reporting

Advancements in medical technology and increased awareness among healthcare professionals and the public have led to better detection and reporting of BCC. People are more likely to seek medical advice for suspicious skin changes, leading to higher diagnosis rates.

4. Environmental Changes

Depletion of the ozone layer has led to increased UV radiation reaching the earth’s surface. This environmental change contributes to a higher risk of skin cancers, including BCC. Australia, located near Antarctica’s ozone hole, is particularly vulnerable to these effects.

Risk Factors and Prevention

Identifying Risk Factors

While UV exposure is the primary risk factor, other factors can increase the likelihood of developing BCC:

• Fair Skin: Individuals with lighter skin, hair, and eyes have less melanin, providing less protection against UV radiation.
• Genetic Predisposition: A family history of skin cancer increases the risk.
• Frequent Sunburns: A history of severe sunburns elevates the risk, especially in early life.
• Immune Suppression: People with weakened immune systems, such as organ transplant recipients, are more susceptible.
• Radiation Exposure: Previous radiation therapy for other conditions can increase the risk of developing BCC in the treated areas.

Prevention Strategies

Preventing BCC involves minimising UV exposure and protecting the skin. Effective strategies include:

• Regular Use of Sunscreen: Applying broad-spectrum sunscreen with at least SPF 30 can protect against harmful UV rays.
• Protective Clothing: Wearing hats, sunglasses, and long-sleeved clothing can reduce sun exposure.
• Avoiding Peak Sun Hours: Limiting outdoor activities between 10 a.m. and 4 p.m., when UV radiation is vital, can help.
• Avoiding Tanning Beds: Artificial tanning devices emit UV radiation, which should be avoided.
• Routine Skin Checks: Regular self-examinations and dermatological check-ups can help detect BCC early.

SunSmart Campaign in Australia

Australia’s SunSmart campaign, run by Cancer Council Australia, has raised awareness about skin cancer prevention. The campaign promotes the Slip, Slop, Slap, Seek, Slide message:

• Slip on a shirt
• Slop on sunscreen
• Slap on a hat
• Seek shade
• Slide on sunglasses

These preventive measures have been widely adopted nationwide, helping reduce skin cancer incidence, including BCC.

Treatment Options and Advancements

Standard Treatments

Treatment for BCC depends on the cancer’s size, location, and depth. Common treatments include:

Surgical Excision: Removing the cancerous tissue along with a margin of healthy skin.

Mohs Surgery: A precise surgical technique that removes the cancer layer by layer, minimising damage to surrounding healthy tissue.

Cryotherapy: Freezing the cancer cells with liquid nitrogen.

Topical Medications: Applying creams or ointments that target cancer cells.

Emerging Treatments

Recent advancements in medical research have led to new and innovative treatments for BCC:

• Photodynamic Therapy (PDT): Using light-sensitive drugs and light to destroy cancer cells.
• Targeted Therapy: Drugs specifically target molecular changes in cancer cells.
• Immunotherapy: Boosting the immune system to recognise and attack cancer cells.

Importance of Follow-Up

Even after successful treatment, individuals with BCC are at a higher risk of developing new skin cancers. Regular follow-up visits with a dermatologist are essential to monitor for recurrence and to detect any new lesions early.

Public Health Initiatives and Education

Public health initiatives and education are crucial in combating BCC’s rise in Australia. The SunSmart program, along with other campaigns by Cancer Council Australia, focuses on educating the public about the dangers of UV exposure and the importance of regular skin checks. Schools, workplaces, and community organisations are increasingly participating in these programs, promoting a culture of sun safety.

Role of Healthcare Providers

Healthcare providers also play a vital role in early detection and prevention. General practitioners and dermatologists are often the first line of defence in identifying suspicious skin lesions and providing appropriate referrals for further evaluation and treatment. Training healthcare providers to recognise early signs of BCC and educating patients about preventive measures are critical components of an effective strategy to combat BCC’s rise.

Remember, in Australia, where BCC is exceptionally high, public awareness and education through campaigns like SunSmart are crucial. By promoting sun safety and regular skin checks, we can work towards reducing the burden of Basal Cell Carcinoma and ensuring healthier futures for all. Public health initiatives, combined with personal preventive measures, can help mitigate the impact of this prevalent skin cancer, making a significant difference in the lives of Australians.