Long-term follow-up. Regardless of the type of BCC therapy used, patients need to be educated about proper sun-protective behaviors. Instruct these individuals to apply sunscreen—with a sun-protection factor (SPF) of 30 or higher—20 minutes before sun exposure and to reapply it every two hours, or more often if they have been in the water or are sweating.

Sunscreens generally work in one of two ways, depending on their ingredients. The more traditional formulations, which contain metals such as zinc oxide or titanium dioxide, reflect light. Other sunscreens use different chemicals, such as avobenzone or ecamsule, which actually absorb the UV radiation and disperse the energy as heat. Heat is currently believed to be harmless to cells and certainly less harmful than true UV radiation.

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Also advise patients to avoid peak sunlight hours (10 a.m.-2 p.m.), to seek shade when possible, to wear clothing that protects the skin from ultraviolet (UV) light, and to wear hats.

Routine clinical monitoring in the form of complete skin examinations for BCC and other skin cancers is essential. A person who has had one BCC has as high as a 44% risk of developing another BCC within the first three years following initial diagnosis.6

For persons with a new diagnosis of BCC, a common recommendation is to undergo skin examinations every 6 months for the first 5 years depending on the patient’s history, risk level, and ability to monitor his or her own skin. The most common histologic types of BCCs to recur are micronodular, infiltrative, morpheaform, and superficial carcinomas.2 Tumors that are larger than 2 cm or that have been treated more than once have a higher recurrence rate.2 Recurrence is most common on the nose and elsewhere on the face.2

The following are warning signs of a BCC recurrence:

  • Breakdown of previously healed scar tissue
  • Enlargement of the scar tissue
  • Formation of a papule or nodule within the scar tissue
  • Development of crusting or scale on the scar tissue
  • Bleeding or ulceration of the scar tissue.

Any change at the site of a previously treated BCC must be evaluated pathologically. Patients with a history of BCC are at an increased risk of developing cutaneous melanoma, making the need for regular skin examinations for these patients even more vital. 

This article originally appeared on Clinical Advisor