I am a 45 year old white male from England with a North European complexion (pale, freckled skin, blue eyes, reddish hair) and I have lived in Rio de Janeiro, Brazil for 12 years. I do not like to sunbathe or stay in the sun for any period of time, and if I do have to stay in the sun, I usually use sun protection and wear a hat. I have only had sunburn 3-4 times in my life and have never had to seek medical treatment for it. I have always avoided going out in the sun if possible.
I first noticed a small red mark (less than 1 cm) on my forehead about 7 years ago. I wasn't concerned about it and so didn't seek any medical advice. About 5 years ago the mark was still there and slightly bigger so I decided to see a dermatologist who prescribed Efudix cream. The cream didn't seem to have any effect so I stopped using it.
After doing nothing about the Basal Cell Carcinoma for a further couple of years I decided to see another dermatologist who said that surgery was the only way to get rid of the Basal Cell Carcinomaas it was so large. I did all the regular examinations before the surgery (blood test, x-rays etc..) but then just before the scheduled surgery I got another job which meant I was away from home 6 days a week, so I didn't do the surgery.
After another year (I managed to get a better job closer to home) I went back to the same dermotologist who (after severely repremanding me) sent me to a specialist cancer clinic.
I have seen several methods for defining the sizes of Basal cell carcinomas and many of those vary, but the Section of Dermatology, at the Mayo Clinic, Jacksonville, Florida, USA in a published article defined sizes of Basal cell carcinomas as:
T1 = Small (less than 2 cm)
T2 = Intermediate-sized (2-5 cm)
T3 = Giant basal cell carcinomas (over 5 cm)
Immediately prior to treatment, the visible size of the Basal cell carcinoma I had was about 5.33 square centemeters (measuring was difficult because of the irregular shape) So it was very large/giant.
As mentioned before, Basal Cell Carcinomas have roots that extend beyond the visible part of the tumor, just like the roots of a tree, so when you see a BCC you are really seeing the “tip of the iceberg”. These 'roots' spread along the surface of the skin and downwards into the skin.
When the lighting was just right I could often make out a paler waxy kind of skin surrounding the obvious tumor shown in the first picture. In the above picture I was lucky enough to get the lighting just right. I have put a very faint white line around the edge of the pale waxy skin to better highlight it. You can also see a serpentine (snake like) blood vessel that is sometimes characteristic of Basal Cell Carcinoma.
In this picture the white dotted line shows the total area of the Basal Cell Carcinoma, the visible part and the normally invisible 'roots'. Outside this dotted line the BEC5 cream had no effect which seems to support the manufacturers claim that BEC5 only attacks the cancerous cells whilst leaving the healthy cells alone.
If I had chosen to have surgery, this is the total area that would have been cut out and replaced by a skin graft from my neck or groin, almost half the area of my forehead. This picture was taken after 8 days of treatment.