Overview

Basal cell carcinoma (BCC) is the most common skin cancer and the most common cancer overall in Kuwait, per data from the As'ad Al-Hamad Dermatology Center. It develops in basal cells in the deepest layer of the epidermis. BCC grows slowly and rarely spreads to other organs, but causes significant local tissue destruction if untreated.

Symptoms

• Pearly or waxy bump, often with visible blood vessels, on face, ears, or neck
• Flat flesh-coloured or brown scar-like lesion
• Bleeding or scabbing sore that heals then returns
• Any non-healing sore lasting more than 4-6 weeks must be evaluated immediately

Causes & Risk Factors

• Cumulative UV radiation damage — the primary cause; lifelong outdoor activity in Kuwait is a major risk factor
• History of sunburns; age over 50; immunosuppression; radiation therapy history
• BCC occurs in all skin types, including darker GCC skin tones

Complications

• Local tissue destruction and disfigurement if untreated; perineural invasion (growth along nerves)
• Recurrence after treatment; high risk of developing additional skin cancers

Diagnosis

Skin biopsy (punch or shave) to confirm diagnosis. Dermoscopy for suspicious lesion assessment. CT/MRI for locally advanced tumours.

Treatment

• Surgical excision with clear margins — most common treatment
• Mohs micrographic surgery: gold standard for high-risk BCC (face, recurrent, large)
• Topical imiquimod or 5-fluorouracil for superficial BCC; cryotherapy for small lesions
• Hedgehog pathway inhibitors (vismodegib, sonidegib) for advanced/metastatic BCC

Prevention

• Daily SPF 50+ broad-spectrum sunscreen — the most important step
• Avoid sun 10am-4pm; wear protective clothing, hats, and UV sunglasses
• Monthly skin self-examinations; annual full-body dermatology checks
• Report any non-healing skin sore immediately

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