Basal cell carcinoma (BCC) is common, but deaths from this type of skin cancer are, fortunately, not very common. Yet the recent death of fitness personality Richard Simmons has been linked to BCC. 

 

 

Cancer diagnosis earlier this year

 

In March 2024, Simmons shared that he had been diagnosed with BCC, which first appeared as a blemish under his eye.

Madani D. Richard Simmons shares skin cancer diagnosis a day after worrying fans with 'I'm dying' post. NBC News. March 20, 2024.

Details on when the lesion arose were not disclosed. Simmons said his dermatologist scraped the area and examined the cells under a microscope, providing the BCC diagnosis within 20 minutes. Simmons’ oncologist informed him he would need to undergo a procedure to burn the skin and remove the cancer cells. 

 

"I know some of you reading this have had cancer or have known someone in your life who has had cancer," Simmons shared on his personal Facebook and Twitter pages, at the time. "Promise me you will see your doctor and get a complete checkup."

Madani D. Richard Simmons shares skin cancer diagnosis a day after worrying fans with 'I'm dying' post. NBC News. March 20, 2024.

Lenthang M. Richard Simmons clarifies he's not dying after cryptic social media post. NBC News. March 18, 2024.

 

 

BCC statistics

 

According to the American Cancer Society, about 5.4 million cases of the most common types of skin cancer—BCC and squamous cell carcinoma (SCC)—are diagnosed each year in the US, of which 80% are BCCs.

American Cancer Society. Key statistics for basal and squamous cell skin cancers. October 31, 2023.

Along with being the most common type of skin cancer, BCC is also one of the most common types of cancer. Its numbers have been increasing for many years, which may be due to better skin cancer detection, increasing sun exposure, and longer life spans.

 

 

Advanced BCCs grow deeply into the skin, enclosing the local nerves and blood vessels, potentially causing disfigurement. Metastatic BCC is rare, but when the cancer spreads, it initially travels to the closest lymph nodes, followed by the blood and bones, the lungs, and other skin areas.

“When found early, this skin cancer is highly treatable,” states the American Academy of Dermatology (AAD). “An early basal cell carcinoma can often be removed during an appointment with your dermatologist.”

AAD. Skin cancer types: Basal cell carcinoma overview. April 28, 2023.

 

Unlike most other types of cancer, BCC and SCC are not tracked by cancer registries.

American Cancer Society. Key statistics for basal and squamous cell skin cancers. October 31, 2023.

Still, US deaths from BCC and SCC are thought to be rare, with estimates ranging from around 2,000 to 8,000 per year, mainly from SCC.

 

“Most people who die from these cancers are older and may not have seen a doctor until the cancer has already grown quite large. Other people more likely to die of these cancers include those whose immune system is suppressed, such as people who have had organ transplants or are being treated for autoimmune diseases such as lupus or rheumatoid arthritis,” the AAD notes.

American Cancer Society. Key statistics for basal and squamous cell skin cancers. October 31, 2023.

 

 

Warning signs

 

 

A growth or scaly patch on or near the ear can be mistaken for dry skin, a minor injury, or a scar. A non-healing or returning sore that bleeds or oozes may be mistaken for a sore or pimple. A raised, scaly patch of irritated skin may be mistaken for dry, irritated skin. A round growth of the same color as the patient’s skin can be mistaken for a mole or a wart. A scaly spot can be mistaken for an age spot or freckle. Finally, a scar-like mark that looks shiny with tight surrounding skin can be mistaken for a scar.

 

Current guidelines

 

The AAD published guidelines on the management of BCC and SCC in 2018.

Mittal A, Mittal BB. Comparative analysis of US guidelines for the management of cutaneous squamous cell and basal cell carcinoma. J Skin Cancer. 2024;3859066.

The following year, the American Society for Radiation Oncology (ASTRO) released its guidelines, focusing on the indications for radiation therapy. The National Comprehensive Cancer Network (NCCN) updated its skin malignancies management guidelines in 2022.

 

A review published in the Journal of Skin Cancer compared these US guidelines and found that, while AAD, ASTRO, and NCCN use different methodologies to grade evidence, the three groups agree that surgery is the preferred treatment for curing BCC and SCC.

Mittal A, Mittal BB. Comparative analysis of US guidelines for the management of cutaneous squamous cell and basal cell carcinoma. J Skin Cancer. 2024;3859066.

For patients ineligible for surgery, definitive radiation therapy is recommended by all three groups, with postoperative radiation therapy (PORT) recommended for patients with positive margins unable to be cleared with surgery and for those with nerve invasion.

 

For patients with lymph node metastases, the AAD, ASTRO, and NCCN guidelines recommend surgery as the primary treatment to cure the disease. NCCN and ASTRO use lymph node size and number, along with extracapsular extension, for recommending PORT. Both NCCN and ASTRO recommend adding systemic treatment to PORT for patients with extracapsular extension.

The US guidelines provide “contemporary and complementary information” on the management of BCC and SCC, the authors concluded.

Mittal A, Mittal BB. Comparative analysis of US guidelines for the management of cutaneous squamous cell and basal cell carcinoma. J Skin Cancer. 2024;3859066.

“There are opportunities for research, particularly in the areas of staging, indications for adjuvant treatment in curative settings, extent of nerve invasion and prognosis, and the role of systemic treatments in curative and palliative settings.”