Is the cancerous lesion removed from Biden dangerous and what is basal cell carcinoma?

President Joe Biden will require “no further treatment” after a lesion removed from his chest last month during an annual physical was identified as basal cell carcinoma, a common form of skin cancer, the White House physician said.

On Friday 3 March, Physician to the President Dr Kevin O’Connor said in a memorandum released by the press office that a biopsy “confirmed that the small lesion” removed from President Biden’s chest “was basal cell carcinoma”.

According to Dr O’Connor, “all cancerous tissue was successfully removed,” and the president will not have to undergo further treatment.

In the letter released by the White House on Friday, the White House physician also noted that, unlike more aggressive forms of skin cancer, basal cell carcinoma lesions do not typically spread, and that the site of the biopsy has “healed nicely”.

Moving forward, Dr O’Connor said the president “will continue dermatologic surveillance as part of his ongoing comprehensive healthcare”.

Here is what you need to know about the disease.

Named after the cells from which the cancer develops, basal cell carcinoma is the most common form of skin cancer, with The Skin Cancer Foundation reporting that, in the US alone, an estimated 3.6 million cases are diagnosed each year. 

Around three quarters of every case of non-melanoma skin cancers are basal cell, according to Cancer Research UK.

The cancer forms in the basal cells, which are in the top layer of the skin, known as the epidermis, and mainly in areas that are often exposed to the sun, such as the nose.

Basal cell carcinoma often forms as a result of DNA damage from ultraviolet (UV) radiation, which can trigger changes to the cells and result in uncontrollable growth, according to The Skin Cancer Foundation.

Although the cancer is usually treatable, it can grow deep and injure nerves, blood vessels, and lead to disfigurement if left untreated, according to the American Academy of Dermatology Association (AAD).

Basal cell cancer is different from melanoma, which generally develops from abnormal moles.

Melanoma is a highly aggressive cancer that can spread to other parts of the body and can be fatal if not treated. However, unlike melanoma, most instances of basal cell carcinoma “are curable and cause minimal damage when caught and treated early,” according to The Skin Cancer Foundation.

There are four forms of basal cell cancers: nodular, superficial, morphoeic and pigmented – each with their own characteristics.

Although the lesions can take on many forms, the Mayo Clinic notes that basal cell cancers will typically have one of the following characteristics, a shiny, skin-coloured bump that is translucent, a brown, black or blue lesion with a slightly raised, translucent border, a flat, scaly patch with a raised edge, or a white, waxy, scar-like lesion without a clearly defined border.

A crust can also form in the centre, or an ulcer can develop. If left untreated, this will get wider and deeper.

The cancerous area can be cut out during surgery. When the cancer is relatively small, it can be done in a dermatologist office while the patient is awake. Techniques known as curettage and electrocautery may also be combined. During this process, a spoon-shaped blade removes the cancer and an electric needle takes away the skin around the wound.

Freezing is also another option, through a procedure called cryosurgery. According to the AAD, this invovles “spraying an extremely cold substance, such as liquid nitrogen, on the BCC to destroy the tumour”.

Photodynamic therapy, or light therapy, is also another option, while some patients may be treated with a topical medication that can be applied at home.

Middle-aged and older people are most likely to be diagnosed with this form of cancer.

Additionally, the AAD notes that individuals with lighter skin, sun-sensitive skin, those with weakened immune systems, and those who have had skin cancer previously all have an increased risk of developing BCCs.

First Lady Jill Biden also had lesions of basal cell carcinoma removed recently, with Dr O’Connor revealing in January that examinations found a lesion over Ms Biden’s right eye and one on her chest were both confirmed to be basal cell carcinoma.