Basal-cell carcinoma
Basal-cell carcinoma (BCC), also known as basal-cell cancer, is the most common type of skin cancer. It often appears as a painless raised area of skin, which may be shiny with small blood vessels running over it; or it may present as a raised area with ulceration. Basal-cell cancer grows slowly and can damage the tissue around it but is unlikely to spread to distant areas or to result in death.
Risk factors include exposure to ultraviolet light, having lighter skin, radiation therapy, long-term exposure to arsenic, and poor immune-system function. Exposure to UV light during childhood is particularly harmful. Tanning beds have become another common source of ultraviolet radiation. Diagnosis often depends on skin examination, confirmed by tissue biopsy.
It remains unclear whether sunscreen affects the risk of basal-cell cancer. Treatment is typically by surgical removal. This can be by simple excision if the cancer is small; otherwise Mohs surgery is generally recommended. Other options may include application of cold, topical chemotherapy, laser surgery, or the use of imiquimod. In the rare cases in which distant spread has occurred, chemotherapy or targeted therapy may be used.
Basal-cell cancer accounts for at least 32% of all cancers globally. Of skin cancers other than melanoma, about 80% are basal-cell cancers. In the United States, about 35% of white males and 25% of white females are affected by BCC at some point in their lives.
Individuals with a basal-cell carcinoma typically present with a shiny, pearly skin nodule. However, superficial basal-cell cancer can present as a red patch similar to eczema. Infiltrative or morpheaform basal-cell cancers can present as a skin thickening or scar tissue – making diagnosis difficult without using tactile sensation and a skin biopsy. It is often difficult to visually distinguish basal-cell cancer from acne scar, actinic elastosis, and recent cryodestruction inflammation.
About two thirds of basal-cell carcinomas occur on sun-exposed areas of the body. One-third occur on areas of the body that are not exposed to sunlight, emphasizing the genetic susceptibility of basal-cell cancer.
Intuitive statistics
In studies of base rate neglect, the problems given to participants often use base rates of disease prevalence. In these experiments, physicians and non-physicians are similarly susceptible to base rate neglect, or errors in calculating conditional probability. Here is an example from an empirical survey problem given to experienced physicians: Suppose that a hypothetical cancer had a prevalence of 0.3% in the population, and the true positive rate of a screening test was 50% with a false positive rate of 3%. Given a patient with a positive test result, what is the probability that the patient has cancer? When asked this question, physicians with an average of 14 years experience in medical practice ranged in their answers from 1-99%, with most answers being 47% or 50%. (The correct answer is 5%.) This observation of clinical base rate neglect and conditional probability error has been replicated in multiple empirical studies. Physicians' judgments in similar problems, however, improved substantially when the rates were re-formulated as natural frequencies.