TibotSkin ProblemSuspicious TumorsBasal Cell Carcinoma

Basal Cell Carcinoma

Basal cell carcinoma 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 is non-melanoma skin cancer, grows slowly and can damage the tissue around it but is unlikely to spread to distant areas or to result in death.

Basal cell cancers are abnormal, uncontrolled growths or lesions that arise in the skin’s basal cells, which line the deepest layer of the epidermis (the outermost layer of the skin). Basal cell cancers often look like open sores, red patches, pink growths, shiny bumps, or scars and are usually caused by a combination of cumulative and intense, occasional sun exposure.

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. Analyze often depends on skin examination, confirmed by tissue biopsy.

Basal cell cancer accounts for at least 32% of all cancers globally. Of skin cancers other than melanoma, about 80% are basal-cell cancers. Basal cell cancer almost never spreads (metastasizes) beyond the original tumor site. Only in exceedingly rare cases can it spread to other parts of the body and become life-threatening. It shouldn’t be taken lightly, though: it can be disfiguring if not treated promptly.

In fact, Basal cell carcinoma is the most frequently occurring form of all cancers. More than one out of every three new cancers is skin cancer, and the vast majority are Basal cell cancers.

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 the 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.

Approximately 85% of Basal cell carcinomas occur on the face, head (scalp included), and neck, others appear on the trunk or extremities, rarely, they may occur on the hands.

Other characteristic features of Basal cell carcinoma tumors include:

  • Waxy papules with a central depression,
  • Pearly appearance,
  • Erosion or ulceration: Often central and pigmented,
  • Bleeding: Especially when traumatized,
  • Oozing or crusted areas: In large Basal cell carcinomas,
  • Rolled (raised) border,
  • Translucency,
  • Telangiectases over the surface,
  • Slow growing: 0.5 cm in 1-2 years,
  • Black-blue or brown areas.

Clinicopathologic types of Basal cell carcinoma, each of which has a distinct biologic behavior, include:

  • Nodular: Cystic, pigmented, keratotic. The most common type of Basal cell carcinoma usually presents as a round, pearly, flesh-colored papule with telangiectases.
  • Infiltrative: Tumor infiltrates the dermis in thin strands between collagen fibers, making tumor margins less clinically apparent.
  • Micronodular: Not prone to ulceration, may appear yellow-white when stretched, is firm to the touch, and may have a seemingly well-defined border.
  • Morpheaform: Appears as a white or yellow, waxy, sclerotic plaque that rarely ulcerates, is flat or slightly depressed, fibrotic, and firm.
  • Superficial: Seen mostly on the upper trunk or shoulders, appears clinically as an erythematous, well-circumscribed patch or plaque, often with a whitish scale.

Prolonged sun exposure is the main factor so these tumors are most common in white people living near the equator. They may also occur in scars caused by X-rays, vaccination or trauma. Photosensitizing pitch, tar, and oils can act as cocarcinogens with ultraviolet radiation. Previous treatment with arsenic, once present in many tonics, predisposes to multiple basal cell carcinomas, often after a lag of many years.

Multiple basal cell carcinomas are found in the naevoid basal cell carcinoma syndrome (Gorlin’s syndrome) where they may be associated with palmoplantar pits, jaw cysts and abnormalities of the skull, vertebrae, and ribs. The syndrome is inherited as an autosomal dominant trait and recent studies indicate that the genetic abnormality lies on chromosome 9q.

People living in states closer to the equator, or with a history of sunburns during childhood, can see Basal cell carcinoma lesions form in their 20s. More typically, the incubation period lasts for 10 to 20 years.

Treatment depends on the type, extent, and location of the lesion. Although Basal cell carcinoma doesn’t typically spread to distant organs (metastasize), the lesions can eventually cause disfigurement and should be removed as soon as possible. Basal cell carcinoma is usually treated with relatively minor surgery. The specific type of surgery depends on the location of the tumor and likelihood of recurrence.

Excision: This technique may be used for tumors that are unlikely to recur. The area will heal rapidly, but the treatment will leave a scar. About 5% of excised tumors recur within 5 years.

Curettage and electrodesiccation: Another technique used for tumors that are unlikely to recur is curettage and electrodesiccation. The curette looks like a long, thin wand with a loop on the end that scrapes the tissue. The doctor will treat the area with an electric needle, called an electrode, to destroy any cancer cells that remain. This type of surgery does not damage healthy skin. The treated area may heal slowly and scar. Between 8% and 18% of tumors treated with curettage and electrodesiccation recur within 5 years.

Mohs surgery: When there is a greater risk that a tumor will recur, the doctor may remove it using a procedure called Mohs surgery. This surgery is expensive and must be done by a specially trained surgeon. It has the highest cure rates. Five years after Mohs surgery, only 1% of the tumors recur. It also saves the most healthy skin. This makes it good for cancers near on the face, ear, or fingers. Mohs surgery is also performed when the tumors are large or invasive.

To perform this surgery, the surgeon removes a thin layer of skin and looks at it under a microscope. If sees cancer cells again, then another layer will be removed. The surgeon will continue to remove the skin one layer at a time until there are no cancer cells in the sample.

Radiation therapy: Basal cell carcinomas are usually radiosensitive. Radiation therapy can be used in patients with advanced and extended lesions, as well as in those for whom surgery is not suitable. Postoperative radiation can also be a useful adjunct when patients have aggressive tumors that were treated surgically or when surgery has failed to clear the margins of the tumor.

Photodynamic therapy: Photodynamic therapy as an adjunct is a reasonable choice in the following cases:

  • Tumor recurrence with tissue atrophy and scar formation,
  • Elderly patients or patients with medical conditions preventing extensive oculoplastic reconstructive surgery,
  • Tumor with poorly defined borders based on clinical examination,
  • Tumor requiring difficult or extensive oculoplastic surgery.

Pharmacologic therapy: Topical agents used in the treatment of superficial Basal cell carcinoma include the following:

  • Topical 5-fluorouracil 5%: May be used to treating small, superficial Basal cell carcinomas in low-risk areas,
  • Imiquimod: Approved by the US Food and Drug Administration (FDA) for the treatment of nonfacial superficial Basal cell carcinoma,
  • Tazarotene: Can also be used to treat small, low-risk Basal cell carcinomas.

Oral agents approved by the FDA for advanced forms of Basal cell carcinoma include the following Hedgehog pathway inhibitors:

  • Vismodegib (Erivedge),
  • Sonidegib (Odomzo),

Cryotherapy: Cryotherapy, which involves freezing the lesion to kill cancer cells, is usually used to treat precancer. It is sometimes used to treat small, thin Basal cell carcinoma.

Targeted therapies: may be used to treat patients with advanced or recurrent Basal cell carcinoma.

Observed a long time non-curable lesion, must visit a doctor to confirm the analyze. In case of Basal cell carcinoma, need to start treating as soon as possible.

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TibotSkin ProblemSuspicious TumorsBasal Cell Carcinoma

Basal Cell Carcinoma

TUI - Tibot Urgency Index

Basal cell carcinoma 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 is non-melanoma skin cancer, grows slowly and can damage the tissue around it but is unlikely to spread to distant areas or to result in death.

Basal cell cancers are abnormal, uncontrolled growths or lesions that arise in the skin’s basal cells, which line the deepest layer of the epidermis (the outermost layer of the skin). Basal cell cancers often look like open sores, red patches, pink growths, shiny bumps, or scars and are usually caused by a combination of cumulative and intense, occasional sun exposure.

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. Analyze often depends on skin examination, confirmed by tissue biopsy.

Basal cell cancer accounts for at least 32% of all cancers globally. Of skin cancers other than melanoma, about 80% are basal-cell cancers. Basal cell cancer almost never spreads (metastasizes) beyond the original tumor site. Only in exceedingly rare cases can it spread to other parts of the body and become life-threatening. It shouldn’t be taken lightly, though: it can be disfiguring if not treated promptly.

In fact, Basal cell carcinoma is the most frequently occurring form of all cancers. More than one out of every three new cancers is skin cancer, and the vast majority are Basal cell cancers.

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 the 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.

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Dr. Lora Smith

MBBS (Dhaka), DGO (DU) Ex SR. Gynaecologist & Obstetrician

09 606 111 222

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