Basal cell carcinoma: Description, Causes and Risk Factors:
Alternative Name: Basal cell epithelioma.
A slow-growing, invasive, but usually non-metastasizing neoplasm recapitulating normal basal cells of the epidermis or hair follicles, most commonly arising in sun-damaged skin of the elderly and fair-skinned. It is the most common of all cancers. Basal cell carcinoma affects 800,000 Americans each year. This type of cancer has a 95 percent cure rate but can cause complications or even death if it is neglected.
Types May Include:
Nodular BCC – This type is often found on the face and presents as a small translucent and shiny (“pearly”) bump. It can expand into larger plaques with rolled edges. Often, there are small blood vessels visible on the surface. Sometimes the lesion is pigmented (brown). Another common presentation is an open sore (termed “rodent ulcer”) that bleeds spontaneously and does not heal. Sometimes BCCs are difficult to distinguish from melanoma.
- Superficial BCC – This variant often present with multiple lesions, typically on the upper trunk or shoulders. They are red, shiny patches with a slight scale that tend to grow slowly and bleed easily.
- Morpheaform or sclerosing BCC – This is the most difficult type to diagnose since it looks like a skin-colored or pale, waxy, thickened scar. It is prone to recur, even after apparently adequate surgery.
Basal cell carcinoma is a slow growing type of skin cancer which can take months or years to grow. At the initial stages it appears as only a dry patch of skin and so it is difficult to distinguish it from the normal skin. As the time progresses it often appears as a shiny nodule few millimeters in diameter. It contains tiny blood vessels superficially and also some fluid generally looking like a pearl. This can appear on any sun exposed parts of the body like face, mouth, neck or on hands. Sometimes the nodule can ulcerate and ooze out fluid. These nodules do not metastasize but many of them can congregate to form a single one. This property makes this kind of skin cancer unique from others and less dangerous but it can cause local destruction or disfigurement if it occurs on nose, eyes or ears.
Causes and Risks Factors:
Basal cell carcinomas are malignant tumors that originate in the basal cells lining the inner part of the epidermis. They are the most common form of skin cancer, accounting for 75% of all diagnosed cases. This type of skin cancer usually appears on areas of the skin most exposed to the sun (head, face, neck, hands and arms).
- Ultraviolet (UV) exposure is thought to be the major risk factor for BCC and most other skin cancers. This is because UV can damage the DNA carried by skin cells causing them to grow and divide uncontrollably. Sunlight and tanning beds are the main sources of UV radiation. People with excessive and unprotected exposure, people with a dark complexion, individuals with pale skin, with red or blonde hair, blue or green eyes and who are tan-resistant and burn easily, are particularly at risk of developing BCC.
- Men are 50% more likely to develop basal cell carcinoma than women. This is thought to be mainly because men are more exposed to the sun (outdoor labor).
- Family history also plays a role in the development of skin cancers. This is partly because complexion is largely genetically determined.
Protecting yourself from the sun with clothing, hats, and sunscreen is the best way to prevent the development of all skin cancers. Your dermatologist can talk to you about good sun protection habits. Make sure you have a complete skin examination done periodically by your physician. Examine your own skin every month and bring any new or unusual growths to the attention of your doctor. BCCs that are detected early are easier to treat and result in less scarring.
Some warning symptoms of BCC are:
Some smooth nodule like appearance on the skin with tiny superficial blood vessels. Sometimes these nodules can also be dark.
- An irregular shaped white or yellow waxy scar on sun exposed skin.
- A reddish spot with or without irritation mostly on hands and legs.
- A sore which is open for more than three weeks. Sometimes such sores can bleed or ooze out some fluid.
Differential diagnosis may include cyst, infected spot, sebaceous hyperplasia, nevus, molluscum contagiosum, wart, Bowen disease, tinea, eczema, malignant melanoma, seborrheic keratitis, erosions, etc.
BCC is usually is diagnosed by a procedure called `shave biopsy’ in which a small portion or entire growth of skin is removed after anesthesia. Then the sample is observed for cancer cells under a microscope.
Depending upon the size, depth and location of basal cell carcinoma, it can be treated by topical medications, curettage and electrodessication, surgery, or radiation. It’s important to learn as much as you can about your treatment options and to make the decision that’s right for you.
Common topical medications for the treatment of superficial basal cell carcinoma include imiquimod and 5-FU (5-fluorouracil).
Using curettage and electrodessication, the physician scrapes off the growth and desiccates the tumor site with an electrocautery needle.
Surgical approaches include excisional surgery, during which a surgeon removes the tumor along with a margin of normal skin as a safety margin. The pathologist examines the removed tissue to assure all cancer cells have been removed. Another surgical approach is micrography surgery, during which a physician removes the visible tumor and then removes surrounding skin one layer at a time. Each layer is checked under a microscope for signs of cancer until the physician is sure all the cancer is gone. This technique has a highest cure rate and can save the greatest amount of healthy tissue.
Cryosurgery is a technique that can be performed without any cutting or anesthesia. Liquid nitrogen is applied to the tumor with a cotton-tipped applicator or spray device. The tumor then becomes dry and crusted and falls off. The procedure is repeated until the cancer is gone. Side effects may include temporary redness, swelling, or loss of pigment.
Laser surgery is often used for cancers on the lip, face, or scalp because it provides surgeons with greater control over the depth of skin that is removed. Often used as a secondary therapy after the first option is unsuccessful, this option has a slightly higher risk of scarring or pigment loss.
Radiation therapy uses high-energy, pinpointed x-rays to kill cancer cells. This type of treatment is directed at a specific area. It can be used to treat small tumors, minimizing the damage to normal cells or tissue surrounding the tumor, or it can be used to destroy cancer cells that remain after surgery.
Photodynamic therapy is best used on cancers on the face and scalp or if individuals have multiple malignancies. A physician applies a topical treatment that is activated by a strong light. The treatment destroys cancer while sparing surrounding tissue.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.