Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the most common skin cancer. It can be destructive and disfiguring. Risk is increased for individuals with a family history of the disease and a high cumulative exposure to UV light via sunlight or, in the past, carcinogenic chemicals especially arsenic. Treatment is with surgery, topical chemotherapy, x-ray, cryosurgery, photodynamic therapy, or topical immune enhancement drugs such as imiquimod. It is rarely life-threatening but if left untreated can be disfiguring, cause bleeding and produce local destruction (eg., eye, ear, nose, lip).

Contents

• 1 Forms
• 2 Diagnosis
• 3 Pathophysiology
• 4 Prevention & Early Diagnosis
• 5 Treatment
• 6 Prognosis
• 7 Epidemiology

Forms

Various forms are recognised:

• Nodular: flesh-colored papule with telangiectasis. If it ulcerates, it becomes a "rodent ulcer" (ulcus rodens), an ulcerating nodule with (often) a pearly border.
• Cystic: rarer and hard to distinguish from the nodular form. It has a central cavity with fluid.
• Pigmented: a variant of the nodular form that may be confused with melanoma.
• Sclerosing/cicratising: a scar-like lesion.
• Superficial: a red scaling patch

About two thirds of the carcinomas occur in sun-exposed areas and one third occur in non-sun-exposed areas, emphasizing the genetic susceptability of the basal cell cancer patients.

Diagnosis

To diagnose, a biopsy (where tissue is taken for pathological study) is done using local anesthesia. In small lesions, the tumor is generally removed in its entiriety, while larger ones are biopsied first and surgically removed later if it is confirmed that it is malignant.

Histopathology: Basal cell carcinoma is a malignant epithelial tumor arising only in skin, from the basal layer of the epidermis or of the pilosebaceous adnexa. Tumor is represented by compact areas, well delineated and invading the dermis, apparent with no connection with the epidermis. Tumor cells resemble normal basal cells (small, monomorphous) are disposed in palisade at the periphery of the tumor nests, but are spindle-shaped and irregular in the middle. Tumor clusters are separated by a reduced stroma with inflammatory infiltrate.

Pathophysiology

Basal cell carcinomas develop in the basal cell layer of the skin. Sunlight exposure leads to DNA crosslinking between thymidine residues. While DNA repair removes most UV-induced damage, not all crosslinks are excised. There is, therefore, cumulative DNA damage leading to mutations. Apart from the mutagenesis, sunlight depresses the local immune system, possibly decreasing immune surveillance for new tumor cells.

Prevention & Early Diagnosis

Basal cell carcinoma is the most common skin cancer. It occurs mainly in fair-skinned patients with a family history of this cancer. Sunlight is a factor in about two thirds of these cancers, but one third occur in non sun-exposed areas. Therefore, dermatologists recommend sun screens and annual skin cancer exams to prevent or provide early detection of this common tumor.

Treatment

Most basal cell carcinomas are removed surgically by dermasurgeons. A common method is "electrodessication and curettage" (ED&C). This is done by scraping the tumor out with a curette and cauterizing the base and margins. The wound is left to heal by itself (secondary intention healing). The cure rate and cosmetic result are excellent, especially in concave areas. It is also the most cost effective treatment. Surgical excision by the dermasurgeon is another option with the margins of excised tissue examined under the microscope. Certain types, like the sclerosing basal cell cancers may need a wider margin, as they develop subtle processes that project outside the visible part of the tumor.

Some superficial cancers respond to local therapy with 5-fluorouracil, a chemotherapy agent.

Mohs micrographic surgery has the highest cure rate and is especially indicated for recurrent tumors or tumors in areas (eg. eyelid or nose) where minimal amounts of tissue removal are important. Mohs surgery involves checking the base and edges under a microscope before the surgical repair of the site. Specially trained dermasurgeons do this procedure, usually in-office.

A new immune enhancement agent (topical imiquimod, "Aldara") is effective for the treatment of superficial skin cancers (basal cell and squamous cell cancer, and even malignant melanoma in-situ). It is also used pre-operatively to shrink nodular basal cell cancers, thus allowing a smaller surgical excision.

X-ray is still appropriate in older patients who are not candidates for surgery. Cryosurgery is another option, particularly for basal cell cancer invading cartilage, as the healthy cartilage is cryo-resistant.

Dermatologic surgeons (dermasurgeons) will recommend one of these modalities as appropriate treatment depending on the tumor size, location, patient age and other variables.

There is also a new treatment using Euphorbia peplus a common garden weed.

Prognosis

Although basal cell carcinoma rarely metastasizes, it grows locally without stopping. The cancer can impinge on vital structures and result in loss of function or rarely death. The vast majority of cases can be successfully treated before serious complications occur.

Epidemiology

Basal cell cancer is the most common skin cancer. It is much more common in fair skinned individuals with a family history of basal cell cancer and increases in incidence closer to the equator or at higher altitude. According to Skin Cancer Foundation, there are approximately 800,000 new cases yearly in the United States alone.

Most sporadic BCC arise in small numbers on sun-exposed skin of people over age 50, although younger people may also be affected. The development of multiple basal cell cancer at an early age could be indicative of Nevoid basal cell carcinoma syndrome.

Hair colour a risk factor for recurring basal cell carcinoma - Irish Medical Times Irish Medical Times Hair colour a risk factor for recurring basal cell carcinoma Irish Medical Times Patients who receive a diagnosis of the skin cancer basal cell carcinoma at a younger age ? along with those who have red hair, a higher socioeconomic ... Fri, 03 Sep 2010 08:25:44 GMT+00:00 Year-Round Skin Protection: Are Sun Exposure and Diet Protective Factors? - Dynamic Chiropractic Year-Round Skin Protection: Are Sun Exposure and Diet Protective Factors? Dynamic Chiropractic Eighty percent are basal-cell carcinoma, 16 percent are squamous-cell carcinoma and 4 percent are melanomas. ... Fri, 03 Sep 2010 03:52:24 GMT+00:00 Skin cancer recurrence may be prevented with combo of surgery, adjuvant therapies - ModernMedicine ModernMedicine Skin cancer recurrence may be prevented with combo of surgery, adjuvant therapies ModernMedicine Imiquimod is clearly proven in its ability to treat thin basal cell carcinoma and squamous cell carcinoma in situ, making it a good idea in these cases, ... Thu, 02 Sep 2010 10:31:39 GMT+00:00 Red Hair a Risk Factor for Recurrence of Basal Cell Carcinoma - Medscape Red Hair a Risk Factor for Recurrence of Basal Cell Carcinoma Medscape August 17, 2010 ? Factors that increase the likelihood of an individual developing multiple basal cell carcinoma (BCC) lesions have been identified in a ... More money, more skin cancerIndependent Younger age, red hair, higher educational level associated with risk for ...HemOncToday Redheads at Higher Risk for Common Skin Cancer's ReturnHealth.com all 6 news articles » Tue, 17 Aug 2010 20:44:45 GMT+00:00 Skin Cancer in Minorities - WTVQ Skin Cancer in Minorities WTVQ There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma and melanoma. Basal cell carcinoma forms from the cells lining the ... and more » Thu, 26 Aug 2010 16:15:56 GMT+00:00 Most Likely to See Basal Cell Carcinoma Return with Red Hair, More Education ... - SeniorJournal.com SeniorJournal.com Most Likely to See Basal Cell Carcinoma Return with Red Hair, More Education ... SeniorJournal.com "Basal cell carcinoma is the most common type of cancer in people with European ancestry, and its incidence continues to increase steeply," the authors ... and more » Mon, 16 Aug 2010 21:33:54 GMT+00:00 Basal Cell Carcinoma Risk Factors - MD News (press release) MD News (press release) Basal Cell Carcinoma Risk Factors MD News (press release) Individuals who have red hair, are of higher socioeconomic status, are relatively young upon initial basal cell carcinoma diagnosis, and/or develop a lesion ... and more » Fri, 20 Aug 2010 05:41:38 GMT+00:00 Curis Provides Update on Genentech's Phase II Clinical Trial of GDC-0449 in ... - MarketWatch (press release) Curis Provides Update on Genentech's Phase II Clinical Trial of GDC-0449 in ... MarketWatch (press release) "Genentech and Roche have completed enrollment in a pivotal Phase II trial in advanced basal cell carcinoma, a use for which proof of concept has already ... Curis says cancer treatment needs more analysisBusinessWeek Curis says Roche seeks more analysis of cancer drugReuters UK Genentech: More study needed on Curis drugSan Jose Business Journal all 32 news articles » Mon, 09 Aug 2010 12:06:35 GMT+00:00 Red heads more likely to get basal cell cancer - WLBT-TV Red heads more likely to get basal cell cancer WLBT-TV Researchers say people with red hair or anyone with an initial lesion of basal cell carcinoma on the upper extremities are much more likely to have ... Wed, 25 Aug 2010 15:53:49 GMT+00:00 Lentigo maligna melanoma, UV light exposure associated, study finds - ModernMedicine Lentigo maligna melanoma, UV light exposure associated, study finds ModernMedicine "However, for basal cell carcinoma, the risk is about 30 percent higher for patients in areas of high UV exposure," Dr. Linos says. ... Thu, 02 Sep 2010 13:41:12 GMT+00:00 Page:  1