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Basal cell carcinoma

Definition


Disease: Basal cell carcinoma Basal cell carcinoma
Category: Tumors
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Disease Definition:

The most common form of nonmelanoma skin cancer is called basal cell carcinoma, which is the most easily treated and the least likely to spread.

Even though this kind of cancer is rarely fatal, but if not removed, it can cause extensive damage to surrounding tissue and bone. In case someone has had one basal cell carcinoma, they’re likely to develop another within five years, because this cancer has a high rate of recurrence.

Although sunscreen is a vital part of a sun-safety program, but it can’t prevent basal cell carcinoma or other forms of skin cancer by itself. So, avoiding the sun as much as possible is the best protection, because this kind of cancer is caused by long-term exposure to UV radiation from sunlight.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Although in most cases this kind of cancer develops on the sun-exposed parts of the body, particularly the head and neck, sometimes on the trunk and legs, but it can also develop on parts of the body that rarely see the light of day.

Normally, a sore that won’t heal or that repeatedly bleeds and scabs over is a warning sign of skin cancer. However, basal cell tumors could take one of these forms:

  • A flat, scaly, flesh-colored or brown patch on the chest or back, which can grow quite large over time, up to 10 to 15 cm (about 4 to 6 inches).
  • A bump that has a waxy, or a pearly white color, usually with visible blood vessels on the neck, face or ears. This bump could develop a crust, bleed or form a depression in the center. This type of tumor is usually black or brown in darker skinned people.
  • A white, waxy scar. This type of basal cell carcinoma is quite rare and easy to overlook. This could be a sign of morpheaform basal cell carcinoma, which is an especially invasive and disfiguring cancer.

The sooner these sores are diagnosed and treated, the better the outcome, even though some basal cell carcinomas are difficult to distinguish from ordinary sores. A person should contact their dermatologist in the case of noticing:

  • Visible blood vessels in or around a sore.
  • A scar in an area where the person hasn’t injured themselves.
  • A skin sore that bleeds easily or doesn’t heal in about two weeks.
  • A repeatedly crusting or oozing sore.

Causes:

Skin consists of three layers, the subcutis, the dermis and the epidermis, which is the closest to the surface. At the bottom or basal layer of the epidermis are the basal cells that produce new skin cells that push older cells toward the skin’s surface, where the old cells die and are sloughed off.
This process is controlled by DNA, which is the body’s genetic blueprint. However, when someone’s DNA is damaged, for example by solar radiation, the process of cell death and renewal no longer occurs as it should, leading to the uncontrolled growth of cells, forming a cancerous tumor.

ENVIRONMENTAL FACTORS:
Basal cell carcinoma seems to result from a combination of genetic and environmental factors. Exposure to UV radiation from sunlight is the most environmental damage to skin cells. The greatest harm from the sun occurs during adolescence and childhood, but UV damage seems to be cumulative, so that the more time someone spends in the sun, the greater their chance of developing skin cancer. In case a person’s most outdoor exposure takes place at times of day when the sun is strongest, their risk will increase even more.

Some of the other environmental factors that might lead to this type of cancer include:

Therapeutic radiation:
A person’s risk of basal cell carcinoma as well as of other, more serious forms of skin cancer is increased when X-rays are used to the head or neck, and PUVA (psoralen plus ultraviolet A) treatments for psoriasis. Many radiation-induced carcinomas that occur later in life could have their origins in radiation treatments for childhood acne or ringworm, meaning that skin cancers could take years to develop. The pigmentation in the patient’s skin, the total dose of radiation they receive and their medical status are some of the factors that therapeutic radiation resulting in cancer depends on.

Chemical toxins:
A well known cause of cancers in general, including basal cell carcinoma is arsenic, which is a toxic metal that is widely found in the environment. Most people get their greatest exposure in food, particularly fish, beef, chicken and wine grapes that are sprayed with arsenic-containing toxins, even though arsenic usually contaminates the soil, air and groundwater. Refinery workers, farmers and people who drink contaminated well water or even live near smelting plants are likely to ingest high levels of arsenic.

Immunosuppressant drugs:
People have an increased risk of basal cell carcinoma if they take medications to prevent organ rejection after a transplant surgery. However, the symptoms may not appear for years after the operation.


GENETIC FACTORS:
Basal cell carcinoma can be caused or its risk increased by several inherited disorders, such as:

Xeroderma pigmentosum:
This disorder causes an extreme sensitivity to sunlight. So, people with this disorder are at a high risk of developing basal cell carcinoma because they have little or no ability to repair damage to the skin from UV light.

Gorlin’s syndrome:
Also called nevoid basal cell carcinoma syndrome, people with this genetic disorder have pitting on their hands and feet, spine abnormalities, cataracts, along with numerous basal cell carcinomas.

Bazex’s syndrome:
This disorder is marked by a lack of sweating and body hair, as well as numerous basal cell tumors.

Complications

Complications:

No complications will be caused when basal cell carcinomas are diagnosed and treated early. But when the cancers are left untreated, particularly morpheaform tumors, they can invade and destroy nearby muscles, nerves and bone. Basosquamous, which is one of the unusual kinds of basal cell carcinoma, is capable of spreading to other parts of the body.

If someone has more than one tumor initially, or a tumor on the trunk of their body, it makes recurrence more likely. Basal cell carcinomas are difficult to completely eliminate and they may recur even after successful treatment, usually in the same place.

Someone’s chance of developing more serious types of skin cancer could be increased if they have a history of basal cell carcinoma, including squamous cell carcinoma and even malignant melanoma, mostly because of long-term exposure to sun. Researchers are still not sure about whether having basal cell carcinoma could lead to an increased risk of other types of cancer, or not.

Treatments:

Treatment usually depends on the type, location and severity of the tumor. There are a number of therapies for treating basal cell carcinoma, some of which are:

Surgical excision:
During this procedure, the cancerous tissue, along with a surrounding margin of healthy skin is cut. In some cases, the patient could have a wide excision that involves removing additional normal skin around the tumor. This procedure is done for both new and recurring tumors. The patient should consult a doctor skilled in skin reconstruction to minimize scarring, particularly on their face.

ED and C (electrodesiccetion and curettage): During this procedure, the surface of the skin cancer is removed with a scraping instrument (curette), and the base of the tumor is seared with an electric needle. This procedure is usually used for tumors that are located on the arms, trunk or legs, and it can be quite successful in removing new basal cell carcinomas, but it is less effective for recurring tumors.

Laser surgery:
During this procedure, a laser is used to vaporize superficial basal cell carcinomas. In some cases, in order to minimize bleeding, instead of scalpels lasers are used during surgical excisions.

Freezing:
During this procedure, the cancerous cells are frozen with liquid nitrogen and then removed (cryosurgery). Even though this type of treatment has its drawbacks, such as scarring, crusting and slow healing, however, it is quite useful for tumors on certain parts of the body, and for people with more than one tumor.

Mohs’ surgery:
During this procedure, the tumor is removed layer by layer and each layer is examined under the microscope until no abnormal cells remain. This type of surgery allows the removal of the entire growth without taking an excessive amount of surrounding healthy tissue. This is an effective treatment for recurring basal cell carcinomas and those that are deep, large, fast-growing, morpheaform or on the face. This surgery should only be performed by doctors specifically trained in the procedure because it requires particular expertise.

Topical treatments:
In some cases, some superficial basal cell carcinomas could be treated with creams or ointments. There is a prescription cream normally used for acne called tazarotene , which seems to be quite effective in preventing basal cell tumors. Although it is possible that it plays a role in treatment as well, but it hasn’t yet been approved for this use, as tests are ongoing. Some of the other topical treatments are 5-fluorouracil and imiquimod . But because both of these prescription medications can cause severe skin irritation along with systemic side effects, they require careful supervision.
 

Prognosis:

Not available

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