Skin Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Skin
The skin is the bodys largest organ. It protects against heat, sunlight, injury, and infection. Skin also helps control body temperature and stores water, fat, and vitamin D. The skin has several layers, but the two main layers are the epidermis and the dermis . Skin cancer begins in the epidermis, which is made up of three kinds of cells:
- Squamous cells: Thin, flat cells that form the top layer of the epidermis.
- Basal cells: Round cells under the squamous cells.
- Melanocytes: Cells that make melanin and are found in the lower part of the epidermis. Melanin is the pigment that gives skin its natural color. When skin is exposed to the sun, melanocytes make more pigment and cause the skin to darken.
Skin cancer can occur anywhere on the body, but it is most common in skin that is often exposed to sunlight, such as the face, neck, and hands.
Treatment Of Facial Basal Cell Carcinoma: A Review
1Department of Dermatology, Hull Royal Infirmary, Hull and Hull York Medical School , Hull HU2 3JZ, UK
Basal cell carcinomas are locally destructive malignancies ofthe skin. They are the most common type of cancer in the westernworld. The lifetime incidence may be up to 39%. UV exposure is themost common risk factor. The majority of these tumours occur on thehead and neck. Despite BCCs being relatively indolent the highincidence means that their treatment now contributes a significant andincreasing workload for the health service. A good understanding ofthe options available is important. Management decisions may beinfluenced by various factors including the patient’s age andcomorbidities and the lesion subtype and location. Due to theimportance of a good cosmetic and curative outcome for facial BCCstreatment decisions may differ significantly to those that would bemade for BCCs arising elsewhere. There is little good randomizedcontrolled data available comparing treatment modalities. Althoughtraditionally standard excision has been the treatment of choicevarious other options are available including: Mohs micrographicsurgery, curettage and cautery, cryosurgery, radiotherapy, topicalimiquimod, photodynamic therapy and topical 5-fluorouracil. Wediscuss and review the literature and evidence base for the treatmentoptions that are currently available for facial BCCs.
2. Surgical Management
2.2. Mohs Micrographic Surgery
Tests Or Procedures That Examine The Skin Are Used To Diagnose Basal Cell Carcinoma And Squamous Cell Carcinoma Of The Skin
The following procedures may be used:
- Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patients health habits and past illnesses and treatments will also be taken.
- Skin exam: An exam of the skin for bumps or spots that look abnormal in color, size, shape, or texture.
- Skin biopsy: All or part of the abnormal-looking growth is cut from the skin and viewed under a microscope by a pathologist to check for signs of cancer. There are four main types of skin biopsies:
- Shave biopsy: A sterile razor blade is used to shave-off the abnormal-looking growth.
- Punch biopsy: A special instrument called a punch or a trephine is used to remove a circle of tissue from the abnormal-looking growth. Enlarge Punch biopsy. A hollow, circular scalpel is used to cut into a lesion on the skin. The instrument is turned clockwise and counterclockwise to cut down about 4 millimeters to the layer of fatty tissue below the dermis. A small sample of tissue is removed to be checked under a microscope. Skin thickness is different on different parts of the body.
- Incisional biopsy: A scalpel is used to remove part of a growth.
- Excisional biopsy: A scalpel is used to remove the entire growth.
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What Are The Complications/side Effects Of The Treatments For Basal Cell Carcinoma
Most of the complications related to BCC treatments other than the hedgehog inhibitors are cosmetic, such as scarring or redness.
People who use sonidegib or vismodegib should make sure to use effective birth control to avoid pregnancy due to the risk of birth defects. In addition, sonidegib has other potential risks, including problems with nerves and muscles.
What Are The Risk Factors For Basal Cell Carcinoma
Basal cell carcinoma, squamous cell carcinoma and melanoma are all skin cancers caused by exposure to damaging ultraviolet raysfrom natural and artificial sunlight. There’s also a genetic condition called basal cell nevus or Gorlin syndrome, which can cause people to develop hundreds of basal cell skin cancers, but it’s extremely rare, says Dr. Christensen.
People at the highest risk for basal cell carcinoma tend to have fair or light-colored skin, a history of sun exposure and a tendency to sunburn quickly. Fair-skinned people have a 50 percent risk of developing basal skin cancer at some point in their lives, Dr. Christensen says. The cancer is the result of cumulative damage of years spent in the sun, and may take 20 years to manifest.
Although it’s often more common in older people, it can occur in younger adults, too.
Basal cell carcinoma spreads very slowly and very rarely will metastasize, Dr. Christensen says. But if it’s not treated, basal cell carcinoma can continue to grow deeper under the skin and cause significant destruction to surrounding tissues. It can even become fatal. For example, an untreated basal cell carcinoma on the face can grow into the bones and, over time, directly into the brain, Dr. Christensen says.
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What Are The Symptoms Of Basal Cell Cancer Of The Head And Neck
Basal cell cancers usually present as an abnormal growth on the skin. The growth may have the appearance of a wart, crusty spot, reddish patch, mole, nodule or bump, or a sore that does not heal. It may or may not bleed and can sometimes be painful. These are usually slow-growing tumors that begin as small spots on sun-exposed areas of the face. Because they can have such a range of appearances, any new persistent skin lesion should be evaluated.
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How To Identify Basal Cell Carcinoma
Basal cell carcinomas look like flesh-colored, pearl-like bumps or pinkish patches of skin. They can develop into sores. They tend to grow most often on areas of the skin that are exposed to the sun, such as your arms, face, and neck. Often the first detected symptom of a basal cell carcinoma is a bleeding spot without a preceding cause. It is extremely rare to see regional spread or metastasis to other locations in the body. However, if left untreated, the lesion will expand and destroy more tissue locally where it is found.
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When Is Radiation Therapy Used
If a tumor is very large or is on an area of the skin that makes it hard to remove with surgery, radiation therapy may be used as the main treatment. Radiation therapy can also be useful for some patients who, for other health reasons, cant have surgery. Radiation therapy can often cure small basal or squamous cell skin cancers and can delay the growth of more advanced cancers.
Radiation is also useful when combined with other treatments. For example, radiation can be used after surgery as an adjuvant treatment to kill any small areas of remaining cancer cells that may not have been visible during surgery. This lowers the risk of cancer coming back after surgery. Radiation may also be used to help treat skin cancer that has spread to lymph nodes or other organs.
Treating Advanced Squamous Cell Cancers
Lymph node dissection:Removing regional lymph nodes might be recommended for some squamous cell cancers that are very large or have grown deeply into the skin, as well as if the lymph nodes feel enlarged and/or hard. The removed lymph nodes are looked at under a microscope to see if they contain cancer cells. Sometimes, radiation therapy might be recommended after surgery.
Immunotherapy: For advanced squamous cell cancers that cant be cured with surgery or radiation therapy, one option might be using an immunotherapy drug such as cemiplimab or pembrolizumab . However, these drugs havent been studied in people with weakened immune systems, such as people who take medicines for autoimmune diseases or who have had an organ transplant, so the balance between benefits and risks for these people isnt clear.
Systemic chemotherapy and/or targeted therapy:Chemotherapy and targeted therapy drugs might be other options for patients with squamous cell cancer that has spread to lymph nodes or distant organs. These types of treatment might be combined or used separately.
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How Can Basal Cell Carcinoma Be Prevented
The most important way to prevent BCC is to avoid sunburn. This is especially important in childhood and early life. Fair skinned individuals and those with a personal or family history of BCC should protect their skin from sun exposure daily, year-round and lifelong.
- Stay indoors or under the shade in the middle of the day
How Is Basal Cell Cancer Of The Head And Neck Diagnosed
Diagnosis is made by clinical exam and a biopsy. Basal cell cancers are staged by size and extent of growth. These cancers rarely metastasize to lymph nodes or other organs, but they can grow quite large and invade small nerves and local structures.
Biopsy can help determine if the basal cell cancer is a low-risk tumor or a high-risk tumor that requires more aggressive treatment. Low-risk tumors are often nodular and do not have nerve involvement. High-risk tumors in the head and neck are those that involve the central face, nose and eye area, as well as those tumors that are greater than or equal to 10 millimeters on the cheeks, scalp and neck tumors that are recurrent or arising from previously radiated tissue and tumors arising in patients who are immunosuppressed. An aggressive growth pattern on the pathology evaluation and perineural invasion are also features of high-risk basal cell cancers.
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Can You Die From Basal Cell Carcinoma
Death from either basal cell or squamous cell cancers is quite rare. Statistics for these types of skin cancer arent tracked by cancer registries, so its difficult to have specific numbers, but its thought that less than 2,000 people in the U.S. die from both basal cell and squamous cell carcinomas each year.
These deaths are predominantly in elderly people who have not had their skin checked in a long time and cancer has grown quite large.
Considering there are over 4 million diagnosed cases of basal cell carcinoma each year in the U.S. , the risk of death from this form of skin cancer is quite low.
Basal Cell Carcinoma: The Most Common Skin Cancer
Basal cell carcinoma, or BCC, is a form of skin cancer that arises from basal cells deep in the lining of the skins top layer, the epidermis.
It’s common: According to the Skin Cancer Foundation, over 4 million cases of BCC are diagnosed each year in the U.S. alone. As most people know, its associated with frequent or prolonged sun exposure.
If theres something good to say about BCC, its that most cases are manageable. Its a slow-growing cancer that seldom spreads. Also, BCCs occur on the skin, usually where they can be readily seen. Surgical removal is an effective treatment.
But when a BCC grows undetected, it can become more serious.
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Where Does Bcc Develop
As the above pictures show, this skin cancer tends to develop on skin that has had lots of sun exposure, such as the face or ears. Its also common on the bald scalp and hands. Other common areas for BCC include, the shoulders, back, arms, and legs.
While rare, BCC can also form on parts of the body that get little or no sun exposure, such as the genitals.
General Principles In Outer Nose Repair
Most of nasal skin is of the sebaceous type. Whenever possible, scar lines should be placed along relaxed skin tension lines. Aesthetic units of the nose need consideration although tumours do not respect their borders. Aging affects the nose anatomy. Characteristic symptoms are frown lines , transverse crease on the nasal root, drooping of tip of nose, and deepened nasolabial folds. Skin diseases of elderly, like rosacea and rhinophyma can interfere with surgical techniques.
The skin covering the bony parts is highly movable, while the skin over cartilage parts is thicker, tighter and bound to the cartilage. Healing by second ary intention of convex surfaces like the nose tip should be avoided since healing often is delayed and may lead to uneven scars.
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Basal Cell Carcinomas Topical Treatment
Topical treatments can be successful on superficial basal cell carcinomas with little depth. These drugs work by inflaming the area where they are applied. The body responds by sending white blood cells to attack the inflammation. These white blood cells go after the mutated basal cells. Aldara, Efudex, and Fluoroplex are three of the most used drugs.
What Is The Treatment For Advanced Or Metastatic Basal Cell Carcinoma
Locally advanced primary, recurrent or metastatic BCC requires multidisciplinary consultation. Often a combination of treatments is used.
- Targeted therapy
Targeted therapy refers to the hedgehog signalling pathway inhibitors, vismodegib and sonidegib. These drugs have some important risks and side effects.
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What Is The Best Medication For Basal Cell Carcinoma
Treatment for basal cell carcinoma will be highly individualized. Surgery is the mainstay, and most cases wont require drug treatment. Only a limited number of medications are prescribed for basal cell carcinoma, but there is no best medication.
|Best medications for basal cell carcinoma|
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This article is not medical advice. It is intended for general informational purposes and is not meant to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, immediately call your physician or dial 911.
Basal Cell Cancer Of The Head And Neck Treatment
Surgery is the preferred method of treatment for basal cell cancer. Radiation is an alternative when surgery is not desirable because of cosmetic concerns or medical reasons. Many early stage small basal cell cancers can be removed by Mohs surgery, which is a technique that spares normal tissue through repeated intraoperative margin testing, removing only the cancer and leaving adjacent normal tissue. Excision, curettage and desiccation, and cryosurgery can also be used to remove the cancer while sparing normal tissue. Large tumors and tumors with nerve or lymph node involvement are not suitable for Mohs surgery and require a multimodality approach to treatment with formal surgical resection and adjuvant radiation or chemotherapy. Larger tumors require reconstruction, which can be done at the time of surgery if margin status is clear.
Patients with high-risk tumors should meet with a radiation therapist to discuss postoperative radiation. In patients with high-risk tumors who are not surgical candidates, systemic treatment with chemotherapy that inhibits the Hedgehog pathway of tumor progression has been shown to be effective. Such cases require multidisciplinary care by a team of surgeons, radiation oncologists and medical oncologists.
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Mohs Micrographically Controlled Excision
Mohs micrographically controlled surgery involves examining carefully marked excised tissue under the microscope, layer by layer, to ensure complete excision.
- Very high cure rates achieved by trained Mohs surgeons
- Used in high-risk areas of the face around eyes, lips and nose
- Suitable for ill-defined, morphoeic, infiltrative and recurrent subtypes
- Large defects are repaired by flap or skin graft
Curettage With And Without Cautery
Curettage is widely used in management of BCC. The tumour is scraped off with a curette and then the base and wound margin is often treated with electrocautery to control bleeding and destroy any residual tumour. This may be repeated. As excision margins are being destroyed it is advisable to confirm the diagnosis and determine the histological subtype with a preoperative biopsy, especially for facial lesions, unless a very confident clinical diagnosis can been made.
For standard curettage and electrocautery recurrence rates have been reported to be between 7.7% and 19% at 5 years. Recurrence rates have been found to be much higher for facial lesions and recurrent disease . A prospective study of 69 re-excised BCC wounds immediately after curettage and electrocautery found residual tumour in 47% of head and neck wounds and 8.3% of trunk and limb wounds . Curettage is very operator dependant however, a retrospective study of curettage alone reported a 5-year cure rate of 96% for nonaggressive BCC, and tumours involving more than 50% of the deep edge of the specimen were found to have an increased risk of recurrence .
Given the disproportionate amount of residual tumour on head and neck wounds and higher recurrence rates curettage and electrocautery is not considered first line treatment for BCCs on the face.
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