Treatment Of Facial Basal Cell Carcinoma: A Review
Vanessa Smith
1Department of Dermatology, Hull Royal Infirmary, Hull and Hull York Medical School , Hull HU2 3JZ, UK
Abstract
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 patients 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.
1. Introduction
2.4. Cryosurgery
Expert Treatment For Basal Cell Carcinoma
ColumbiaDoctors dermatologists offer a full range of treatments for basal cell carcinoma. We perform a careful evaluation to determine the best treatment plan for each patient’s unique set of circumstances. Our physicians have expertise with the latest treatments, including Mohs surgery, which is considered one of the most effective forms of treatment for basal cell carcinoma.
The Pursuit Of False Perfection
So imagine my alarm years later when, in June 2015, my dermatologist, Patricia Mauro, MD, at the University of North Carolina , did a biopsy of a suspicious spot on my nose and informed me that I had basal cell carcinoma. My head started spinning, and it took me a few seconds to process. Dr. Mauro immediately escorted me to the Mohs Center at the university hospital to meet Brad Merritt, MD, who would soon become my Mohs surgeon and skin sculptor.
My thoughts drifted back to summer days as a teen, spent at the pool swimming and smearing iodine and baby oil on my skinny frame to amplify the suns effects.
In his office, my thoughts drifted back to summer days as a teen, spent at the pool swimming and smearing iodine and baby oil over my skinny frame to amplify the suns effects. Later, when I was a cheerleader at UNC, having bronzed limbs helped to set off the school colors, Carolina blue and white. A week before football season, we practiced cheers at the beach, and Who has the darkest legs? became our mantra. At the Tri Delta house, sunny days meant climbing onto our third-story roof to work on our tans without our greased bodies sliding into the gutters. All of this, it turns out, was sheer insanity for someone of Scotch-Irish descent like myself, with skin especially vulnerable to sun damage and prone to developing skin cancers.
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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.
Johns Hopkins Head and Neck Cancer Surgery
How Quickly Should Basal Cell Carcinoma Be Removed
How long after diagnosis of basal cell carcinoma would a doctor recommend removing it? I am aware that basal cell carcinoma is very common and there is a %90 cure rate, as well as the fact that it rarely metastasizes. Will waiting several months after diagnosis to remove it decrease cure rate? Is this something that needs to be removed immediately to have the best prognosis?? Thank you so much for your time, you have no idea how much this will help me!
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Mohs Microscopically Controlled Surgery
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Because skin cancer cells often have spread beyond the edges of the visible patch on the skin, doctors sometimes use a special surgical technique to make sure they remove all of the cancer. In this technique, called Mohs microscopically controlled surgery or Mohs micrographic surgery, doctors first remove the visible tumor and then begin cutting away the edges of the wound bit by bit. During surgery, doctors examine pieces of tissue to look for cancer cells. Tissue removal from the area continues until the samples no longer contain cancer cells. This procedure enables doctors to limit the amount of tissue removed and thus is especially useful for cancers near such important sites as the eye. After removing all of the cancer, doctors decide how best to replace the skin that has been cut away. They may bring the edges of the remaining skin together with sutures or use a skin graft or skin flap. Or they may place dressings on top of the wound and let the skin heal on its own. Mohs surgery reduces recurrence rates for skin cancers. This surgery is useful for basal cell and squamous cell cancers but is less often used for melanoma. |
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
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What Is The Treatment For Primary Basal Cell Carcinoma
The treatment for a BCC depends on its type, size and location, the number to be treated, patient factors, and the preference or expertise of the doctor. Most BCCs are treated surgically. Long-term follow-up is recommended to check for new lesions and recurrence the latter may be unnecessary if histology has reported wide clear margins.
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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What Are The Symptoms Of Basal Cell Carcinoma
A basal cell carcinoma is a stubborn, persistent spot that usually appears on areas that have been exposed to the sun, such as the head, neck, chest, arms and legs. The spot may take one of several forms: an open sore, a reddish irritated patch, a shiny red bump or nodule, a pink growth, or a small scar-like patch. In some people, the condition may resemble psoriasis or eczema. The spot will sometimes bleed, scab and heal up after a week or two, then bleed or become irritated again.
The main warning sign for basal cell carcinoma is that the spot doesn’t go away on its own. Patients often mistake basal cell carcinomas for minor injuries, says Dr. Christensen. They dont realize that an ordinary cut or scratch will heal within a month or so. So if something hasnt healed within a month, it should be examined by a dermatologist.
Is Mohs Right For Me
Mohs surgery is the gold standard for treating many basal cell carcinomas and squamous cell carcinomas , including those in cosmetically and functionally important areas around the eyes, nose, lips, ears, scalp, fingers, toes or genitals. Mohs is also recommended for BCCs or SCCs that are large, aggressive or growing rapidly, that have indistinct edges, or have recurred after previous treatment. Some surgeons are also successfully using Mohs surgery on certain cases of melanoma.
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Mohs Surgery Is Very Precise
During Mohs surgery, a dermatologic surgeon like Maher removes skin from a skin cancer site one stage at a time. First, a dermatologic surgeon outlines the lesion with ink to map the tumor. After a local anesthetic is injected, the doctor removes the thinnest possible layer of cancerous tissue. While the patient waits, that layer is processed in an onsite pathology lab. After processing, the dermatologic surgeon can then examine the entire margin of removed tissue under the microscope to determine whether any cancer remains. If skin cancer persists, the dermatologic surgeon can identify the precise location of the remaining cancerous cells. At that point, the patient returns to the operating room so that the surgeon can take another layerand the process is repeated until all cancerous tissue has been removed. Roughly 80 percent of patients only need a single layer of skin removed in order to remove all the cancerous tissue. This layer-by-layer approach keeps the incision as small as possible to reduce scarring and promote healing.
Because of the way we process these tissue samples, looking at 100 percent of the margin, we can know for certain when weve removed all of the cancer, Maher said.
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.
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Basal Cell Carcinoma Surgery: Treating This Skin Cancer Surgically
Basal cell carcinoma is a type of non-melanoma skin cancer, and it is also the skin cancer that is the most common. This type of skin cancer is least likely to spread, is the most easily treated, and is rarely fatal. However, there is a high recurrence rate, and people who have had this cancer must often battle it again within five years. If this cancer is not removed, it can cause extensive damage to the tissue and bone that surrounds it. Various types of basal cell carcinoma surgery are the most common ways to remove this cancer.
Women Share Exactly What Getting Skin Cancer Surgery Is Like
“It took eight hours for them to cut everything out.”
You know youre supposed to wear hats, slather on sunscreen, and go to the dermatologist for a skin cancer screening every year. But what happens if your doctor actually finds something? If you need to remove basal cell carcinomas or squamous cell carcinomas , the two most common types of skin cancer, the answer is usually Mohs surgery.
The procedure has a 98 percent cure rate and leads to pretty minimal scarring, says Bruce E. Katz, M.D., director of JUVA Skin and Laser in New York City. But what is it like to actually go through it? And how do the results look? To find out, we talked to four women who’ve navigated the experience.
Michelle Charlesworth, 45When I was 30, I was doing a story about liposuction for ABC. It was odd because I dont normally do health stories. I was interviewing a dermatologist, and as I was leaving, the doctor came over to me and said, Whats this on your face? How long has it been there?
I get facials about twice a year, and every time, the aesthetician would remark about a little skin-colored bump by my mouth and try to pop it. I found out they were trying to pop my cancer. You cant pop cancer.
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Within 48 hours of leaving the doctors office, I had been told it was basal cell carcinoma and that I would have to have surgery.
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Topical 5% Imiquimod Cream
Imiquimod is an immune response modifier. It acts by binding to toll-like receptor. This induces proinflammatory cytokine production and subsequent cytotoxic T cell mediated cell death. It is licensed for use in the treatment of sBCCs.
Vehicle-controlled studies in the treatment of small sBCC by Geisse et al. have reported reasonable results. Twelve weeks following the 6 week treatment course the clearance rates were 82% , 79% and 3% . Moderate to severe local site reactions occurred in 87% with erosions and ulceration in 36% and 22%, respectively. However, it is worth noting that facial BCCs were not included in this study. Schulze et al. found similar clearance rates following a 6 weeks course of 7x/week topical imiquimod, with a 80% histological clearance compared to 6% for vehicle alone. However, long term clearance rates are lower. A prospective study of 182 patients who received topical imiquimod applied 5x/week for 6 weeks gave clearance rates of 69% at 5-years .
There is some data to suggest that imiquimod may be used in the treatment of nBCCs. A randomized dose-response study reported that 6 weeks after treatment with either a 6- or 12-week course of 7x/week imiquimod histological clearance rates were 71% and 76%, respectively . A further randomized trial on nBCCs reported complete clinical clearance in 78% following 3x/week imiquimod. However, 8 weeks later excision revealed residual BCC in 13% of the patients considered to have shown complete clinical clearance .
Of Basal Cell Carcinoma
Basal cell carcinoma: The most common type of skin cancer, a disease in which the cancer cells resemble the basal cells of the epidermis, the outer layer of the skin.
Basal cell carcinomas usually appear as the classic sore that doesnt heal. A bleeding or scabbing sore that seems to get somewhat better, then recurs and starts to bleed, may be a basal cell carcinoma.
Most basal cell carcinomas are on the face and neck where the skin is exposed to sunlight. However, a fair number show up on parts of the body such as the abdomen, leg, and scalp exposed to little or no sunlight.
Basal cell carcinomas typically are locally invasive. They tend to burrow in locally and not metastasize to distant locations.
Small basal cell carcinomas can be removed by being scraped and burned . Larger basal cells can be removed by surgery. Basal cell carcinomas on the scalp, ears, and sides of the nose, as well as those which have come back after being treated, are treated best by Mohs surgery.
One basal cell carcinoma means an increased risk of developing another. Prudent sun precautions and annual skin checkups by the doctor are advisable.
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Symptoms Of Basal Cell Carcinoma
There are several types of basal cell carcinomas.
The nodular type of basal cell carcinoma usually begins as small, shiny, firm, almost clear to pink in color, raised growth. After a few months or years, visible dilated blood vessels may appear on the surface, and the center may break open and form a scab. The border of the cancer is sometimes thickened and pearly white. The cancer may alternately bleed and form a scab and heal, leading a person to falsely think that it is a sore rather than a cancer.
Other types of basal cell carcinomas vary greatly in appearance. For example, the superficial type appears as flat thin red or pink patches, and the morpheaform type appears as thicker flesh-colored or light red patches that look somewhat like scars.
Targeted Therapy Or Immunotherapy For Advanced Basal Cell Cancers
In rare cases where basal cell cancer spreads to other parts of the body or cant be cured with surgery or radiation therapy, a targeted drug such as vismodegib or sonidegib can often shrink or slow its growth.
If these drugs are no longer working , the immunotherapy drug cemiplimab can sometimes be helpful.
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Specialized Care For The Most Common Skin Cancer
Basal cell carcinoma also called basal cell cancer is the most common type of skin cancer, accounting for approximately 80 percent of all skin cancer cases.
One of the three primary types of cells that make up the skin , basal cells are located at the bottom of the epidermis.
Although basal cell carcinomas usually grow slowly and rarely spread to other parts of the body, if left untreated, they can grow deeply into the skin and bone.
Its important that they are entirely removed to prevent recurrence in the same area.