Causes Of Basal Cell Carcinoma
The top cause of basal cell carcinoma is exposure to ultraviolet rays from indoor tanning or from the sun. According to the Skin Cancer Foundation , if youve ever tanned indoors you have a 69% increased risk of developing basal cell skin cancer before age 40.
And the more time you spend under the suns rays, the higher your risk. McMichael said, I have patients tell me all the time, I dont lay outside. It doesnt matter what youre doing outside. If youre playing golf or gardening you need a hat, sunscreen and sun-protective clothing.
McMichael is concerned that with COVID-19, people are spending a lot more time outdoors without protecting their skin. Were going to come out of this pandemic with a whole lot more skin cancer, she said.
Can You Prevent Basal Cell Carcinoma
Protecting yourself against the non-melanoma skin cancer isnt always possible, but there are measures that can help.
These include avoiding being exposed to UV light and sunbeds, and reducing your risk of sunburn by avoiding the sun and using sun tan lotion.
You should check your skin regularly, as an early diagnosis can help your chance of a successful treatment.
Those who have a history of BCC may need frequent check-ups as there is a chance the condition can return.
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 A Basal Cell Carcinoma
Basal cell carcinoma is a type of skin cancer that occurs when there is damage to the DNA of basal cells in the top layer, or epidermis, of the skin. They are called basal cells because they are the deepest cells in the epidermis. In normal skin, the basal cells are less than one one-hundredth of an inch deep, but once a cancer has developed, it will spread deeper.
What Is The Cause
The basal cell carcinoma usually happens on the neck and the head as it is most common on those areas which are commonly exposed to the sun. But the underlying cause is a mutation in the basal cells, and it causes them to multiply faster and continue to grow instead of dying and falling off. The risk factors which contribute to this condition include radiation, chronic sun exposure, family or personal history of a skin cancer, fair skin, a regimen of immune-suppressing medication, and exposure to arsenic.
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What Are The Clinical Features Of Basal Cell Carcinoma
BCC is a locally invasive skin tumour. The main characteristics are:
- Slowly growing plaque or nodule
- Skin coloured, pink or pigmented
- Varies in size from a few millimetres to several centimetres in diameter
- Spontaneous bleeding or ulceration
BCC is very rarely a threat to life. A tiny proportion of BCCs grow rapidly, invade deeply, and/or metastasise to local lymph nodes.
Surgical Procedures For Basal & Squamous Cell Skin Cancers
Basal or squamous cell skin cancers may need to be removed with procedures such as electrodessication and curettage, surgical excision, or Mohs surgery, with possible reconstruction of the skin and surrounding tissue.
Squamous cell cancer can be aggressive, and our surgeons may need to remove more tissue. They may also recommend additional treatments for advanced squamous cell cancer, such as medications or radiation therapyenergy beams that penetrate the skin, killing cancer cells in the body.
Basal cell cancer is less likely to become aggressive, but if it does, our doctors may use surgery and other therapies to treat it.
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Basal Cell Carcinoma Overview
Basal cell carcinoma, also called epithelioma, is the uncontrolled growth of the skin’s basal cells. These are the cells that line the deepest layer of the epidermis, the skin’s outermost layer. This type of cancer rarely spreads to other parts of the body.
It is mainly caused by repeated long-term exposure to sunlight. Light-skinned people who spent a lot of time in the sun as children, or who spend time in tanning booths, are especially susceptible. X-ray treatments for acne and exposure to industrial pollutants such as arsenic and hydrocarbons also increase the risk of developing basal cell carcinoma.
Basal cell carcinoma is the most common skin cancer in the United States, with nearly 3 million cases diagnosed each year.
Who Gets Basal Cell Carcinoma
Basal cell carcinoma is by far the most common cancer in the world. With more than four million people in the United States diagnosed with basal cell carcinoma each year, this cancer affects more people than all other cancers combined. Fortunately, its also the least serious of all cancers. 99% of basal cell carcinoma cases stay local meaning it only affects the area where it starts. Sure, sometimes its more complicated they can invade structures locally near the eyes, nose, or ears, but true metastasis from basal cell carcinoma is extraordinarily rare. Other cancers quickly learn to metastasize and spread through the body, but basal cell carcinoma usually does not spread.
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Choosing To Stop Treatment Or Choosing No Treatment At All
For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. Whether or not you continue treatment, there are still things you can do to help maintain or improve your quality of life.
Some people, especially if the cancer is advanced, might not want to be treated at all. There are many reasons you might decide not to get cancer treatment, but its important to talk to your doctors and you make that decision. Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms.
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.
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Can Skin Cancer Be Prevented
In most cases, skin cancer can be prevented. The best way to protect yourself is to avoid too much sunlight and sunburns. Ultraviolet rays from the sun damage the skin, and over time lead to skin cancer.
Here are ways to protect yourself from skin cancer:
- Seek shade. Dont spend long periods of time in direct sunlight.
- Wear hats with wide brims to protect your face and ears.
- Wear long-sleeved shirts and pants to protect your arms and legs.
- Use broad-spectrum sunscreens with an SPF of 30 or higher that protect against burning and tanning rays. Apply the sunscreen 30 minutes before you go outside.
- Wear sunglasses to protect your eyes.
- Use a lip balm with sunscreen.
- Avoid the sun between 10:00 a.m. and 4:00 p.m.
- Show any changing mole to your healthcare provider.
Neglected Basal Cell Carcinomas In The 21st Century
Erika Varga
1Department of Dermatology and Allergology, Albert Szent-Györgyi Clinical Center, University of Szeged, Korányi fasor 6, 6720 Szeged, Hungary
2Department of Oral and Maxillofacial Surgery, Albert Szent-Györgyi Clinical Center, University of Szeged, Kálvária sgt. 57, 6725 Szeged, Hungary
Abstract
Although tumors on the surface of the skin are considered to be easily recognizable, neglected advanced skin neoplasms are encountered even in the 21st century. There can be numerous causes of the delay in the diagnosis: fear of the diagnosis and the treatment, becoming accustomed to a slowly growing tumor, old age, a low social milieu, and an inadequate hygienic culture are among the factors leading some people not to seek medical advice. The treatment of such advanced neoplasms is usually challenging. The therapy of neglected cases demands an individual multidisciplinary approach and teamwork. Basal cell carcinoma , the most common cutaneous tumor, usually develops in the elderly, grows slowly, and has an extremely low metastatic potential these factors are suggesting that BCCs might well be the ideal candidates for neglected tumors. Five neglected advanced cases of BCC were diagnosed in our dermatological institute between 2000 and 2009. The clinical characteristics and treatment modalities of these neoplasms are discussed, together with the possible causes of the neglect.
1. Introduction
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Answer: Risk Of Not Treating Basal Cell Carcinoma
Basal Cell Carcinoma is a locally destructive type of skin cancer that is notorious for recurrence when not adequately treated. It can become quite disfiguring if left untreated, especially when located in cosmetically sensitive areas such as the nose. Typically this type of skin biopsy is performed for diagnosis and is not adequate treatment for a skin cancer. Biopsies sample a portion of the lesion, leaving some behind. This type of sampling biopsy is not intended to remove the entire lesion. It is not advisable to leave a known skin cancer untreated as it will likely grow and become more of a problem to remove in the future. Mohs micrographic surgery allows for 100% margin control and is tissue-sparing, which means it offers the highest cure rate while preserving as much normal tissue as possible.
Signs Of Basal Cell Carcinoma
BCC generally starts out in the upper layer of your skin. Thatâs called your epidermis. Hereâs what it may look like:
- A bloody or oozing sore that doesnât go away
- A rough patch of skin, usually in a sun-exposed area
- A reddish area that may hurt or itch
- A shiny bump thatâs clear, reddish, or white
- A flat white, yellow, or âwaxyâ area that looks like a scar
- A colored mole-like bump
BCC tends to grow slower than other kind of cancer, but thatâs not always the case. And if itâs advanced BCC, it can spread much deeper into your tissue. Call your doctor if you see any of these changes in your skin. Ask them about genetic conditions and other risk factors that can raise your chances of advanced BCC.
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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.
How Is Superficial Basal Cell Carcinoma Of Skin Treated
In general, the treatment of Superficial Basal Cell Carcinoma of Skin depends upon a variety of factors including:
- The location of the tumor
- The number of tumors
- The size of the tumor
- Any health considerations of the patient
A number of treatment methods may be used to treat Superficial Basal Cell Carcinoma of Skin. The treatment types may include:
Topical medications can be used to treat Superficial Basal Cell Carcinoma. This is because the thinness of the tumor permits permeation of the active ingredient to the full depth of the carcinoma. The two most frequently used active ingredients are imiquimod and 5-Flurouracil.
- Imiquimod is an immune system signal which calls for the migration of T-cells into the area of the tumor, which actively kill the cancer cells
- 5-Flurouracil is a metabolic agent which toxically kills the more basal cell carcinoma cells. The surrounding normal skin does not absorb the medication and hence is safe from the toxicity
Both these topical applications take at least a few weeks to treat a typically sized lesion, longer for larger lesions. The actions will lead to redness, irritation, sometimes crusting and possibly secondary infection
One advantage of these creams is that it is sometimes possible to treat the Superficial Basal Cell Carcinoma without affecting the underlying skin at all, so after healing, little to no scarring is detectable.
Other techniques to treat this skin cancer may include:
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After Squamous Cell Cancer Of The Skin Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Skin Or To Other Parts Of The Body
The process used to find out if cancer has spread within the skin or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment for squamous cell carcinoma of the skin.
Basal cell carcinoma of the skin rarely spreads to other parts of the body. Staging tests to check whether basal cell carcinoma of the skin has spread are usually not needed.
The following tests and procedures may be used in the staging process for squamous cell carcinoma of the skin:
What Do I Need To Know
- AKs are evidence of sustained sun damage. Having them raises your lifetime risk for skin cancer. Since having one AK means that its likely you have already developed more, this may translate into an especially elevated risk for developing an SCC.
- An untreated SCC can become invasive and even life-threatening.
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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.
What Causes Skin Cancer
The main cause of skin cancer is overexposure to sunlight, especially when it results in sunburn and blistering. Ultraviolet rays from the sun can damage the skin and, over time, lead to skin cancer. The UV light damages DNA in the skin and causes it to grow abnormally. Exposure to certain chemicals such as tar and coal can cause skin cancer for those with jobs that require them to frequently be in contact with these chemicals. Those with a weakened immune system also have an increased risk for skin cancer.
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Standard Excision Of Primary Bcc With Predetermined Margins
Standard surgical excision is a highly effective treatment for primary BCC and historically has been the mostly common treatment option. BCCs are generally removed with a predetermined excision margin of 3-4mm of normal skin. Especially on the face, grafts and flaps may be necessary to close the wound, rather than direct closure.
A study of 2016 BCCs byBreuninger and Dietz, using horizontal sections to accurately detect BCC at any part of the surgical margin, found that excision of small lesions with a 2-mm peripheral surgical margin cleared 70%, margins of 3-mm cleared 84% and margins of 5-mm cleared 95% of all tumours. Morphoeic and large BCCs required wider surgical margins in order to maximize the chance of complete excision. For primary morphoeic lesions, the rate of complete excision was 66% for a 3-mm margin, 82% for 5-mm and > 95% for 1315mm.
Although little data exists on the correct deep surgical margin, excision through to the subcutaneous fat is generally advisable. Overall the 5-year recurrence rate after a simple excision of a BCC is reported as being between 4.1% and 10.1% . If the excision has been reported as histologically complete the recurrence rate is reported to be < 2% . This is due to sampling errors that occur as histological specimens are examined in a vertical plane.