Basal Cell Carcinoma

 

Other Name: Basal-cell cancer

Description:
A basal cell carcinoma (BCC) is a type of skin cancer. There are two main types of skin cancer: melanoma and non-melanoma skin cancer. BCC is a non-melanoma skin cancer, and is the most common type (> 80%) of all skin cancer (skin cancer incidence is < 1%) in the UK. BCC are sometimes referred to as ‘rodent ulcers’.

It often appears as a painless raised area of skin, which may be shiny with small blood vessels running over it; or it may present as a raised area with ulceration.

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Sign & Symtoms:
Basal cell carcinoma usually develops on sun-exposed parts of the body, especially on head and neck. This skin cancer appears less often on the trunk and legs, and basal cell carcinoma can — but rarely — occur on parts of the body usually protected from the sun such as genitals or women’s breasts.

Basal cell carcinoma appears as a change in the skin, such as a growth or a sore that won’t heal. These changes in the skin, or lesions, usually have one of the following characteristics:

1. A pearly white, skin-colored or pink bump that is translucent, meaning you can see a bit through the surface. Tiny blood vessels are often visible. In people with darker skin tones, the lesion would be darker but still somewhat translucent. The most common type of basal cell carcinoma, this lesion often appears on the face, ears or neck. The lesion may rupture, bleed and scab over.

2. A brown, black or blue lesion — or a lesion with dark spots — with a slightly raised, translucent border.

3. A flat, scaly, reddish patch with a raised edge is more common on the back or chest. Over time, these patches can grow quite large.

4. A white, waxy, scar-like lesion without a clearly defined border, called morpheaform basal cell carcinoma, is the least common. This lesion is easy to overlook, but it may be a sign of a particularly invasive and disfiguring cancer.

Causes:
The commonest cause is too much exposure to ultraviolet (UV) light from the sun or from sun beds. Basal cell carcinomas can occur anywhere on your body, but are most common on areas that are exposed to the sun, such as your face, head, neck and ears. It is also possible for a basal cell carcinoma to develop where burns, scars or ulcers have damaged the skin. Basal cell carcinomas are not infectious.

1.Basal cell carcinomas mainly affect fair skinned adults and are more common in men than women. Those with the highest risk of developing a basal cell carcinoma are:

2.People with freckles or with pale skin and blond or red hair.

3.Those who have had a lot of exposure to the sun, such as people with outdoor hobbies or who work out of doors, and people who have lived in sunny climates.

4.People who use sun beds.

5.People who have previously had a basal cell carcinoma.

6.Are basal cell carcinomas hereditary?
Apart from a rare familial condition called Gorlin’s syndrome, basal cell carcinomas are not hereditary. However some of the things that increase the risk of getting one (e.g. a fair skin, a tendency to burn rather than tan, and freckling) do run in families.

Risk factors :
Basal-cell cancer grows slowly and can damage the tissue around it but is unlikely to spread to distant areas or to result in death. It is exposed to ultraviolet light, having lighter skin, radiation therapy, long-term exposure to arsenic, and poor immune-system function. Exposure to UV light during childhood is particularly harmful. Tanning beds have become another common source of ultraviolet radiation. Diagnosis often depends on skin examination, confirmed by tissue biopsy.

It remains unclear whether sunscreen affects the risk of basal-cell cancer.  Treatment is typically by surgical removal.  This can be by simple excision if the cancer is small; otherwise Mohs surgery is generally recommended. Other options may include application of cold, topical chemotherapy, laser surgery, or the use of imiquimod.  In the rare cases in which distant spread has occurred, chemotherapy or targeted therapy may be used.

Basal-cell cancer accounts for at least 32% of all cancers globally. Of skin cancers other than melanoma, about 80% are basal-cell cancers.  In the United States about 35% of white males and 25% of white females are affected by BCC at some point in their life.

Complications:

Complications of basal cell carcinoma can include:

1. A risk of recurrence. Basal cell carcinomas commonly recur. Even after successful treatment, a lesion may reappear, often in the same place.

2. An increased risk of other types of skin cancer. A history of basal cell carcinoma may also increase the chance of developing other types of skin cancer, such as squamous cell carcinoma.

3. Cancer that spreads beyond the skin. Rare, aggressive forms of basal cell carcinoma can invade and destroy nearby muscles, nerves and bone. And rarely, basal cell carcinoma can spread to other areas of the body.

Treatment:
Radiation therapy:

Radiation therapy is often a good option for treating patients who aren’t able to have surgery and for treating tumors on the eyelids, nose, or ears – areas that can be hard to treat surgically – especially in older patients where cure may not be as important as control over the long term. It’s also sometimes used after surgery if it’s not clear that all of the cancer has been removed.
Immune response modifiers, photodynamic therapy, or topical chemotherapy

These treatments are sometimes options for treating very superficial tumors (tumors that have not grown too deeply into the skin). Close follow-up is needed because these treatments do not destroy any cancer cells that have grown deep below the surface.

Cryotherapy:

Cryotherapy (cryosurgery) can be used for some small basal cell carcinomas, but it’s not usually recommended for larger tumors or those on certain parts of the nose, ears, eyelids, scalp, or legs.

Cryotherapy can also be used to treat large tumors in one treatment session to relieve symptoms from the cancer. The site of treatment often takes a month or two to heal.
Targeted therapy for advanced basal cell cancers

In rare cases where basal cell cancer spreads to other parts of the body or can’t be cured with surgery or radiation therapy, a targeted drug such as vismodegib (Erivedge) or sonidegib (Odomzo) can often shrink or slow its growth.

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Preventions:

For prevention the following may be observed:

1. Avoid the midday sun. Avoid the sun when its rays are the strongest. For most places, this is between about 10 a.m. and 4 p.m. Because the sun’s rays are strongest during this period, try to schedule outdoor activities for other times of the day, even in winter. You absorb UV radiation year-round, and clouds offer little protection from damaging rays.
Use sunscreen year-round. Choose a sunscreen that blocks both UVA and UVB types of radiation from the sun and has an SPF of at least 15. Apply sunscreen generously, and reapply every two hours — or more often if you’re swimming or perspiring. The American Academy of Dermatology recommends using a broad-spectrum sunscreen with an SPF of 30 or more. Even the best sunscreen might be less effective than the SPF number on the bottle would lead you to believe if it isn’t applied thoroughly or thickly enough, or if it’s perspired away or washed off while swimming.

2.Wear protective clothing. Wear protective clothing. Sunscreens don’t provide complete protection from UV rays, so wear tightly woven clothing that covers your arms and legs, and a broad-brimmed hat, which provides more protection than a baseball cap or visor does. Some companies also sell photoprotective clothing. Wear sunglasses that provide full protection from both UVA and UVB rays.

3.Avoid tanning beds. Tanning beds emit UV radiation, which can increase the risk of skin cancer.
Become familiar with the skin so that one can notice changes. Examine skin to observe normally how it looks like. This way, one may be more likely to notice any skin changes. With the help of mirrors, check the face, neck, ears and scalp. Examine your chest and trunk, and the tops and undersides of your arms and hands.

4.Examine both the front and back of the legs, and feet, including the soles and the spaces between the toes. Also check genital area, and between the buttocks. If anything un usual is noticed doctor should be consulted.
about screening. If one already had skin cancer, he or she may have an increased risk of a second cancer.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
https://en.wikipedia.org/wiki/Basal-cell_carcinoma
https://www.mayoclinic.org/diseases-conditions/basal-cell-carcinoma/symptoms-causes/syc-20354187
https://www.cancer.org/cancer/basal-and-squamous-cell-skin-cancer/treating/basal-cell-carcinoma.html
http://www.britishskinfoundation.org.uk/SkinInformation/AtoZofSkindisease/BasalCellCarcinoma.aspx

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