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Thu, September 1, 2011
Basal Cell Carcinoma: A Serious, Yet Curable Skin Cancer
Basal cell carcinoma, commonly called basal cell epitheliomas, is the most common form of skin cancer. The good news is it’s almost always curable and rarely spreads. Less than one-half percent of this type of skin cancer actually metastasizes.

When one hears the words skin cancer, it can often send a chill of fear. That initial feeling of the unknown can strike panic in anyone. Any form of skin cancer is serious. Yet with today’s medicine, there is always hope.
Basal cell carcinomas are the result of prolonged sun damage to the skin. They usually affect blonde and red-haired individuals, and appear to have a genetic predisposition. Recently it’s been discovered that within the genetic code, the nucleic acids guanine and thymine found in our DNA, together form what’s called di-thymine dimers. When subjected to ultraviolet light, the light disrupts them and starts the process of inflammation, eventually leading to basal cell carcinomas.

These carcinomas often start out as a small spot. Translucent and ulcerated, they frequently have telangiectatic (or small blood vessels) within them. They usually require a microscopic examination to determine whether the growth is cancerous.

Typically, these tumors are very slow growing, but sudden, rapid growth periods can occur. Destructive forms of the tumor can invade cartilage, bone, blood vessels and large areas of skin surface, and can in rare cases result in death. The mortality rate is very low though, approximately 0.3 percent.

Types of Basal Cell Carcinoma

There are four major clinical types of basal cell carcinomas:
  1. Nodular ulcerative
  2. Pigmented
  3. Fibrosing or Sclerosing (commonly called morpheaform)
  4. Superficial
The nodular ulcerative basal cell carcinoma is one of the most common. It is usually a small, waxy nodule (raised “bump” lesion) that enlarges over a period of years. It typically has a central depression and is surrounded many times by an ulcer that has a pearly border. Upon stretching the skin, a gray translucence can appear and may aid in the diagnosis.

Pigmented basal cell carcinoma is similar to the nodular ulcerative type. In addition to having a brown and black pigment, under dermatoscopy (a special magnifying tool) it has a maple leaf appearance that is characteristic and aids in the diagnosis.

The fibrosing type is extremely slow growing, usually seen on the face, and consists of whitish, scarred plaques and an ill-defined border that rarely becomes ulcerative. This type is difficult to treat and many times has deeper “roots.”

The superficial form of carcinoma may be single or multiple and is usually seen on the back or chest. It is characterized by slow growing, enlarging and red-scaling areas. Careful examination reveals a nodular border with telangiectatic vessels. A healed atrophic (scar like) center may be present.

Areas Most Commonly Found

Skin cancers are most commonly found on the face and other sun-exposed areas. More than 90 percent of all basal cells appear on the head and neck, with the main trunk of the body next in frequency. On the trunk and extremities, the tumors may appear pink and flat without ulcerations.

Basal cell carcinomas can occur anytime beginning in childhood to beyond 50 years of age. They occur most often in people living in sunny areas like Texas, Arizona, Florida, and California. Individuals of African ancestry or with very dark skin rarely get a basal cell carcinoma.

Treatment

Basal cell cancers are best treated early on and when they are small. Surgical removal of a basal cell carcinoma is almost 100 percent curative. Rarely will the cancer grow back. In order to detect a rare event of recurrence, the treated area should be checked periodically, usually once or twice a year. Individuals who are concerned about treated areas or any other lesion should always consult their physician for further evaluation and possible biopsy.

Surgical excision of the basal cell carcinoma, where the tumor is cut out and stitched up, is usually the most common treatment method, although there are other forms of treatment including:
  • Curettage for small lesions – Many dermatologists prefer this method, which consists of scooping out the basal cell carcinoma by using a spoon-like instrument called a curette.
  • Cryosurgery - This technique freezes the basal cell carcinoma. Typically, liquid nitrogen is applied to the growth to freeze and kill the abnormal cells.
  • Radiation therapy - Doctors occasionally use this method for skin cancers occurring in areas that are difficult to treat with surgery. Obtaining a good result can possibly involve as many as 20 treatment sessions.
  • Mohs micrographic surgery – This treatment is used for recurrent, deeply ulcerated, large superficial basal cells. With this technique, a surgeon will remove a small piece of the tumor and examine it under a microscope. This cutting and examination is repeated so that the basal cell carcinoma can be mapped and taken out without having to estimate the width and depth of the lesion. The cure rate for this form of treatment is very high, exceeding 98 percent.
Other forms of treatment can include chemotherapy, electrosurgery, and laser therapies.

Typically, it is recommended an individual return for a checkup every four to six months for a period of time following any treatment.

Prevention

The skin damage and the effects of sun damage are permanent. Sun bathing and sunburns produce gradual sun damage and these should always be avoided. Ten years or more can pass between the time of sun exposure and sun damage to be detected in a basal cell carcinoma. Thus, teenage sun worshipers often pay for their deep tans when they reach their 40s and 50s.

You can prevent further sun damage or injury by utilizing sun protection of SPF 15 or greater and reapplying every two to three hours. It’s recommended to avoid PABA-free derivatives.

If an individual notices a new growth or sore that doesn’t heal or keeps coming back, they should consult their physician immediately.

To learn more about basal cell carcinoma, contact your physician or visit hgbhealth.com.

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