Basal Cell Carcinoma
BASAL CELL CARCINOMA
The basal cell carcinoma is by far the most common form of skin cancer. Roughly 75% of all skin cancers are basal cells. Yet of the approximately 1,000,000 Americans who will develop a basal cell carcinoma this year, only a handful will die from it.
The incidence of basal cell cancers is growing at an astounding clip. It is estimated that there were 300,000 basal cell cancers 25 years. Now look at the incidence.
What is also alarming is that people are developing their first basal cells at a younger and younger age. The rate among women has now increased to nearly the level of men.
Why Are They Called Basal Cell Carcinomas?
A basal cell carcinoma is called a basal cell because it develops from the basal layer of the skin. The basal layer in turn is so named because it is positioned at the base of the epidermis.
The basal layer of the skin is the layer that produces all the skin cells.
The basal layer is pluri-potential. This means that it is capable of differentiating or developing into any skin line be it oil gland, hair follicle or the normal epidermis.
Interestingly, most basal cell carcinomas are heading toward hair follicle differentiation until something goes terribly wrong and a cancer is produced.
What Causes Basal Cell Carcinomas?
Nearly all basal cell carcinomas are caused by excessive sun exposure. That is why they form on the areas of the body which have the most sun exposure such as the face, ears, neck and scalp.
Who Gets Basal Cell Carcinomas?
Those people with fair skin, light hair, and blue, green or gray eyes are at highest risk. People with extensive sun exposure are obviously the most in danger. Those who spend their leisure time in outdoor activities. Workers who have occupations that force them to be in the sun such as sailors, farmers, carpenters are also imperiled.
The nearer to the equator, the higher the number of cases among fair-skinned individuals.
What Do You Look For?
Since basal cells have the ability to form different skin structures, their appearance on the skin can vary markedly.
The most common form is a pearly, somewhat glassy bump. Often there will be tiny blood vessels coursing on top of it. This form is the nodular basal cell. This is the most common variety.
Occasionally, a darker skinned patient will have a pigmented basal cell carcinoma. These will be a pearly, black color. They can be confused with melanoma. This is also a nodular basal cell carcinoma. It behaves no differently.
Another type of basal cell will have an open sore that bleeds, or crusts. A persistent, non-healing sore is a very common sign of this form of basal cell. Often the term ulcerative is appended to the word nodular, thus producing the moniker of the nodulo-ulcerative basal cell carcinoma. A scar-like area—white, yellow or waxy-with poorly defined borders may signify the most insidious form of basal cell carcinomas. These are termed a morphea-form basal cell carcinoma and tend to be very aggressive.
Sometimes, a basal cell will be a red patch. Careful inspection may reveal a silvery threadlike border. This can be a tricky basal cell to diagnose, as they can look like a patch of psoriasis or ezcema. This often may cause a delay in diagnosis. This type of basal cell is more common on the chest, shoulders, arms or legs.
This form of basal cell is called the superficial, multicentric basal cell. This is the least aggressive of all the basal cell carcinomas. Unfortunately, it has a very annoying habit of recurring. This is the only form of cancer in which a cream, called 5 Fluoro-uracil ( Efudex), may cure cancer.
A last type I would like to mention is the cystic basal cell. This type has a jelly like substance in it. This jelly like substance makes the cystic basal cell look like a mole.
How Do Basal Cell Carcinomas Behave?
Most basal cell carcinomas behave quite well. Pathologists would off-handedly describe them as “good actors”. Only very rarely do they spread (metastasize) to other organs.
However, basal cells can be very aggressive locally. They do have the capability to invade tissue. There are even reports of the basal cell penetrating through bone.
The most aggressive kind as far as local invasion is concerned is the so-called rodent ulcer. When one sees a rodent ulcer it does not take much imagination to figure out how this term was derived. The skin looks like a rat has been chewing on it.
Most basal cells grew slowly. Sometimes, they can exist for years before becoming invasive.
How Are Basal Cell Carcinomas Diagnosed?
Sometimes, the diagnosis is so apparent on visual inspection that the physician will proceed directly to treatment. However, on most occasions a biopsy will be done. That is the tissue will be removed from the sore and sent to the laboratory. There the pathologist will examine the slide and determine whether the lesion is indeed a basal cell. Luckily, basal cells are nearly always easy to diagnose.
How Are Basal Cell Carcinomas Treated?
There are a number of effective treatments. Choice of treatment will hinge on as the type, size, and location of the lesion. Other factors such as the patient’s age and general health will sometimes come into play.
Nearly always, the treatment is performed in the physician’s office under local anesthesia. Nowadays there are a number of methods to minimize the pain. Post-operative pain is very minimal.
The most commonly used type of treatment is surgical excision. The entire lesion is excised along with a small rim of normal tissue. The wound is then closed with stiches. The specimen is sent to the pathologist who will then ascertain whether the entire basal cell has been removed. If there is still tumor remaining, the procedure can be repeated.
Electrosurgery (electrodessiccation and currettage). This is also a very commonly used method. The basal cell carcinoma feels softer than normal skin. The dermatologist can use this soft sensation to scrape out the malignancy with a ring-shaped instrument called a currette. The physician then employs an electric needle to burn a safety margin of normal skin around the tumor and at the base. This is repeated a few times. E & C as it is termed is a very valuable technique on the trunk where it can often limit a scar.
Cryosurgery is a rather quick simple way to remove a basal cell. The area of the tumor is first numbed. Then the area is sprayed with liquid nitrogen two to three times. This technique is helpful in that there is no bleeding. If need be in can be done without anesthesia.
Radiotherapy is an underutilized treatment. It is an excellent treatment for the elderly and infirm. It is totally painless. Superficial X Ray beams are directed at the tumor site. The doses are fractionated necessitating repeat visits.
Laser surgery has recently been added to our armamentarium. The advantage is that the laser seals blood vessels creating a clean visual field. In this technique a laser beam is employed either to excise the malignancy, similar to a scalpel, or to destroy ;it through vaporization, much like electrodessication.
Photodynamic Therapy is a rather new form of treatment. In this treatment the patient ingests a light sensitive material. The swallowed substance concentrates at the basal cell site. Then a light beam is shined on the tumor destroying it.
Interferon: A product of the immune system is injected into or applied to the tumor.
Preventing Basal Cells
Minimize sun exposure. No other form of skin cancer is as directly linked to the sun. Wear protective clothing. Wear long sleeve shirts, long skirts and a hat. Avoid the sun between the hours of 10:00 to 3:00. Make abundant use of sunscreens. If you are going to be in the sun choose a sunscreen that has the Skin Cancer Foundation seal of approval. Use a 15 SPF ( sun protection factor) if you have not had skin cancer. Use a sunscreen with a SPF greater than 15 if you are fair or have had skin cancer.
Examine your skin and that of those close to you once a month for all types of skin cancer. Become familiar with the appearance of melanoma and atypical moles.
Any new lesion that ulcerates, bleeds easily or does not seem to be healing should be taken seriously. A suspicious change in an existing lesion should wave a red flag in your mind.
If you note any of the above, see your physician. Basal cell carcinomas are easily to treat when they are caught early.
Those with a history of a basal cell should be careful that the one they have had does not recur. Of course, having had a basal cell stacks the cards that you may develop another one. Be on guard.
