The cells inside the skin producing new skin cells after older cells die are called basal cells. Basal cell carcinoma is a type of skin cancer beginning in the basal cells. It starts in the form of bumps in the areas of the skin exposed directly to the sun - the head, neck, or face. Basal cell carcinoma is the most common cancer in humans. Prolonged exposure to ultraviolet radiations from the sun is a common cause of basal cell carcinoma. Men are more prone to basal cell carcinoma than women. People with less melanin in the body (fair-skinned) are at higher risk of this cancer.
Basal Cell Carcinoma Associated anatomy
Causes of Basal cell carcinoma
Direct exposure to sunlight alone may not result in skin cancer; many other factors can cause basal cell carcinoma:
- Prolonged exposure to sunlight: People living in sunny areas or high-altitude regions are more prone to exposure to UV radiation.
- Fair skin: People with light skin, blond hair, freckles, or light-colored eyes are at a higher risk of basal cell carcinoma.
- Radiation therapy: The radiations used to treat acne or any skin condition can also cause basal cell carcinoma.
- Family history of skin cancer: With a frequent family history of basal cell carcinoma, you have more chances of suffering from skin cancer.
- Immunosuppressive drugs: These drugs usually administered after a transplant suppress the immune system, thus increasing the risk of skin cancer.
- Exposure to toxins like arsenic: People drinking water from wells or those working in an environment with arsenic exposure are more prone to basal cell carcinoma.
- Genetic diseases like Gorlin-Goltz syndrome and xeroderma pigmentosa
- Old age
Symptoms of Basal Cell Carcinoma
Usually, the symptoms of basal cell carcinoma appear as changes in the skin in the form of growth or non-healing sore. Other symptoms are:
- Lumps or nodules on the skin with visible blood vessels or shine
- Black, brown, or blue lesions
- Non-healing scars
- Itchy regions on the skin
- Waxy, white, scar-like lesion
- Red patches on the skin that look like eczema
- Scaly, flat patches that grow gradually
- Crusty sores with depressions or blood in the middle of the skin
Possible treatment of Basal cell carcinoma
The basis of treatment is to remove all the cancerous cells and some surrounding healthy tissues. The treatment method for basal cell carcinoma depends on various factors:
- Age and health of the patient
- Location of cancerous cells
- The extent of spread of cancer
- Type of cancer
- If it is for the first time or recurring
Various treatments available to treat basal cell carcinoma are:
- Surgical excision: The doctor excises the cancerous cells by cutting lesions and surrounding healthy tissues with a scalpel. This surgery removes basal cell carcinoma in areas like the chest, back, and limbs with lesser chances of recurrence.
- Mohs surgery: The surgeon removes cancerous cells layer by layer by observing under a microscope until no lesions remain. It ensures the removal of all cancerous cells. This surgery reduces the chances of recurrence of cancer and treats sensitive areas of the body.
- Curettage and electrodissection: This method uses a curette (spoon-like tool) to scratch off the cancerous cells. It is followed by searing the cancerous cells using a needle.
- Radiation therapy: This is an alternative for surgeries because it involves high-energy radiation to kill off the cancerous cells.
- Cryosurgery: This is a freezing method to treat superficial skin lesions. Liquid nitrogen freezes the cancer cells after curetting the skin surface.
- Topical treatment: Some prescribed pills, creams, and ointments can kill small and thin basal cell carcinomas.
- Photodynamic therapy: A photosensitizing drug applied to the skin makes cancerous cells sensitive to light. A light is shined on the cancerous cells to kill them.
- Chemotherapy: It uses chemotherapeutic drugs that kill cancerous cells.
- Targeted drug therapy: The growth of cancerous cells requires many molecular signals on the surface. Targeted therapy drugs block those signals, leading to the death of cancerous cells.
Risk factors of Basal Cell Carcinoma
- The exposure of skin to UV light can result in random mutations in the skin cells, resulting in basal cell carcinoma.
- The body parts in direct contact with the sunlight are more prone to skin cancer.
- There is always a risk of recurrence of basal cell carcinoma even after successful treatment.
- The history of basal cell carcinoma increases the chances of squamous cell carcinoma.
- After a while, it can metastasize to the surrounding organs and lymph nodes.
Stages of Basal cell carcinoma
- Stage 0 - It is the initial stage where cancer is present only in the epidermis of the skin and is termed carcinoma in situ.
- Stage 1 - Tumor spreads to the dermis layer of skin with a size of 2 cm.
- Stage 2 - Cancerous cells become larger and may display perineural invasion.
- Stage 3 - At this stage, cancer spreads to muscles, bones, cartilage, and lymph nodes.
- Stage 4 - It is the last stage where cancer cells spread to the brain or lungs.
Diagnosis of Basal cell carcinoma
Dermatologists conduct many physical exams to assess the changes or growths in the skin. The doctor determines the patient’s family history and features of the changes in the skin before deciding the appropriate treatment. The doctor also observes other parts of the skin for lesions. The doctors may also perform a skin biopsy by removing a small portion of a skin lesion for testing.
The doctor typically asks the following questions from the patients:
- Do you spend time in direct sunlight?
- Do you use sunscreen daily?
- Have you used tanning beds?
- Is there a spot on the skin that bleeds and doesn’t heal?
- When did this skin growth start in your body?
- Do you have a family history of skin cancer?
Primary Prevention of Basal Cell Carcinoma
There are multiple ways to prevent basal cell carcinoma:
- Avoid prolonged exposure to sunlight between 10 am to 4 pm.
- Use a broad-spectrum sunscreen of around 30 SPF every day.
- Cover your skin with tightly woven clothes and broad-brimmed hats.
- Wear sunglasses to block the UV radiation.
- You must avoid tanning beds since they emit UV rays and increase the risk of skin cancer.
- If you observe sudden skin growth, freckles, or bump, you must consult a dermatologist.
Secondary Prevention of Basal Cell Carcinoma
- Regularly checking body parts, including the genitals.
- Screening for skin cancer
- Using chemical agents to prevent recurrence of cancer
- Cutaneous screening by dermoscopy
Alternate name of Basal Cell Carcinoma
> Skin cancer
Epidemiology of Basal Cell Carcinoma
Men are more prone to basal cell carcinoma than women. Old age and people who have already recovered from skin cancer are at risk of BCC. Many studies revealed that skin cancer is more common in white people than in black. It is more likely to affect people with light eyes and fair skin.
Basal cell carcinoma has the least risk of spreading to the surrounding organs and almost all the patients can be cured. Even after the treatment, there are chances of recurrence of the cancer. It is advisable to look out for symptoms or changes in the skin regularly.
If left untreated, basal cell carcinoma has the chance of increasing by the size of 3.3% every month. It gradually spreads from epidermis to dermis and eventually to bones, muscles, tissues, or lymph nodes.
Pathophysiology of Basal Cell Carcinoma
Basal cells are responsible for producing new skin cells, followed by pushing off older cells to the surface and sloughing them off. Due to mutation in the basal cells, they rapidly multiply and grow continuously. This results in the build-up of abnormal cells, appearing as lesions on the skin.
Possible complications of Basal Cell Carcinoma
There is a risk of recurrence of basal cell carcinoma even after complete treatment. It can result in the development of other types of skin cancer like squamous cell carcinoma. Under severe conditions, cancer cells might spread to the brain or lungs.
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