Basal cell carcinoma is a common form of cancer that develops on the surface of the skin. Most of the times, it is characterized by a crusted papule. Basal cell carcinoma is one of the most common cancers among people with fair skin, affecting about 3 out of 10 Caucasians around 50 years of age. Its development is correlated with exposure to sunlight and ultraviolet radiation.
The skin is subject to three types of cancer: squamous cell carcinoma, melanoma, and basal cell carcinoma. Basal cell carcinoma, which develops from cells of the epidermis, is the most common form of skin cancer, with 800,000 new cases every year in the United States alone. While other parts of the body may be affected by the tumor, basal cell carcinoma occurs mainly on sun-exposed skin areas like the head and neck.
Unlike many types of cancer, most basal cell carcinomas are effectively treated by surgery with a low risk of recurrence when detected early. However, if left untreated, the tumor can develop rapidly and lead to destructive expansion, particularly in the face. Basal cell carcinomas rarely lead to the development of metastases.
Causes
Basal cell carcinoma develops when the cells of the outermost layer of your skin are damaged and multiply abnormally. Most common factors that can cause skin cells to mutate and become cancerous include:
UV Rays and Sunburn – Basal cell carcinoma develops from cells in the epidermis, particularly the epidermal cells of head and neck. The tumor develops most often on parts of the body that are exposed to sunlight. This is why people who are frequently and extensively exposed to sunlight are more often victims of skin cancers, including basal cell carcinoma. Therefore, chronic exposure to UV radiation and frequent sunburns are considered to be two major risk factors of basal cell carcinoma.
Chronic exposure to certain chemicals – Environmental factors such as certain herbicides, some petroleum products, and arsenic exposure may contribute to the development of basal cell carcinoma and other cancers. The risk is even higher in peoplepredisposed to the disease or those who start those habits during childhood.
Inherited disorders – Certain genetic medical conditions such as albinism, Gorlin’s syndrome (nevoid basal cell carcinoma syndrome), Bazex’s syndrome and xerodermapigmentosum are found to increase the risk of basal cell carcinoma.
Immunosuppressivemedications – Prolonged use of agentsor drugs that inhibit or weaken the immune system can lead to basal cell carcinoma and other types of cancers.
Chronic wounds – Chronic skin ulcers and/or wounds may contribute to the occurrence of basal cell carcinoma.
People at Risk of Basal Cell Carcinoma
Basal cell carcinoma can affect people of any gender, race, or medical history. However, you are more likely to have basal cell carcinoma, if you fall into one of these groups:
- people who have white skin, blue or green eyes, and blond hair
- patients who have a history of melanoma or squamous cell carcinoma
- people who have suffered a significant sun exposure for several years, especially in childhood
- patients who have been exposed to ionizing radiation or ultraviolet light for therapeutic or professional reasons
- people who have been in contact with chemical preparations that include more than five percent of crude coal tar
- people who received cancer treatment such as chemotherapy or radiotherapy
- people who have undergone immunosuppressive therapy due to certain medical reason such as heart or kidney transplant
- people who have scars from severe burns
- people who have many moles
- people who have actinic keratosis – scaly or crusty bump that develop on the skin’s surface
- people over 50 years old
- people living at high altitudes or near the South Pole such as Australia
- people who work outdoors and are constantly exposed to sunrays like farmers, construction workers, etc.
- people who have weakened immune systems such as HIV victims, cancer patients, and those who had organ transplant
- people who work as welders, boilermakers, or printers
Basal Cell Carcinoma Symptoms
Basal cell carcinoma manifests in the form of a white bumps or as a scaly, brown or flesh-colored patch which develops on the surface of the skin. Unlike other ordinary skin lesions, the ulcer does not heal and tends to repeatedly bleed. In nearly 8O% of basal cell carcinoma, the lesion develops in sun-exposed regions of the body: head and neck, especially on the inner corner near eye, nasolabial fold, forehead, temples, scalp, and the upper front of the body.However, in severe cases, the tumor may be located on other areas of the body like the mouth or genitals.
Basal Cell Carcinoma Complications
Basal cell carcinoma is the most common type of skin cancer; nevertheless, it rarely causes complications. However, if left untreated or poorly treated, it can give rise to metastases. Certain forms of basal cell carcinoma can become very dilapidated and invade nearby muscles, nerves, and bone. Although controversial, basal cell carcinoma can increase the risk of developing squamous cell carcinoma or malignant melanoma.
Basal Cell Carcinoma Diagnosis
Your oncologist will ask you questions about your medical history. In addition, he will perform a physical examination looking for clinical signs of basal cell carcinoma. This examination will help him detect not only the tumor but also the type of cancer you have. Depending on the appearance of the tumor and the results of microscopic examination, basal cell carcinoma is divided into many subtypes. The most common include:
- Cicatricial basal cell carcinoma: Also called morpheaform basal cell carcinoma or morphoeic basal cell carcinoma, this subtype of basal cell carcinoma develops as small papular and translucent patch, which gradually spread and turn into a central white scar-like patch covered with small hemorrhagic crusts.
- Rodent ulcer: Also known as a Jacobi ulcer, a rodent ulcer is a form of basal cell carcinoma characterized by a slow growing ulceration of the skin that usually appears on the face. Although named “rodent ulcer,” the tumor is not caused by rodents.
- Nodular basal cell carcinoma – This subtype of basal cell carcinoma is often called “classic basal cell carcinoma.” It tends to develop as a waxy, translucent papule with a central depression and a few small erosions. The papule has a smooth surface with small, dilated blood vessels (telangiectasia).
- Cystic basal cell carcinoma: Cystic basal cell carcinoma is often mistakenly taken for nodular basal cell carcinoma because they have almost the same characteristics. The tumor ischaracterized by dome-shaped, blue-gray cystic nodules. Usually, the center of the lesion contains a clear mucin that has a gelatin-like consistency.
- Basal cell carcinoma Pigmented: This type of carcinoma is characterized by brown-blacklesions that are clinically closed to those of melanoma and seborrheic warts. In general, the lesions are numerous and pigmented.
- Superficial basal cell carcinoma: This subtype of basal cell carcinoma is characterized by multiple circumscribed erythematosus patches that tend to develop on the upper trunk or shoulders. Unlike most basal cell carcinomas, the patches grow slowly and can develop on any area of the skin.
Skin biopsy
After typical signs of basal cell carcinoma have been found, your oncologist will take a skin sample in the affected area to be examined under a microscope. The biopsy will be performed by a skilled pathologist who will be able to confirm if you have basal cell carcinoma or not.
Basal Cell Carcinoma Treatment
To treat your basal cell carcinoma, your oncologist will take into consideration several factors such as age, severity of the tumor, appearance, size, etc. Nowadays, several methods of treatment are available to eradicate a skin cancer: electrocautery, surgery, cryosurgery, radiotherapy, and chemotherapy. Sometimes, the therapies require the cooperation of several specialists.
Cryosurgery
This method aims to destroy the cancer cells by using extreme cold. During the procedure, the specialist applies liquid nitrogen on the diseased tissue for a few seconds, which freezes the tumor and destroys cancer cells. In general, cryosurgery is performed to treat very small cancers and pre-cancerous or abnormal skin changes.
Surgical excision
This surgical technique involves removing the cancer of the skin with a portion of surrounding healthy tissue. Surgical excision can be used in the successful treatment of medium-size basal cell carcinomas. However, it often leaves scars.
Cauterization
Also called electrosurgery, cauterization consists of burning the tumor and then removing it with a sharp instrument called curette. Because of its effectiveness in the removal of small tumors, cauterization is often performed to treat basal cell carcinoma. It may leave a scar, which can be recovered by a skin graft.
Radiation therapy
Radiation therapy is a local regional treatment, consisting of using high energy rays to kill cancer cells and to shrink or completely eradicate a tumor. Unlike chemotherapy, radiation therapy treats a precise area of the body, which means it has little impact on normal cells. Depending on the size of the tumor, radiotherapy can be used alone or in combination with surgery or chemotherapy.
Chemotherapy
Chemotherapy is a cancer treatment consisting of using very strong drugs to destroy cancer cells in the entire organism. Most of the time, chemotherapy medications are taken in pill form or intravenously to kill or slow down the proliferation of cancer cells. In the treatment of basal cell carcinoma, chemotherapy drugs are mostly administered in the form of cream (tazarotene, imiquimod, 5-fluorouracil, and others) or lotion. In fact, chemotherapy is rarely used in the treatment of basal cell carcinoma; it is used only when the cancer has spread into other parts of the body.
Basal Cell Carcinoma Prognosis
Unlike many types of cancer, basal cell carcinoma prognosis is not heart breaking, especially if it is diagnosed early, and treated with appropriate therapies. Most basal cell carcinomas are treated successfully. In fact, the recurrence risk of basal cell carcinoma after treatments is low. However, if left untreated or poorly treated, basal cell carcinoma can lead to serious complications or death.
It is important that you do a self examination of your skin regularly to detect any changes in your skin. This practice can help you detect skin cancer in their genesis and prevent complications. See your doctor if you discover signs related to basal cell carcinoma or any type of skin cancer.
Basal Cell Carcinoma Prevention
If you want to prevent basal cell carcinoma, it is important that you avoid prolonged sun exposure, especially if you are at risk. Other preventive measures include:
- perform regular self-examination of your skin
- increase your vitamin D intake (respect the recommended dose by your nutritionist)
- wear protective clothingif you go outside during sun-light. You can protect your skin by wearing hats, long-sleeved shirts, long skirts, or pants
- apply effective sunscreens with SPF (sun protection factor) – always look for sunscreens that block both UVA and UVB light
- apply sunscreen at least 30 minutes before going outside, and reapply it frequently
- reduce bad cholesterol in your diet: egg yolk, organ meats (brain, kidney, liver), nuts, almonds, lobster, shellfish, fish eggs, etc.
- consume polyunsaturated fatty acids such as omega-6 (sunflower oil) omega 3 (flax seed oil, fish oil) as they lower the bad LDL cholesterol in your blood and prevent formation of a blood clot.
- Eat plenty of fruits (2 to 3 per day), vegetables (3 to 4 servings per day), polyphenols (moderate consumption of wine and green tea) and phyto-oestrogens: soy, green tea, chickpeas, lentils, beans, grains, carrots, fennel, onions, garlic, etc.
