Basal cell carcinoma (BCC), also known as a nonmelanoma cancer, is one of the most common forms of skin cancer. Patients diagnosed with BCC often have more than one primary tumours formed over time.
There has been identified a number of risk factors associated with basal cell carcinoma. Age and sex are one of them. The higher prevalence of BCC is observed in elderly males. However, females and younger adults can also be diagnosed with BCC. Other risk factors include sun damage, past history of BCC or other form of skin cancer, and previous series of sunburns. Additionally, inherited syndromes like basal cell naevus syndrome (Gorlin syndrome), Rombo syndrome, or xeroderma, contribute to the formation of BCC.
The cause of basal cell carcinoma is multifactorial. Usually, DNA mutations found in the patched (PTCH) tumour suppressor gene lead to the development of BCC. These mutations can be triggered due to ultraviolet (UV) radiation. Moreover, different spontaneous and inherited gene defects contribute to the development of BCC.
Basal Cell Carcinoma (BCC) is known as a locally invasive skin tumour. The main clinical features include the following:
BCC is diagnosed clinically based on the presence of a skin lesion that slowly increases in size and has a typical appearance. The diagnostic biopsy or excision is done to pathologically confirm the diagnosis and histological subtype of BCC.
The treatment for a BCC is determined based on its type, location, and size as well as patient’s personal factors. Majority of cases are treated surgically. Regular long-term follow-ups are scheduled in order to check for recurrence and formation of new lesions.
Excision biopsy is one of the treatment options. It involves cutting out the lesion and stitching up the skin. Further surgery may be required for lesions that have not been removed completely.
Mohs micrographically controlled surgery involves a careful examination of each layer of excised tissue under the microscope in order to ensure that complete excision was performed. This type of surgery is usually used in high-risk areas, such as areas around eyes, nose, and/or lips.
Superficial skin surgery involves shave, curettage, and electrocautery. This is a rapid technique which does not require any sutures; however, local anaesthesia is used. It is suitable for small and well-defined nodular or superficial BCCs. The affected lesions are usually found either in a trunk or limbs. The wound is left open to heal by secondary intention. The moist wound dressings facilitate the healing process.
Cryotherapy refers to the treatment of a superficial skin lesion administrated by freezing it, usually by using liquid nitrogen. The double freeze-thaw technique is used. It is mostly used on small superficial BCCs on covered areas of limbs and trunk. After spraying the liquid nitrogen over the affected area, the blister forms then crusts over and eventually heals after a few weeks. The permanent white mark will be left.
The most important way to prevent occurrence of BCC is to avoid getting sunburns, especially during childhood years. Individuals with fair skin and those who have a personal or family history of BCC should be always protect themselves from sun exposure on daily basis regardless of their age. Some of the general recommendations include staying indoors or under the shade, avoid indoor tanning (e.g. solaria and sun beds), wearing covering clothing, and applying high protection SPF50+ broad-spectrum sunscreens.
Majority of BCC cases are cured with proper treatment, The successful cure is most likely to occur if treatment is administrated when lesion is small.
Approximately half of individuals diagnosed with BCC will develop a second one within a 3-year interval. They are also at greater risk of getting a different form of skin cancer, especially melanoma. Regular follow-up skin checks and self-skin examinations are highly recommended.
Centre for Medical and Surgical Dermatology offers different Basal Cell Carcinoma (BCC)
treatments unique to each patient.
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