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Basal cell carcinoma

Basal cell carcinoma (BCC) is the most common skin cancer. It can be destructive and disfiguring. Risk is increased for individuals with a family history of the disease and a high cumulative exposure to UV light via sunlight or, in the past, carcinogenic chemicals especially arsenic. Treatment is with surgery, topical chemotherapy, x-ray, cryosurgery, photodynamic therapy, or topical immune enhancement drugs such as imiquimod. It is rarely life-threatening but if left untreated can be disfiguring, cause bleeding and produce local destruction (eg., eye, ear, nose, lip). more...

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Forms

Various forms are recognised:

  • Nodular: flesh-colored papule with telangiectasis. If it ulcerates, it becomes a "rodent ulcer" (ulcus rodens), an ulcerating nodule with (often) a pearly border.
  • Cystic: rarer and hard to distinguish from the nodular form. It has a central cavity with fluid.
  • Pigmented: a variant of the nodular form that may be confused with melanoma.
  • Sclerosing/cicratising: a scar-like lesion.
  • Superficial: a red scaling patch

About two thirds of the carcinomas occur in sun-exposed areas and onw third occur in non-sun-exposed areas, emphasizing the genetic susceptability of the basal cell cancer patients.

Diagnosis

To diagnose, a biopsy (where tissue is taken for pathological study) is done using local anesthesia. In small lesions, the tumor is generally removed in its entiriety, while larger ones are biopsied first and surgically removed later if it is confirmed that it is malignant.

Histopathology: Basal cell carcinoma is a malignant epithelial tumor arising only in skin, from the basal layer of the epidermis or of the pilosebaceous adnexa. Tumor is represented by compact areas, well delineated and invading the dermis, apparent with no connection with the epidermis. Tumor cells resemble normal basal cells (small, monomorphous) are disposed in palisade at the periphery of the tumor nests, but are spindle-shaped and irregular in the middle. Tumor clusters are separated by a reduced stroma with inflammatory infiltrate. 1

Pathophysiology

Basal cell carcinomas develop in the basal cell layer of the skin. Sunlight exposure leads to DNA crosslinking between thymidine residues. While DNA repair removes most UV-induced damage, not all crosslinks are excised. There is, therefore, cumulative DNA damage leading to mutations. Apart from the mutagenesis, sunlight depresses the local immune system, possibly decreasing immune surveillance for new tumor cells.

Prevention & Early Diagnosis

Basal cell carcinoma is the most common skin cancer. It occurs mainly in fair-skinned patients with a family history of this cancer. Sunlight is a factor in about two thirds of these cancers, but one third occur in non sun-exposed areas. Therefore, dermatologists recommend sun screens and annual skin cancer exams to prevent or provide early detection of this common tumor.

Treatment

Most basal cell carcinomas are removed surgically by dermasurgeons. A common method is "electrodessication and curettage" (ED&C). This is done by scraping the tumor out with a curette and cauterizing the base and margins. The wound is left to heal by itself (secondary intention healing). The cure rate and cosmetic result are excellent, especially in concave areas. It is also the most cost effective treatment. Surgical excision by the dermasurgeon is another option with the margins of excised tissue examined under the microscope. Certain types, like the sclerosing basal cell cancers may need a wider margin, as they develop subtle processes that project outside the visible part of the tumor.

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The Skin Cancer Answer : The Natural Treatment for Basal and Sqamous Cell Carcinomas and Keratoses $0.72 Imiquimod effective treatment for molluscum contagiosum, basal cell carcinoma, and more.(General Dermatology) : An article from: Dermatology Nursing $5.95
Saving Face $1.50 DNA repair enzyme lotion may cut malignancies. (Actinic Keratosis, Basal Cell Carcinoma). : An article from: Skin & Allergy News $5.95
BCC and SCC pose different threats. (Separate Diseases).(basal cell carcinoma; squamous cell carcinoma) : An article from: Skin & Allergy News $5.95 Pre-Mohs imiquimod treatment recommended: be wary, however, of using this approach with any type of sclerosing basal cell carcinoma.(Dermatologic Theraphy) : An article from: Skin & Allergy News $5.95
Basal cell carcinoma metastatic to the parotid: Report of a new case and review of the literature : An article from: Ear, Nose & Throat Journal $20.00 Gale Encyclopedia of Alternative Medicine : Skin cancer $4.70
New mechanism found for imiquimod in BCC.(Dermatologic Therapy)(Basal cell carcinomas) : An article from: Skin & Allergy News $5.95 Imiquimod offers alternative for select superficial BCCs: cure rates, however, are not comparable to such simple destructive techniques as electrodesiccation ... : An article from: Skin & Allergy News $5.95

Odontogenic keratocysts in nevoid basal cell carcinoma syndrome: CT and MRI evaluation
Abstract We describe the imaging findings in a 13-year-old boy with nevoid basal cell carcinoma syndrome (NBCCS). The initial imaging work-up included ...
Celecoxib in preventing basal cell carcinoma in patients with basal cell nevus syndrome - Clinical Trial Review
This study is currently recruiting patients. Sponsored by University of California at San Francisco, National Cancer Institute (NCI) Chemoprevention ...
Aldara™ Cream to treat basal cell carcinoma - Imiquimod - Clinical Trial Review - Brief Article
This study is currently recruiting patients. Sponsored by Warren G Magnuson Clinical Center (CC) This study will evaluate the effectiveness of Aldara ...
Clinical clearance of basal cell carcinoma with topical cidofovir - Washington Whispers - Brief Article
In this case report, four patients are described with basal cell carcinomas (BCC) treated with 1% topical cidofovir. Cidofovir is a purine nucleotide ...
Diagnosis and treatment of basal cell and squamous cell carcinomas
Rates of squamous cell and basal cell carcinomas have been increasing, possibly as a result of increased exposure to ultraviolet radiation. Primary care ...
Axillary basal cell carcinoma: a need for cutaneous examination
Basal cell carcinoma is the most common skin malignancy. While this lesion most often occurs in sun-exposed areas of the skin, it can also develop in sites ...
Nevoid basal cell carcinoma syndrome and fetal rhabdomyoma: a case study
Abstract Fetal rhabdomyoma is not generally considered part of nevoid basal cell carcinoma syndrome. However, a review of the literature revealed five patients with this syndrome who also had fet
Once-Daily Imiquimod Promising Therapy for Basal Cell Carcinoma - Brief Article
WASHINGTON -- Imiquimod continues to show efficacy in the treatment of superficial basal cell carcinomas, Dr. John K. Geisse reported in a poster session ...

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