A Family Doctor's Tale - BASAL CELL CANCER

DOC I HAVE BASAL CELL CARCINOMA
 Basal cell carcinoma typically occurs on the face. 
Although common for skin cancer, it is relatively rare in Singapore. The one patient that I saw was an old lady with a typical ulcerated papular skin swelling at the bridge of her nose. It was slow growing. She responded well to 5-fluorouracil cream with complete disappearance of the cancer after 1 month.  
She had no recurrence since the treatment.

Basal cell carcinoma is a localized malignant tumor of the basal cells of the skin which seldom spread beyond its location.

It is the most common skin cancer.

It usually occurs in fair skinned people above the age of 50.

It is never life threatening.

Basal cell carcinoma is more common in :
People with fair skin than in those with darker skin.

People with a family history of Basal cell carcinoma.

Familial cases of Basal cell carcinoma with
1.autosomal dominant genes(basal cell nevus) and

2.xeroderma pigmentosum (autosomal recessive)

are more common especially in fair skin people.

People who spend time outdoors under the sun than those staying indoors.

Exposure to the sun is one of the most common causes of Basal cell carcinoma.

The majority of basal cell carcinomas occur on sun-exposed areas of the body.

Risk factors are:
1.intensity of the sun

2.duration of sun exposure,

3.age when sun exposure takes place

4.degree of skin pigmentation

Environmental causes:
1.Arsenic exposure in certain occupations(preparation of arsenic products)

2.Exposure to X-ray radiation especially radiotherapy



Symptoms and Signs:
1.Nodular: flesh-colored papule with capillaries which can become ulcerated ( called rodent ulcer )

2.Cystic: less common with a central cystic cavity.

3.Pigmented: pigmented nodular form

4.Sclerosing: looks like a keloid

5.Superficial: a red scaly flat lesion.

Basal cell carcinoma can present as:
1.firm nodule which grows within the skin and below it

2.Color may be like normal skin, dark brown or black.

3.Border is characteristic rolled up edge

4. red, flat, scaling areas similar to a patch of eczema.

Diagnosis is confirmed by:
1.Skin biopsy under local anesthesia

2.small lesions can be totally removed 

3.larger ones are biopsied first and surgically removed if there is confirmed malignacy.

Complications are:
1.local growth and destruction of neighbouring tissues (e.g. nose).

2.Growth into vital structures resulting in the loss of extension or function

3.rarely metastases or cause death. 


Treatment of Basal Cell Carcinoma:
Surgery:
Most basal cell carcinomas are removed by surgical excision with margins of 4-6mm.

Chemotherapy:
local therapy with 5-fluorouracil(a chemotherapy agent) with 70-90% success rate

Radiation:
Radiation therapy may be used in older patients not suitable for surgery.

Cryosurgery:
Cryosurgery can be done for basal cell cancer that invades cartilage.

Mohs surgery:
Mohs micrographic surgery is an outpatient procedure in which the cancer nodule is surgically excised and then immediately examined under a microscope. The base and edges are microscopically examined to confirm no evidence of malignancy before repair is done.

Immunotherapy:
Immunotherapy research indicates that treatment with Euphorbia peplus, a common garden weed, may be effective against Basal cell carcinoma.

Prognosis of majority of cases is good if there is complete removal.

Sclerosing lesions are harder to treat because they invade deeper into the tissues.

Prevention is by:
1.Avoid the direct sun (long-sleeved shirts, long trousers, and broad-brimmed hats). Use sunscreens.

2.Good nutrition and healthy lifestyle boost the immune system and helps prevant malignancy.

3.Patients with family history of skin cancer should be reviewed yearly