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Basal Cell Carcinoma

DEFINITION

Basal cell carcinoma is the most common type of skin cancer apart from melanoma. Fortunately, basal cell carcinoma is not likely to spread and easily treated by removal. However, if left alone, basal cell carcinoma can grow large and invade surrounding bone, muscles and nerves. Skin is made of three layers: the epidermis (on the outside), the dermis (the second layer) and the subcutis at the bottom. Basal cell carcinoma comes from the basal cells which live at the bottom of the epidermis. The normal function of basal cells is to reproduce to make new cells to come to the surface of the skin and protect the body. DNA normally controls how the cells grow and reproduce. In cancer, the DNA of some cells gets altered and causes them to grow and reproduce in an uncontrolled manner. Usually the damage to the DNA is caused by damage done by ultraviolet (UV) radiation from the sun. Like many other skin cancers, basal cell carcinoma is caused by exposure to UV sunlight over time. It appears that the more time you spend in the sun, the higher the likelihood that you will have these types of cancers, especially during high-risk times like midday and high-risk locations, like those at high altitude. Preventing UV light exposure by staying out of the sun can help prevent basal cell carcinoma. Other risk factors include exposure to therapeutic radiation (like those used for treatment of psoriasis), exposure to chemical toxins like arsenic, taking immunosuppressant drugs, being a man, having fair skin, being older, having family members with skin cancer, having had skin cancer before, having nevoid basal cell carcinoma syndrome (a genetic condition with basal cell carcinomas), having Bazex’s syndrome (a disease with tumors on the face), or having xeroderma pigmentosum (genetic condition with extreme sensitivity to sunlight). Regular sunscreen use does not decrease the likelihood of getting basal cell carcinoma very much. Unfortunately, if you have one basal cell carcinoma, you are very likely to have another. If treated, basal cell carcinomas usually don’t cause further problems. However, there is one type of basal cell carcinoma, basosquamous carcinoma, which can spread to other parts of the body. Having a basal cell carcinoma can also increase the risk of having other types of skin cancer, so regular skin check-ups by your doctor or dermatologist are necessary.

SYMPTOMS
Pearly white bump on skin, waxy growth on skin, bump with visible vessels on the skin, scaly patch on skin, brown or skin-colored bump on skin, white or waxy scar on skin, bleeding from bump on skin

DIAGNOSIS
Your doctor will talk to you about the history of your skin and do a thorough physical examination. If your doctor finds anything abnormal on your skin, he or she may want to take a sample of your skin (a biopsy). The biopsy is then sent to a pathologist who looks at it under a microscope with special stains to see what kind of growth it is. If your doctor strongly suspects that you have a basal cell carcinoma he or she will likely use a surgical blade to shave off the growth. If the growth is deeper, your doctor may select a different type of biopsy to remove the growth.

TREATMENT
The treatment for basal cell carcinoma depends on the location of the growth as well as the size and depth. One type of removal that your doctor might recommend is called electrodessiccation and curettage (ED and C) which is generally used only for new basal cell carcinomas. Electrodessication and curettage involves alternating scraping the surface of the skin to remove the abnormal cells (curettage) and burning the area with an electric burning instrument (electrodessication). Alternatively, your dermatologist may recommend surgical excision which involves cutting out the area with the cancer as well as some of the surrounding tissue. Your doctor may offer some reconstruction if the cancer is in a visible place, like the face. Another treatment your dermatologist may recommend is freezing the cancer with liquid nitrogen, though freezing tends to take longer to heal and peel more than other treatment options. A more extensive surgical option called Mohs’ surgery is available for cancers that are fast-growing, larger in size, deeper, located on the face, or morpheaform type. Mohs’ surgery involves removing the tumor then looking at the removed cells under a microscope to make sure that every cancer cell was removed. If not all of the cancer cells were removed, your dermatologist will remove more layers until all of the cancerous cells are removed. Your doctor may also offer laser removal of your basal cell carcinoma. In addition to surgical procedures, your dermatologist may recommend a variety of topical medications including tazorotene, imiquimod, or 5-fluouracil. In order to prevent basal cells carcinomas, you should avoid the strongest midday sun, always use sunscreen and reapply frequently, wear clothing that protects the skin from sunlight, check your skin for abnormal growths regularly, eat five fruits and vegetables daily and take vitamin D daily. You should discuss all your treatment options with your dermatologist.

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