Basal cell carcinoma is the most common type of all cancers. It is said to attack 30% of all persons some time in life. However, it probably occur in most persons to some degree if one gets old enough. 80% of the occurances are on the head and neck
It grows very slowly and does very seldome spread to other parts of the body than the skin. Therefore it does not threaten the life of the patient, but can destroy large skin areas, give serious cosmetic problems and cause a high degree of discomfort. The cancer is higly variable and it is sometimes difficult to distinguish between this type of cancer and the more dangerous skin cancer, malignant melanoma, so all unnormal growth in the skin should therefore be investigated.
By basal cell carcinoma the lowest cells in the outer skin layer, the basal cells, get unnormal and begin to divide uncontrolably. The cells will spread upwards and to all sides, but more selldom downwards to lower areas of the skin. Indiviual cells only very selldom spread by blood and lymph to remote areas.The cancer is therefore often confined to the epidermis but can also infiltrate deeper layers of the skin. The basal cells are those that normally divide and make replacement for the outer cells of the epidermis, but then in an orderly fashion.
Basal cell carcinoma often appear as irregular lunps that grow and spread at the surface of the skin. It can also appear as irregular flakes of variable thickness that spread on the skin or like thickened scars. The growths can be pale, pearly or shiny, but can also be red or brownish. Sometimes sores develop in the cancerous tissues, and sometimes the cancer appear mainly as sores, often with thicker rims that are spreading.
The types appearing as lumps, so-called nodular basal cell carcinoma, can often be diagosed only from the appearance. Other types must be diagosed by taking a biopsi under local anesthesia to get a certain diagosis, because early occurances very often resamble other types of skin lessions and skin cancers.
Excessive sun exposure is a causing factor of this cancer. Genatic predisposition is another causing factor. People with pale skin get in more easily than people with darker skin. Two thirds of the occurances are on skin surfaces often exposed to the sun.
Basal cell carcinoma can often be prevented by avoiding excessive sun exposure. If one wants to or has to expose the skin for prolonged sunshine, one must use a protective cream with a high shielding factor. for people with eccessive damage in the skin due to sun exposure, cytostatica is sometimes used to prevent the damage to develop further to cancer.
Treatment of basal cell carcinoma is successful in most cases, but it can be difficult to remove all the cancer tissue when it has spread wide or there are many cancerous spots. Bacause the cancer is not usually a life-threatening disease, the method used will often depend upon possible cosmetic results, cost and time duration for treatment.
Surgical excission has been a standard treatment of the disease. For small lessions that do not invade the skin, it is a very simple and succesful treatment.
Chemotherapy with locally applied cystostatica is a simple treatment method with cure rates of 70-90% . The agents most often used are 5-fluorouracil and imiquimod. The drug visimodegib has newly come into use for this disease for recurring occurance and when the cancer has spread to other organs..
Radiation therapy is a traditional treatment with a high degree of success, but used excessively it will damage normal tissue too. It is usually used where it will be complicated to remove the cancer with surgery or where surgery will give bad cosmetic effects. It is often combined with some degree of surgery.
Cryosurgery is destroying the cancer tisue by freezing. Is successful in most cases, but it is difficult to controle the effects of the treatment so that too much normal skin can destroyed by the freezing.
Photodynamic therapy is a newly developed method to treat basal-cell carcinoma. By this methods substances that change the chemical structure when illuminated are applied to the skin. One lets the substance stay on some time to spread into the skin. Then light with the approprtiate frequencies is directed towards the area that is treated. Methyl aminolevulinate is a photosensitizer approved for use in many countries. This therapy is also used in other skin cancer types. The method is mostly used in complicated and extended cases of skin cancer.
By electrodessication and curettage the surface of the affected area is scraped by an appropriate tool. Then the sraped area is heated by elctric current applied to te area, which softens the underlaying tissue. Then the underlaying tissue is scraped. The cycle of scraping and burning is repeated some times. The method is easy to use, but doe not allways give good cosmetic results. It is therefore mostly used at seurfaces where the apearance is not so important.
The herb Euphorbia peplus contains substances that seem to enhance the immune reponce towards the canser and topical drugs with these substances are under development.
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