Bazalioma or Basal-cell carcinoma (BCC), a skin cancer, is the most common cancer. It rarely metastasizes or kills. However, because it can cause significant destruction and disfigurement by invading surrounding tissues, it is still considered malignant.
Statistically, approximately 3 out of 10 Caucasians may develop a basal-cell cancer within their lifetime. In 80 percent of all cases, basal-cell cancers are found on the head and neck. There appears to be an increase in the incidence of basal-cell cancer of the trunk (torso) in recent years.
Basal-cell carcinomas may be divided into the following types:
Nodular basal-cell carcinoma (Classic basal-cell carcinoma
Cystic basal-cell carcinoma
Cicatricial basal-cell carcinoma (Morpheaform basal-cell carcinoma, Morphoeic basal-cell carcinoma)
Infiltrative basal-cell carcinoma
Micronodular basal-cell carcinoma
Superficial basal-cell carcinoma (Superficial multicentric basal-cell carcinoma)
Pigmented basal-cell carcinoma
Rodent ulcer (Jacobi ulcer)
Fibroepithelioma of Pinkus
Polypoid basal-cell carcinoma
Pore-like basal-cell carcinoma
Aberrant basal-cell carcinoma
For simplicity, one can also divide basal-cell carcinoma into 3 groups, based on location and difficulty of therapy:
Superficial basal-cell carcinoma, or some might consider to be equivalent to "in-situ". Very responsive to topical chemotherapy such as Aldara, or Fluorouracil. It is the only type of basal-cell cancer that can be effectively treated with topical chemotherapy.
Infiltrative basal-cell carcinoma, which often encompasses morpheaform and micronodular basal-cell cancer. More difficult to treat with conservative treatment methods such as electrodessiccation and curettage, or with curettage alone.
Nodular basal-cell carcinoma, which essentially includes most of the remaining categories of basal-cell cancer. It is not unusual to encounter morphologic features of several variants of basal-cell cancer in the same tumor.
Signs and symptoms
Patients present with a shiny, pearly nodule. However, superficial basal-cell cancer can present as a red patch like eczema. Infiltrative or morpheaform basal-cell cancers can present as a skin thickening or scar tissue – making diagnosis difficult without using tactile sensation and a skin biopsy. It is often difficult to distinguish basal-cell cancer from acne scar, actinic elastosis, and recent cryodestruction inflammation.
Prevention
Basal-cell carcinoma is a common skin cancer, but when solar (actinic) keratosis are also considered, basal cell carcinomas are second in prevalence. Basal cell carcinoma occurs mainly in fair-skinned patients with a family history of this cancer. Sunlight is a factor in about two-thirds of these cancers; therefore, doctors recommend sun screens with at least SPF 30. One-third occur in non-sun-exposed areas; thus, the pathogenesis is more complex than UV exposure as the cause.
The use of a chemotherapeutic agent such as 5-Fluorouracil or Imiquimod, can prevent development of skin cancer. It is usually recommended to individuals with extensive sun damage, history of multiple skin cancers, or rudimentary forms of cancer (i.e., solar keratosis). It is often repeated every 2 to 3 years to further decrease the risk of skin cancer.
Treatment
The following methods are employed in the treatment of basal-cell carcinoma (BCC):
Standard surgical excision
Mohs surgery
Chemotherapy
Immunotherapy
Radiation
Photodynamic therapy
Cryosurgery
Electrodesiccation and curettage
Vismodegib
Prognosis
Prognosis is excellent if the appropriate method of treatment is used in early primary basal-cell cancers. Recurrent cancers are much harder to cure, with a higher recurrent rate with any methods of treatment. Although basal-cell carcinoma rarely metastasizes, it grows locally with invasion and destruction of local tissues. The cancer can impinge on vital structures like nerves and result in loss of sensation or loss of function or rarely death. The vast majority of cases can be successfully treated before serious complications occur. The recurrence rate for the above treatment options ranges from 50 percent to 1 percent or less.
