Basal cell carcinoma, also called Non melanoma skin cancer or Rodent ulcer is the most prevalent skin cancer among humans (almost 80%). This epithelial tumor stems from the round basal cells located in the epidermal layer.Even though the morphologically or functionally abnormal basal cells invade the skin but rarely metastasize or target the other body areas. The most preferred location of these destructive neoplasms is the nose or ala (constitutes 70% of all reported cases) followed by the torso, reproductive parts such as vulva.
Some of the chief contributing factors for initiation and growth of Basal cell carcinoma is prolonged exposure to sunlight and chemicals like paraffin or arsenic as well as radiation exposure. Mutations in the specific genes (TP53) have a role too. Interestingly, this skin cancer becomes more likely with advancing age and has a predilection for people in the age slot of 55-70 years.The treatment of Basal cell carcinoma is determined after keeping many factors in mind, some of which include the general health of the patient, the type, size and location of the tumor. Take a look at the common treatment options for this cancerous tumour mass.
The Goal Of Treatment
As mentioned in 2011 National Comprehensive Cancer Network Clinical Practice Guidelines For Oncology, the aim of Basal cell carcinoma treatment is to excise the tumor mass and damaged tissue with maximal preservation of aesthetics and functional ability.
Effective Treatment Options For Basal Cell Carcinoma
Excision Surgery
This mode of treatment involves the exclusion of the neoplasm while preserving the cosmetic appearance. A surgical route is, by far the most efficacious and extensively used skin cancer treatment. Using a dermatoscope that enables the experienced surgeon precisely view the collection of neoplastic cells, he/she understands the significance of the width of marginal tissue to be removed.If for tumors with small dimensions (below 6 mm), 4mm of surrounding tissue, which displays no, neoplastic changes (known as free surgical margin) is excised, the chances of recovery are bright (almost by 95% or more).The same goes for big sized basal cell carcinomas in which a surgical margin of 6mm is obtained. Failure to do so while performing simple or surgical excision can result in recurrence rates as high as 38%. The only shortcoming of this surgical intervention is the lack of precision needed to determine the exact marginal tumour tissue to be excise
Mohs’ Surgery
Unlike simple excision, Mohs’ micrographic surgical procedure is always performed by a well experienced Mohs’ surgeon, in Basal cell tumor cases which are challenging to separate. This happens due to the aggressiveness of certain Basal cell carcinoma types to infiltrate the adjoining areas. The below given information explains how this surgical procedure is different from the other surgeries.As soon as the tumor is excised, it is instantly examined under the microscope in relation to the tumour margin. In case the tumor cells are still left, more tissue excision is accordingly done.The repeated microscopic evaluation of the base and tumor edges during the surgery ensures reduced recurrence rate as compared to other treatment modalities. The cons, however, include the exorbitant and time consuming nature of the procedure.
Curettage And Electrodessication
The purpose of this curative procedure is to destroy the abnormal collection of tumor cells with the help of an electrocautery device. After curettage, the application of an electric current makes the skin soft enough for the surgical knife to deeply and cleanly cut through the subsequent layers.This completes the first cycle. With each cycle, (3-5 cycles in all) the destruction caused by the infiltration of the tumor is removed and a healthy, safe margin measuring approximately 4 to 6 mm is targeted.The rate of success after the process is decided by taking several factors into consideration. These include the type and dimension of Basal cell carcinoma. This method is preferred for aesthetically less conspicuous regions or for those tumors which are easier to access, for example, the torso. In case of recurrent tumors, Curettage and Electrodessication is not the preferable choice of treatment.
Cryosurgery
Cryosurgery has been a treatment option for many types of skin cancers since several years. This treatment procedure requires special tools along with thermocouple. Liquid nitrogen is utilized as cryogen to freeze the atypical cells, thus eliminating the need for administration of anesthesia.The mechanism involved in freezing the cells is the lightening fast heat transfer from the skin to the liquid nitrogen which evaporates off instantly.Some of the immediate complications associated with cryotherapy include pain, blister formation or headache. Infection and haemorrhage are some of the complications that do not surface immediately.The disadvantages are increased risk of hypopigmentation or the multiple number of cryosurgery sessions before the tumor resolves thoroughly, followed by an extended healing time.
Photodynamic Therapy
This is an unconventional form of treatment based on certain photosensitizers that interact with light leading to a chemical reaction confined to a local area. The procedure is valid for many skin conditions such as psoriasis as well as skin cancer.Once the selected photosensitizing agent is topically spread over the targeted area, it is stimulated via a light source. The cancer cells have an affinity for the photosensitizer and will thus accumulate more of it. This is what makes the process highly effective.One of the key reasons for its preference as a beneficial alternative is the non toxic and minimally invasive nature of the therapy. In tumours of bigger size, the treatment may need to be repeated.
Radiation
Radiation dose either provided as internal or external radiotherapy is applicable for use in all types of Basal cell carcinoma. Patients of more age are generally not the best candidates for undergoing surgical treatments.Regardless of the age, some patients do not want their facial skin or features to be disfigured and sometimes, the surgeons deliberately leave a certain portion of tumor or affected tissue behind that are dangerously close to certain nerves.Even though, radiation treatment is noninvasive and pain free, this non surgical mode of treatment is linked with certain immediate or delayed side effects such as ulcerations, erythema, skin rash or secondary cancer.
Topical Immunotherapy
To treat superficial Basal cell carcinomas, a cream known as Imiquimond has been formulated. The cream is applied onto the outgrowth as per the doctor’s instruction and assists in stimulating the immune system. Another lotion approved by the U.S Food and Drug Administration is 5-fluorouracil.Although both the topical products are said to bring about 80-90% improvement, some of the adverse effects include skin irritation in the adjacent areas. This necessitates careful use and monitoring by both the patient as well as the doctor.
Drugs To Treat Basal Cell Carcinoma
Vismodegib (commercially available as Erivedge) is a potent drug indicated in the following cases- People diagnosed with Basal cell carcinoma which has spread or metastasized to different parts of the body, patients who are not suited for either surgical procedure or radiotherapy and in cases where the cancerous growth has resurfaced.
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