Basal Cell Carcinoma : Description, Management and Natural Treatment With Advice For Patient
Description
● A slow-growing, locally invasive malignant tumour of the epidermal keratinocytes normally in older individuals, only rarely metastasises
● Most common malignant skin tumour
Causes
● Risk factors include UV exposure, history of frequent or severe sunburn in childhood, skin type I (always burns, never tans), increasing age, male sex, immunosuppression, previous history of skin cancer, and genetic predisposition
Presentation
● Various morphological types including nodular (most common), superficial (plaque-like), cystic, morphoeic (sclerosing), keratotic and pigmented
● Nodular basal cell carcinoma is a small, skin-coloured papule or nodule with surface telangiectasia, and a pearly rolled edge; the lesion may have a necrotic or ulcerated centre (rodent ulcer)
● Most common over the head and neck
Management
● Surgical excision - treatment of choice as it allows histological examination of the tumour and margins
● Mohs micrographic surgery (i.e. excision of the lesion and tissueborders are progressively excised until specimens are microscopically free of tumour) - for high risk, recurrent tumours
● Radiotherapy - when surgery is not appropriate
● Other e.g. cryotherapy, curettage and cautery, topical photodynamic therapy, and topical treatment (e.g. imiquimod cream) - for small and low-risk lesions
Complications
● Local tissue invasion and destruction
Prognosis
● Depends on tumour size, site, type, growth pattern/histological subtype, failure of previous treatment/recurrence, and immunosuppression
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