Basal cell carcinoma (skin cancer)

What is basal cell carcinoma?

Basal cell carcinoma is a malignant skin tumor that arises from the transformation of cells in the epidermal layer. While it can invade adjacent tissues and lead to mutations, metastasis is extremely rare. This type of skin cancer is most commonly observed in individuals with fair skin and hair who spend a lot of time exposed to sunlight, occurring more frequently in both men and women.

What does basal cell carcinoma look like? Mostly, it appears as a small nodule, flat plaque, or surface sore that slowly increases in size. In the initial stages, the growth doesn't require immediate surgical intervention, but regular monitoring is necessary. In medical practice, the following forms of the condition are distinguished:

• Recurrent:
  After surgery, remnants in the tissues may lead to the reappearance of the disease. This recurrence occurs due to an inaccurate assessment of the tumor's size.
• Progressive:
  Basal cell carcinoma can grow in size (exceeding 2 cm), significantly complicating surgical removal.

According to doctors, skin basal cell carcinoma develops extremely slowly. Initially, the tumor is small (up to 2 cm) and only affects the surface of the skin or minimally penetrates the deeper layers of the dermis. Over the following two stages, basal cell carcinoma gradually increases to 5 cm and spreads to nearby tissues—bones, muscles, cartilage, lymph nodes. When transformed into squamous cell skin cancer, basal cell carcinoma can metastasize.

Within the first two years from its formation, it is entirely possible to detect and completely remove the nodule to prevent its further growth. If sores or bleeding appear on the surface, this is also a dangerous sign and requires immediate attention from a specialist.

Symptoms of basal cell carcinoma

Basal cell carcinoma (squamous cell skin cancer) has specific symptoms that depend on its type and localization. Among the characteristic signs are the following: a shiny, smooth-surfaced nodule, bleeding and scaling, presence of small blood vessels on the tumor, darkening (or the appearance of blue or brown discoloration), dark spots on the light background of the nodule, a scar with an indistinct edge, increased pigmentation in the affected area.

The basal cell carcinoma rarely occurs in childhood and usually arises due to prolonged exposure to negative factors. It mostly affects children with fair skin, light or red hair. Typically, it appears as a superficial, flat, or nodular basal cell carcinoma accompanied by corresponding symptoms. Additionally, there can be a congenital form known in medical practice as Gorlin-Goltz syndrome. In the hereditary form, there's a characteristic proliferation of numerous growths on exposed areas of the skin, often affecting the skeletal and reproductive systems. At this stage, individuals may experience severe pain.

Causes of occurrence and types of basal cell carcinoma

During the formation of new cells on the surface of the epidermis, there is a gradual dying off and shedding of the old ones. Basal cell skin cancer, or basal cell carcinoma, develops due to damage to the DNA of cells in the lower part of the epidermis. As a result of cell mutations, they start to rapidly multiply and grow, leading to their accumulation and the formation of a tumor.

Basal cell carcinoma arises under the influence of the following factors:

• Ultraviolet radiation
• Sunburns on the skin's surface
• Actinic keratosis
• Genetic predisposition
• Use of immunosuppressants
• Exposure to arsenic

The development of basal cell carcinoma can also be triggered by past skin injuries, thermal burns, sebaceous nevi, and discoid lupus erythematosus. There's a significantly increased risk of developing basal cell carcinoma after undergoing a course of psoriasis or acne treatment involving skin irradiation with ultraviolet light and the use of a photosensitizing substance. Therefore, it's essential to inform the doctor about past illnesses, dates, and the nature of procedures before starting therapy.

Depending on their external appearance, new growths can be of several types:

1. Nodular (solid) basal cell carcinoma: A shiny pinkish nodule with a smooth surface, primarily occurring on the face. This type of pathology is the most common.
2. Sclerosing (morphoeic) basal cell carcinoma: A dense yellowish plaque that can appear on any area (face, trunk, limb extremities). It occurs relatively rarely, but ulcers may develop in later stages.
3. Superficial basal cell carcinoma: Appears as a shiny patch of pink color with uneven borders, usually found on the shoulders, chest, or back. It mainly occurs in young individuals.
4. Ulcerative basal cell carcinoma: Resembles a light-pink or reddish nodule that enlarges over time, with the development of small blood vessels on the surface. It's a consequence of the development of nodular basal cell carcinoma.
5. Sclerosing basal cell carcinoma: Resembles a scar with indistinct edges and often appears on the face. It may extend deeper into tissues along nerve pathways.
6. Metatypical basal cell carcinoma: A combination of squamous cell and basal cell carcinoma. This type of growth is the most dangerous as it can metastasize when spreading.

To determine the type of illness, it's necessary to undergo a series of clinical examinations and be examined by a specialist. During the examination, the doctor also considers the characteristic signs of the pathology.

Complications

The main feature of the illness is the risk of recurrence even after timely and successful treatment. Moreover, superficial basal cell carcinoma in adults can trigger the development of other types of malignant tumors affecting the skin, oral cavity, esophagus, bronchi, trachea, rectum, and genital organs.

Diagnosis and treatment of basal cell carcinoma

During the appointment, a dermatologist conducts a skin examination and inspects the affected area using a dermatoscope. Through multiple magnifications, this examination studies the structure and shape of the new growth, symmetry, and level of safety. This method allows for a highly precise assessment (over 80%) of the tumor's condition and determination of its nature.

In certain cases, consultation with an oncologist may be necessary to establish a diagnosis. If basal cell carcinoma is suspected, a general and biochemical blood test is prescribed to detect any disruptions in the functioning of internal organs. Additionally, a skin sample is taken to determine the nature of the tumor (benign or malignant). Based on the obtained diagnostic results, the doctor prescribes further therapy.

Treatment of skin basal cell carcinoma is carried out using modern therapy methods, the choice of which depends on the stage and type of tumor, extent of tissue involvement, patient's age, and specific conditions. Among the common methods are:

• Cryotherapy - removal of the growth using liquid nitrogen at -196°C. However, there might be a chance of recurrence since it's challenging to control the depth of tissue destruction. This method is considered the most delicate and is used, for example, when the basal cell carcinoma is on the nose.
• Laser therapy - involves cutting and cauterizing tissues to prevent infections. The main advantage is the absence of side effects and the need for additional treatment. It's mainly applied for tumor removal on the face.
• Surgical treatment - the classic method involves excising the nodule, sending samples for analysis, and suturing the wound. If the analysis shows the presence of cancerous cells, the wound is cauterized with an electrocoagulator. Postoperative scarring can be addressed through plastic surgery.

At the LeoDerm Medical Center in Lviv, an individualized approach is employed for the treatment of skin basal cell carcinoma for each client. This approach involves selecting the most effective therapy method. After tumor removal, regular check-ups with an oncology specialist are recommended.

For preventive purposes, it's important to adhere to certain rules to reduce the risk of developing new growths. Doctors advise maintaining immunity, limiting the intake of animal proteins, protecting the skin from the harmful effects of the sun, and promptly removing warts and papillomas.

Skin basal cell carcinoma of the face, neck, and other areas is successfully treated at the LeoDerm Medical Center in Lviv. Our specialists conduct rapid examinations, diagnostics, and determine effective therapy methods. We offer consultations with specialized experts, a wide range of medical services at affordable prices, the use of modern equipment, and state-of-the-art technologies. Appointments can be scheduled via contact phone numbers or online. We look forward to seeing you at LeoDerm!