Basal Cell Carcinoma:

Introduction:

Basal cell carcinoma (BCC) is the most common type of skin cancer, accounting for about 75% of all skin cancer cases. BCC usually originates from the basal cells of the hair follicles.

Causes:

• Sunlight: Exposure to sunlight, especially ultraviolet (UV) radiation, is the main risk factor for BCC.
• Genetics: Certain genes are associated with BCC, including:
  • P53 gene: This gene plays a role in regulating the cell cycle and repairing damaged DNA. Mutations in the P53 gene can increase the risk of developing BCC.
  • PRAP gene: This gene is involved in the production of a protein that binds to collagen. Mutations in the PRAP gene may also contribute to the development of BCC.
• Other factors:
  • Sensitive skin: People with sensitive skin that burns easily in the sun have a higher risk.
  • Family history: A family history of BCC also increases the risk.
  • Age: BCC is more common in older individuals.

Symptoms:

BCC can manifest in a variety of ways. Here are some common signs:

• Nodule: The nodule is usually firm, pearly, and may have a blood vessel visible on it. They are often painless, non-itchy, and grow slowly.
• Scarring: The affected skin can become flat, scarred, depressed, and have a changing color.
• Paget’s disease: The affected skin may be scaly, flat, and grow slowly.
• Ulcer: The affected skin may ulcerate, become thickened, and resemble melanoma.

Diagnosis:

• Medical history: The doctor will ask about your history of sun exposure, family history of BCC, and symptoms.
• Physical exam: The doctor will carefully examine the affected skin.
• Biopsy: Biopsy is the most accurate way to diagnose BCC. The doctor will remove a sample of tissue from the affected skin to examine under a microscope.

Clinical Types:

BCC can be classified into several different clinical types. Here are some common types:

• Nodular BCC: Nodular BCC is the most common type and is often found on the head, neck, and upper back.
• Superficial BCC:
  • The affected skin is often a patch or plaque, scaly, and usually benign.
  • It is often found on the trunk.
  • In the biopsy, the cancer cells are usually clustered in the superficial dermis.
• Sclerosing BCC:
  • It is usually found on the nose or forehead.
  • The affected skin is often flat, scarred, and difficult to recognize.
  • It has a high risk of recurrence.
  • In the biopsy, cancer cells can invade deep into the dermis.
• Ulcerative BCC: The affected skin often forms an ulcer and may bleed.
• Morpheaform BCC:
  • The affected skin is a uniform black color intermixed with black scale-like secretions.
  • Small pearl-like nodules may appear.

Differential Diagnosis:

BCC needs to be differentiated from several other conditions, including:

• Squamous cell carcinoma: This type of skin cancer is generally more aggressive than BCC.
• Lupus vulgaris: This autoimmune disease can cause skin lesions that resemble BCC.
• Lupus erythematosus: This condition can also cause skin lesions that resemble BCC.
• Extramammary Paget’s disease: This condition can cause skin lesions that resemble BCC in the skin surrounding the breast.
• Sarcoidosis: This condition can cause skin lesions that resemble BCC in multiple locations on the body.

Staging:

BCC is usually staged based on the size of the tumor and the extent of invasion:

• Stage 1 (T1N0M0): The tumor is small and has not spread.
• Stage 3 (T3N1M1): The tumor is large and has spread to lymph nodes or other organs.

Treatment:

Removal of cancerous tissue:

• Wide excision surgery: The most common treatment method. The doctor will remove the affected skin, including a margin of healthy skin around it.
• Mohs surgery: A precise treatment method that helps to remove all cancerous cells. The doctor will remove layers of skin and examine them under a microscope until all cancerous cells are removed.
• Treatment with CO2, cryosurgery, radiotherapy, chemotherapy: These methods are used for individuals with poor health or the elderly.

Reconstructive surgery:

• Skin grafting: The doctor will graft healthy skin from another part of the body onto the area where skin was removed.
• Reconstruction: The doctor will reshape the affected area using surgical techniques.

Notes:

• Regular skin examinations: Check your skin regularly for any unusual signs.
• Avoid direct sunlight: Use sunscreen with an SPF of 30 or higher, wear a wide-brimmed hat, and wear protective clothing when in the sun.
• Regular checkups: See a dermatologist for regular skin checks every 1-2 years to check your skin and detect early signs of skin cancer.

Additional information:

• BCC is usually not metastatic, but if left untreated, it can grow and affect health.
• Mohs surgery can help to remove all cancerous cells and reduce the risk of recurrence.
• BCC treatment can result in scarring, but it usually does not significantly affect health.

Advice:

• Contact a dermatologist if you notice any unusual signs on your skin.
• Follow your doctor’s instructions on skin care and protecting your skin from sunlight.