What is basal cell carcinoma?
The basal cell carcinoma is a form of skin cancer. Basal cell carcinoma rarely metastasizes and is most common in older people on body skin that has been exposed to much light. Even young people, however, can get a Basal cell carcinoma. The illustration shows a late stage again and is not representative of the most common presentation: a little glassy-red lump of a few millimeters in size with some visible blood vessels in it. At a later stage it becomes a non-healing wound or ulcer that permanently has a scab. Distant metastasis actually does not exist, but local growth though.
Basal cell carcinoma causes
The main cause is exposure to sunlight. Perhaps there is also a genetic predisposition. A rare cause is Nevoid basal cell carcinoma syndrome. Also in skin that has been irradiated (with X-rays) can basal cell carcinomas arise - for example, were once wine stains and hemangiomas or irradiated.
Basal cell carcinoma treatment
- The Netherlands has a national guideline Basal cell carcinoma of the Institute for Healthcare Improvement (CBO), which treatment guidelines for the doctor, dermatologist usually summarized. Every physician is free to deviate from this directive if there are good reasons.
- Usually, surgical removal with three or five millimeters margin applied. The margin is determined by the size and type of Basal cell carcinoma: is it superficial, it grows in nests or is it infiltrative. If the cutting surfaces are free, it is sufficient with a controlled follow-up to be able to intervene quickly in the event of recurrence.
- Relatively new (1980) is photodynamic therapy (PDT). Here, a cream with a "photo-active 'substance applied on the carcinoma. Then, the tumor is illuminated with red light of a certain wavelength, after which the photoactive molecule is a reaction which triggers the tumor cells are destroyed.
- In basal cell carcinoma which are unfavorable, it is sometimes not so easy to maintain sufficient margin in the removal (eg, on the nose or the eye). Then it can be chosen for the so-called Mohs' surgery, in which immediately after excision, the edges of the removed tissue can be minutely examined under the microscope in order to be able to make a targeted additional resection. This prevents the unnecessary removal of healthy tissue. Mohs surgery is performed according to a defined protocol to which the specimen edges are colored. The treatment requires close collaboration between a dermatologist and a pathologist, and the whole procedure will take hours often. In some cases will also turn a plastic surgeon for the reconstruction. Therefore, this treatment is carried out only in a few (most university) clinics. Treatment centers in the Netherlands include Rotterdam, Maastricht, Groningen, Nijmegen and Eindhoven.
- Radiation therapy may be an option, at basal cell carcinoma which are difficult to treat surgically. An example is a Basal cell carcinoma on the nose point.
- Freezing (cryosurgery) and curettage combination elektrodessicatie (burning) were mostly in the past often used.
Treatment of superficial basal cell carcinoma
For thin, superficial basal cell carcinoma are additional treatment options:
- Fluorouracil cream. Fluorouracil is a cytostatic agent, which intravenously is also used for other cancers. In cream form is moderately effective in superficial basal cell carcinoma.
- Imiquimod cream is a drug that stimulates the immune system, so that the defense system clears the abnormal cells.
- Photodynamic therapy (PDT) with 5-aminolevulinic acid or methyl-aminolevulinic acid. In particular, the abnormal cells are sensitive to light, and die when the skin is exposed.
These treatment options have fewer scars than surgery. The disadvantage is that the treatments are less effective, and can be controlled only on the eye or the skin cancer is gone.