A basal cell carcinoma is a skin tumor that develops as a result of prolonged and intensive exposure to UV radiation such as sunlight or solarium light. It first appears as a nodule or induration. Because a basalioma initially has the same color as the rest of the skin, it often remains undetected as such. If left untreated, it can grow into weeping, crusting lumps that keep spreading. Therefore, basal cell carcinomas should always be surgically removed, even if a basal cell cancer does not form any secondary tumors and is only life-threatening in the rarest of cases.
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| Basal cell carcinoma |
Causes and risk factor
Excessive UV radiation, either through intensive sunbathing or too frequent visits to the solarium, leads to damage to the skin. Normally, the skin is perfectly capable of repairing this damage. But if the stress is permanent and intense, the repair system can no longer keep up with the repair. The skin cells degenerate and develop into cancer cells.
Risk factors
Beyond recreational activities and preferences, there are some risk factors as to why certain people are more likely to develop skin cancer than others. This includes:
- Fair skin, blond and red hair, blue eyes (Celtic skin type)
- Professional activities outdoors (e.g. farmers, mountain guides, construction workers)
- An older psoriasis disease that used to be treated with arsenic
- Rare hereditary diseases (e.g. moonlight disease, albinism)
Basal cell carcinoma symptoms
Do you have a reddish lump in an area that has often been exposed to UV rays?
Do small blood vessels shine through on its surface?
These symptoms are characteristic of basal cell carcinomas: The tumor often has a yellowish-reddish color, a pearly edge and small blood vessels shining through on the surface (technical term: telangiectasia). But the appearance of a basalioma can be very different. It is often inconspicuous and not recognizable as such for laypersons.
The following features are typical of basal cell carcinoma:
- Glassy hemispherical nodules (medical term: solid basal cell carcinoma)
- Tissue hardening (technical term: sclerodermiform basal cell carcinoma)
- Small blood vessels on the surface of the lesion
- Red warts
- Scaly patches, wounds and scars
- Small crusts that do not heal
- Red spots (often on the trunk)
- Scarring changes
If these small cancerous tumors go undetected and untreated, they can potentially grow into a large tumor. This can not only expand in the area (technical term: ulcerating basalioma), but also penetrate in depth (destructive basalioma). Destroying basal cell carcinomas can look much smaller on the outside than they really are. However, basal cell carcinomas do not spread, which means they do not form daughter tumors (metastases).
Advanced basal cell carcinomas tend to form larger ulcers with oozing and smaller bleeding, which have a trough or central depression in the middle (technical term: cicatricial basal cell carcinoma).
Basaliomas form anywhere on the body, but preferentially where the skin has been in contact with a lot of UV rays. These places are also known as "sun terraces". This includes the face (more precisely: lower lip, forehead, bridge of the nose, edge of the auricle), sparsely hairy scalp and bald head, the neck, but also hands and, in rare cases, the legs and upper body.
In contrast to squamous cell carcinoma, basal cell carcinoma does not have a preliminary stage. As soon as a basal cell carcinoma is detected, it is cancer. Therefore, any skin lesion that does not heal should arouse suspicion.
When to the doctor?
In the case of nodules that remain, crusts that do not heal and spots that are getting larger, it is advisable to consult a specialist.
Treatment
Specialists such as dermatologists can often identify basal cell carcinomas with a practiced eye. In order to diagnose even minimal skin changes, they use a special magnifying glass with an integrated lamp (dermatoscope). If in doubt, they will take a tissue sample and have it examined for histological examination.
The aim of treatment is to remove the entire basal cell carcinoma and prevent the tumor from growing further. Then the healing chance is 95%. Which therapy is suitable for this depends on where the basal cell carcinoma is, how big it is and how far it has spread. In addition, the doctors include the general condition of the person concerned in the treatment. Basically, the decision about the therapeutic procedure should be made in a detailed discussion between doctor and patient.
Surgery
Surgery is the first choice for removing a basal cell carcinoma, especially on the face. For smaller basal cell carcinomas, the dermatologist can perform the surgery on an outpatient basis and under local anesthesia. A laboratory then examines the edges of the cut to see whether they are tumor-free or whether there are still microscopic tumor extensions hiding there. Then, in a second step, the remaining tumor tissue is removed. In this way, the recurrence of a tumor can possibly be prevented (technical term: recurrence).
Alternatives
If an operation is not possible or sensible, there are a number of procedures available (see also "Actnic keratosis"). These include radiation therapy, laser surgery, curettage (more precisely: scraping out with a small spoon), photodynamic therapy or cold treatment (cryotherapy). In addition, local cream treatment with immunomodulator imiquimod and chemotherapeutic agent 5-fluorouracil is possible. The major disadvantage of non-surgical methods is that it is not possible to check whether all of the tumor tissue has been removed. This is why the recurrence rate is often higher with these treatment methods.
In the case of very advanced basal cell carcinomas, the doctors also take a systemic approach, i.e. they prescribe tablets containing the drug vismodegib, which destroys the tumors from the inside. However, vismodegib has many side effects. It is teratogenic and must not be used in women of childbearing age or even pregnant women. It can also cause side effects such as muscle spasms, hair loss, taste disorders, weight loss, fatigue and digestive problems.
Aftercare
If an affected person has had a basal cell carcinoma, the skin change indicates increased sun exposure in the past - whether natural sun or solarium - which can result in further basal cell carcinomas. Doctors therefore recommend semi-annual or at least annual check-ups. At the same time, they give tips on how those affected can keep checking their skin for suspicious changes.
Prevention
White skin cancers can be prevented very well. First and foremost, this includes the reasonable use of solar radiation and artificial UV light (see also sunburn). This includes:
- Avoid the midday sun (between 11 a.m. and 3 p.m.).
- Refrain from going to the solarium
- Stay in the shade when the sun is shining, wear sunscreen and a hat
- Smear yourself with sunscreen with a high sun protection factor, UVA and UVB protection
- Pay attention to sun protection, especially for children
- For outdoor jobs, promote sun protection (sun sails, reducing working hours in the midday sun) and/or wear suitable sun protection clothing
- From the age of 35, skin cancer screening is recommended every two years
- Participation in cancer aftercare: The timely detection of a recurrence of the old tumor (recurrence) ensures the chance of permanent healing