nodular basal cell carcinoma
Basal cell carcinoma is the most common form of skin cancer. This tumor
is not life threatening except in the rarest of circumstances. For most,
basal cell carcinoma grows slowly over years, and appears as a pimple-like
growth that bleeds, heals, and re-bleeds. If untreated, basal cell
carcinoma my penetrate and destroy deeper tissues and can be mutilating.
Most basal cell carcinomas are caused by ultraviolet rays from the sun.
It is known that chronic sun exposure, radiation, and tanning bed use can lead
to the development of basal cell carcinomas.
Several treatments exist for basal cell carcinoma and include:
- Excision. With this procedure, the tumor is cut out and often stitched
together. The skin is sent to a laboratory and examined to ensure that
the entire tumor has been removed. Sometimes all dissolvable stitches
are used, otherwise sutures are generally removed within 7 to 14 days
depending upon what area of the body the cancer is.
The pathology results may take up to 7 days and rarely longer. This treatment is 95%
effective for the treatment of nodular basal cell carcinomas.
- ED&C. With this procedure, the tumor is scraped out and the base of
the wound is burned using an electric needle or a laser. With this
procedure an open sore is left that can take weeks or even months to heal.
The final result is often a permanent white depressed scar or pink raised scar that can
itch.
- Mohs' Micrographic Surgery. This procedure has the highest cure rate
(lowest risk of the tumor coming back)
of any treatment available. With this procedure, the visible tumor is
cut out along with a thin margin of clinically uninvolved skin. While the patient waits, the removed skin is processed and
slides are made for the surgeon to read and interpret under the microscope.
This processing may take 15 to 60 minutes. If the margins are free of
tumor, the wound can be left to heal by itself or can be closed using plastic
surgery that is most often done right in the office. If all of the tumor
is not removed, the surgeon will go back and try to remove the remaining
tumor. This second piece of skin (called a stage) is tested and examined
under the microscope. This process will go on until all of the tumor is
removed.
- Radiation. This treatment is reserved for those who are late-middle
aged or elderly who are not good surgical candidates or do not wish to undergo
surgery. Healing can be excellent,
although 12 or more treatment sessions are needed.
- 5-Fluorouracil Cream (Efudex®, Carac®). This chemotherapy cream may be used for
superficial basal cell carcinomas and results in mild to severe skin
irritation. It is 88% effective for the treatment of superficial basal cell
carcinomas.
- Imiquimod (Aldara®). This cream was FDA-approved for the treatment of
superficial basal cell carcinomas in 2004. Clinical studies have proven
that this treatment is at least 80% effective for early basal
cell carcinomas (superficial type). Skin irritation and crusting is common
and expected with the use of this cream.
- No treatment. In some circumstances, one may choose
not to treat a tumor. This is often done in elderly
individuals or those in extremely poor health when the tumor grows in areas of little cosmetic importance and
when there is little risk of damaging deeper structures. Delay in treatment
can result in enlargement of the tumor, that can bleed and become problematic
later.
Dr. Bader was invited to author the chapter regarding basal cell carcinoma on
the online medical reference textbook on emedicine.com, a subsidiary of WebMD.
To see this article please click here:
Basal Cell Carcinoma.
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