Basal Cell Carcinoma

What is basal cell carcinoma?

Basal cell carcinoma is a type of skin cancer that arises from basal layer of the skin or from a hair follicle. It is one of the most common types of cancer and rarely spreads to distant body parts and organs. The condition is associated with destruction and infiltration of adjacent and deeper tissues. The lesion grows very slowly, burrowing surrounding structures and hence it is commonly known as rodent ulcer.

What are the symptoms?

The lesions most commonly develop on sun exposed surfaces of the skin, middle third of the face and the scalp. The upper lip is involved more frequently than the lower lip. A patient with basal cell carcinoma generally presents with a non-healing ulcer of the skin. The ulcer may have tendency to bleed and it may resemble a scar with no apparent history of injury at the site of the lesion.

The lesion of basal cell carcinoma manifests as a pearly nodule with a shiny surface. It is generally small in initial stages which ulcerates, heals over and then breaks down to form a crusted ulcer. The ulcer has a smooth, rolled border representing tumor cells spreading in lateral direction below the skin. The lesion forms a crater like area in the middle appearing depressed inside the surrounding tissue.

The color of the lesion varies from white to light pink to brown. In few cases the lesion can appear as a reddish patch of irritated skin with crusted borders.

What causes basal cell carcinoma?

The disease more commonly affects male population and chronically sun exposed individuals. The affected age group is generally above 40 years of age but it can also affect younger individuals with occupational sun exposure. The disease is one of the most prevalent types of cancers in the United States. Basal cell carcinoma is more prevalent in people with a fair complexion, blonde hair and freckled skin.

The disease more commonly affects individuals with family history of skin cancers. The prevalence of the disease is high in countries near the equator. Higher altitudes are also one of the risk factors. Multiple basal cell carcinomas present along with odontogenic keratocyst is an indicative of presence of nevoid basal cell carcinoma syndrome (Gorlin Goltz syndrome)

How is it treated?

The treatment of a lesion of basal cell carcinoma depends on the site, depth and extent of surrounding tissue invasion. Patient’s age and overall health is also an important factor in determining the treatment plan. The commonly preferred treatment includes surgical excision of the lesion. The surgical procedures include Mohs surgery, dermabrasion, cryosurgery, excision followed by curettage and electro desiccation can be used.

Margins of the lesion and surrounding invaded tissues should be completely excised to avoid recurrence of the lesion. Chemotherapeutic agents such as 5-fluorouracil and Imiquimod can be prescribed for topical application to reduce the size of the lesion. Radiation therapy can be considered in cases where surgical procedures are difficult to achieve .Radiotherapy can successfully treat smaller lesions. It can be given externally or in the form of brachytherapy. Newer methods of treatment include photodynamic therapy and LASER therapy.


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