Basal cell carcinomas(BCCs) are thought to arise from hair follicle cells which are slow-growing, locally invasive malignant epidermal skin tumours. The tumours form finger-like protrusions which invade the adjacent tissue causing localised cellular destruction. This destruction is most likely to occur in areas of exposure to sun i.e. the neck, face and head.
BCC affects mainly the Caucasian peoples with predominance in Europe, Australia and the US. People diagnosed with one BCC are at increased risk of developing further BCCs; there is a 44% likelihood of presenting a second BCC within three years of the first. Albinism is another associated skin condition that increase the risk of BCC.
Approximately 80% of BCCs occur on the head and neck, with the rest mainly on the trunk and lower limbs. The BCC has a hardened edge and ulcerated centre. It is slow-growing but can spread deeply to cause considerable damage. There are several types of BCC: nodular which occur commonly on the face, may be ulcerated in singular nodes; superficial, are multiple, slower growths and respond to medical treatments (non-surgical); morphoeic (infiltrative BCC), usually found in the mid-facial area, characterised by thickened yellowish plaques and pigmented, similar to nodular or superficial BCCs with the exception they are brown, blue or grey.
Diagnosis is usually carried out by visual inspection and if necessary samples taken for further laboratory analysis.
For low-risk nodular BCCs, a local GP is capable of performing the requisite procedure provided the following criteria are met: that the patient is 24 years or older, is not immunosuppressed, and that the lesion (area of the BCC) is below the collar bone, is less than 1cm in length, not a recurrent BCC and is not located over any nerves, blood vessels, organs or over any area that would cause scarring after excision. For superficial BCCs the full range of treatments is available.
Surgery and radiotherapy are proven effective methods of treatments. Surgical techniques should involve complete excision of the BCC plus margins (millimetres of healthy tissue) to ensure a minimal of recurrence. At each stage of excision, samples of tissue must be taken to ensure progress.
Cryotherapy is well established for treating small low-risk lesions, including superficial BCCs. Non-surgical treatments involve topical creams (imiquimod 5%, an immune-boosting cream and fluororacil 5%, used to treat superficial BCCs) have been shown to clear 70-100% of cases, though recurrence is an issue. Radiotherapy is offered as a means to an alternative to surgery for those who cannot have the surgery or would prefer not to. The cure rates are over 90% but if there is recurrence then surgery is mandatory.
Long-term prognosis usually indicates that mortality is low since BCCs seldom metastasise, however, patients suffering an initial BCC are more likely to suffer subsequent BCCs on other places of the body and also risk developing squamous cell carcinomas (SCCs).
To decrease likelihood of developing BCCs the potential patient must be aware of the risks of exposure to the sun, particularly if the individual is young or adolescent. Usage of sunscreens and clothing to block harmful UV radiation is highly recommended.
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