Basal Cell Carcinoma

Basal cell carcinoma is the least risky type of cancer that grows on areas on your skin that are overexposed to the sun. It usually starts as small, shiny, raised bumps that are clear to pinkish color on the head or neck. These bumps are filled with visible blood vessels. There are different types of lesions but that is the most common one. Although there is only a slim chance for it to spread from skin to other parts of the body there is still a chance that it will move into tissue that is located underneath your skin or a nearby bone. Since it is usually a growth tumor it tends to grow slowly and it often doesn’t show up for various years till after long and intense sun exposure. If this disease is detected early enough it can be treated. There are many treatment options like electrosurgery, photodynamic therapy, topical medications, etc. which will be discussed later on. However, if you allow it to progress the result could be morbid.

Basal cell carcinoma is the most common type of keratinocyte skin cancer in people that have a caucasian ancestry. More than three million people are diagnosed with basal cell carcinoma a year. This type of cancer accounts for more than 3/4ths of all skin cancers. Basal cells produce new skin cells and push the old ones to the surface of the skin where they die and shed off. It is the least dangerous type of skin cancer and only about 2,000 people die from it yearly. The 5-year survival rate for those whose cancer is detected and treated before spreading is 99%.This specific type of skin cancer  A cause for basal cell carcinoma is long-term exposure to ultraviolet (UV) radiation for sunlight. If you use sunscreen and avoid too much exposure to the sun it will help prevent it. A lot of people question how UV lights cause basal cell carcinoma and it is very simple. The more that UV lights hit our skin the more chance it can damage the DNA in our skin cells which causes the body to try to repair its damage. When it becomes too much for the body to handle it leads to the development of mutations which leads us into our next point. Another one of the causes for BCC is a basal cell develops a mutation in the DNA.  There is a mutation in the DNA that tells the basal cell to produce quicker than it usually would and to keep growing when it would normally die of. The accumulation of abnormal cells can form a cancerous tumor. This leads to the lesions that appear on the skin. They often have one of the following characteristics: (pearly white to pink) bumps or (flat scaly reddish) patches. There are also two other lesions a brown, black, or blue lesion and a white, waxy,scar-like lesion. There are quite a number of things that increase your chances of having basal cell carcinoma, for example, light skin tones. It has been scientifically proven that people that have either freckles, light-colored eyes, burn easily, have red or blond hair have a higher risk of getting basal cell carcinoma. People who are older are also more at risk since this type of cancer takes ages to develop as well as people that have had it before or have a family history. Going back to one of the main causes mentioned earlier people with too much exposure to UV light are more at risk, especially if they live in sunny, high altitude locations or get extreme sunburns. People with weaker immune systems or that have some of the following conditions are also at high risk: Gorlin syndrome, Xeroderma pigmentosum, Rombo syndrome or Bazex-Dupe-Christol syndrome.Last but not least if you also have a greater chance of getting basal cell carcinoma if you have had x-ray treatments for acne or dialysis for kidney disease. Some preventions you can take to avoid getting basal cell carcinoma are avoiding tanning beds and the sun during the middle of the day. You should also wear protective clothing, wear sunscreen all year( you should apply it every two hours even if you are sweating or swimming), and check your skin often. You should report any changes to your doctor. It is common for basal cell carcinoma to recur even after successfully getting through the treatment. There is up to a 10% chance of cancer to recur after surgical excision and a 7% to recur after cryotherapy both of which will be discussed later. Your chance of getting other types of cancers increases after having BCC. Basal cell carcinoma rarely spreads but when it does it could spread to nearby lymph nodes or close areas of the body like the lungs.

Although there are many causes and risks to basal cell carcinoma there are also a number of treatments. Some of the ones we will discuss are electrosurgery, Mohs surgery, topical medications, and photodynamic therapy. Electrosurgery is when a dermatologist scrapes of the basal cell carcinoma using a curette and then they proceed to use heat/ a chemical agent to finish off any remaining cancer cells, stop the bleeding, and close up the wound. This procedure usually leaves a scar that resembles a cigarette burn. The process may be repeated a few times until they are sure no cancer cells are left. It works for most BCC lesions on the smaller side and has a 95% cure rate. The Mohs surgery is done in one visit but has different stages. First, they remove the visible tumor along with some tissue around and beneath the tumor site. Then they color code the tissue and draw a map that matches up to the surgical site. If the surgeon examines the tissue and finds more cancer cells he will remove more tissue where the cancer cell is located. Lastly, they will close the wound or in rare cases leave it to heal on its own. This surgery has the highest possible cure rate at 99% and is also used on aggressive BCCs/ recurrent tumors. Topical medications are creams gels or creams that are put directly on the affected areas to treat superficial BCCs. 5-FU, topical chemotherapy, kills cancer cells and Imiquimod attacks cancerous cells by activating the immune system. These medications have cure rates of 80-90%.  Photodynamic therapy is when a dermatologist puts a topical agent that makes the would sensitive to light/ injects the agent directly into the tumor. After it has been absorbed they blue light/laser which causes the BCC to automatically be destroyed. Afterwards the patient has to avoid sunlight for at least 48 hours because if failed to do so it will cause severe sunburns. This can be used on the face or scalp on superficial BCCs but not on invasive ones.

Although basal cell carcinoma has a high cure rate overall it is one of the most common types of skin cancer and many cancer institutes are working on gaining a better understanding of cancer. They have made a great deal of progress on people whose skin cancer has spread however there are many people whose bodies don’t cooperate with the newest drugs and they relapse even after having a successful treatment. Surgery is usually the standard treatment they use for early skin cancer and can be used as a type of therapy for more advanced disease. There have been recent discoveries in targeted therapies, which are treatments that often use drugs to recognize and destroy cancer cells while doing less harm to normal cells along with immunotherapy which is when they use natural substances made from the body or in some cases the laboratory to better the function of the immune system. This has changed the way basal cell carcinoma has been treated. Some of the targeted drugs Odomzo and Erivedge can control tumors but usually, patients develop a resistance to it and get side effects that influence them to stop taking them. Researchers are currently trying to tweak the drugs make it easier to tolerate and increase the amount of time it takes to develop a resistance to it. In 2010 the first immunotherapy was approved using the drug, libtayo. This showed that the immune system can be influenced to recognize cancer cells.Researchers have also developed less- extensive radiation therapy for people who can’t endure surgery for bigger tumors. Researchers are still trying to address skin cancers more effectively by asking what social questions cause people to be at a higher risk and translating it to a more clinical point of view to improve the patients’ outcomes.

In conclusion, basal cell carcinoma is one of the least deadly yet most common skin cancers. It has a 5-year survival rate of 98%. It has many different causes and risk factors one of the main ones being UV light. The light causes a mutation in our DNA which causes basal cells to grow more rapidly than they should. This causes lesions that are usually clear to pinkish but can be other colors. This cancer is more common in older people due to the fact that it takes a long time to grow. There have been many treatment options available but the standard procedure performed are surgeries although there are certain medications and therapies. Mohs surgery ,in particular, has a 99% cure rate and the topical medications following closely behind with an 80-90% cure rate. Researchers are trying to gain a better knowledge of this cancer and trying to find different ways to control it. Many people try to take drugs to control it but the body develops a resistance to it quite quickly and it has harsh side effects. Researchers have recently had a breakthrough with targeted therapies and immunotherapies that have changed the ways we deal with cancer. However, they are still asking various questions to get to the bottom of the absolute cure for cancer.

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