Basal cell carcinoma, or basal cell carcinoma for short, is a semimalignant skin cancer that is almost always localized and not prone to metastasis. However, if left untreated, basal cell carcinoma can damage surrounding tissue, bone, or cartilage by continuing to grow.
What is basal cell carcinoma (basal cell carcinoma)?
Malignant melanoma or black skin cancer is a highly malignant tumor of pigment cells (melanocytes). Basal cell carcinoma develops from the basal cells of the epidermis and can take various forms of appearance. A typical feature of basal cell carcinoma is the skin-colored change. Pigmented basal cell carcinoma, on the other hand, is less common. The skin tumor usually appears as a nodule, but can also take the form of a hemisphere, crater-shaped with raised edge or grow scar-like. Basal cell carcinomas usually develop on sun-exposed areas such as the head, face, neck and décolleté. Basal cell carcinomas are extremely rare on the trunk and limbs. Fair-skinned people have an increased risk of developing basal cell carcinoma. While in past decades basal cell carcinoma often first appeared in people over the age of 60, more and more younger people are developing this form of skin cancer.
Causes
The main cause of basal cell carcinoma is a change in leisure behavior. This includes regular visits to solariums and vacation trips to countries with intense sunlight. Excessive sunbathing promotes the formation of sunburns and, subsequently, skin tumors. In Germany, about 0.1 percent of the population will develop basal cell carcinoma during their lifetime. In the case of intensive sun exposure, the UV rays damage the DNA of the skin cells and a basal cell carcinoma may form. The indirect effect of excessive sun exposure is the weakening of the immune system, which in turn can promote the development of skin tumors. However, a certain genetic predisposition and certain skin diseases such as psoriasis, photosensitivity, tendency to sun allergy, etc. can also be considered as possible causes of basal cell carcinoma formation.
Symptoms, complaints and signs
Schematic diagram showing the anatomy and structure of the skin with black skin cancer. Click to enlarge. In most cases, basal cell carcinoma develops in a place that already has previous skin damage. So-called sun damage is particularly typical in this case. The affected area of skin, which has usually been overexposed to the sun for years and has also suffered sunburns, takes on a pink to light red coloration. This is the preliminary stage of a basal cell carcinoma, which can still be treated well under dermatological supervision. Regeneration is possible in very few cases, but the formation of a basal cell carcinoma can be delayed or prevented. If the basal cell carcinoma develops from the existing skin damage, this is usually not noticeable to the affected person, but can only be detected by the physician with a special lamp. For the final diagnosis the removal of a tissue sample is necessary. Basal cell carcinoma in itself does not cause any direct discomfort such as pain or inflammation. A scaly crust on its surface may be observed in some cases. If the existing basal cell carcinoma continues to be exposed to the sun, it may become more red and develop a slightly bloody surface, such as that seen on a mosquito bite that is healing. Signs of basal cell carcinoma formation can basically be any noticeable change in the skin in one or more areas. To prevent greater damage, regular check-ups with a dermatologist are advisable.
Diagnosis and course
Basal cell carcinomas grow very slowly, usually over a period of years. They form superficial skin lesions such as small nodules that are hardly noticed at first. If the basal cell carcinoma is not treated, it continues to grow unceasingly. The nodule may grow inward in the center, leaving only a raised rim visible, which itself consists of noisy small nodules that appear to be strung on a string of pearls. The ulcer-like basal cell carcinoma, on the other hand, looks like a small skin lesion that refuses to heal and may be covered with scabs. On closer inspection, all forms of basal cell carcinoma can be seen to have blood vessels that nourish the skin tumor. The less common pigmented basal cell carcinoma has a reddish-brown color that can sometimes appear very dark.In this case, it is essential to distinguish it from the dangerous black skin cancer, which often looks like a dark mole. Basaliomas are usually not sensitive to pain. The definite diagnosis of a basal cell carcinoma is made after microscopic-histological examination. To determine the spread of the skin tumor, the diseased skin area and its surroundings are treated with a special cream. A special lamp can then be used to visualize the tumor cells.
Complications
Since basal cell carcinoma is a cancer, the various complications of a tumor occur in the process. In most cases, the diagnosis is relatively late, because basal cell carcinoma forms over a number of years and is barely visible from the outside. In case of a strong spreading, however, lumps may appear on the skin, which are not infrequently covered with scabs. In most cases, the carcinoma can be relatively well distinguished from a mole. If the black spots appear in an unfavorable location, psychological problems may also occur due to visual limitations. Treatment of basal cell carcinoma is usually by removal. Removal of the tissue usually occurs without complications, although healthy tissue around the tumor is also removed. In hard-to-reach areas, other methods of tumor removal may be used. In most cases, new formation of the basal cell carcinoma cannot be prevented, so the patient may need to have another surgical procedure to remove it. Since the tumor is only local, no other tissue is damaged, so there are no further complications. Life expectancy is not reduced by basal cell carcinoma.
When should you see a doctor?
If basal cell carcinoma is not treated, this complaint can lead to the death of the patient in the worst case scenario. For this reason, any ambiguity on the skin or any noticeable areas of the skin must always be examined by a dermatologist. This can prevent complications later in life. As a rule, the patient should see a doctor when there are certain abnormalities on the skin. Pigment spots can change in color, shape or size. If at least one of these changes is present, a doctor should definitely be consulted. If the basal cell carcinoma is detected, there is usually a positive course of the disease and the life expectancy of the affected person is not reduced. The affected person is dependent on the use of sun protection to avoid further complaints. In case of basal cell carcinoma or other changes on the skin, a dermatologist should always be consulted. In acute emergencies, the hospital can also be visited directly. Usually, various preventive examinations can also be performed to avoid the skin cancer.
Treatment and therapy
Various options are available to treat basal cell carcinoma, depending on the size and spread of the carcinoma. In most cases, basal cell carcinoma is surgically removed under local anesthesia. This also involves removing a few millimeters of healthy tissue around the tumor to ensure that all extensions of the basal cell carcinoma have been removed. If the basal cell carcinoma is in an unfavorable location, it can also be treated with radiation. Cryotherapy (icing with liquid nitrogen) or phototherapy (treatment of the tumor with light-sensitive substances) also promise good therapeutic success. The chances of curing basal cell carcinoma are very good, with surgical removal resulting in the fewest recurrences (new growths).
Outlook and prognosis
If basal cell carcinoma is diagnosed and treated early, the patient has a good chance of recovery. The physician removes the skin lesions in a surgical procedure or radiation therapy. The treatment takes place routinely and is completed within a few hours. After the subsequent wound healing, the patient is usually considered cured. Without removal of the basal cell carcinoma, it can spread unhindered in the organism. In the process, it damages surrounding healthy tissue and, in the worst case, can form metastases. People of advanced age suffer from basal cell carcinoma more frequently than younger people. Nevertheless, the number of sufferers in young or middle adulthood increases significantly.The prognosis improves if the affected person takes sufficient measures to protect himself from direct sunlight. The older the patient and the longer he exposes his skin to UV radiation, the poorer the prospects of cure. Even if a basal cell carcinoma is completely removed in a single procedure, new carcinomas can form on the skin at any time. To improve the chances of cure, medical treatment should be given as soon as possible if new basal cell carcinomas form. This also reduces the risk of complications and wound infections. In addition, with regular participation in screening examinations of skin cancer, the appearance of the skin changes can be detected very early.
Prevention
Light-skinned people in particular should avoid excessive sun exposure and visits to tanning beds as a preventive measure against basal cell carcinoma. Sunscreens with a high SPF grant some protection from harmful UV rays when outdoors. In families where basal cell carcinoma occurs more frequently, all family members should regularly examine themselves for suspiciously changed skin areas or make use of the examination at the dermatologist, the costs of which are fully covered by health insurance every two years for patients over 35 years of age.
Aftercare
After surgical removal of basal cell carcinoma, the operated skin area must be kept dry and clean for several days. Generally, the affected area is protected by a dressing, which should only be changed by the physician. Stitches are removed one to two weeks after surgery if wound healing is satisfactory. If severe pain occurs during the healing phase, the attending physician may prescribe an analgesic. Smoking delays wound healing and should be avoided during the initial period after surgery. Light sporting activity is possible as soon as the wound has healed well; competitive sport and other heavy physical exertion can often only be resumed after about three months in the case of larger surgical wounds. In the first three to six months after the operation, the operated area must not be exposed to direct sunlight, as this can lead to conspicuous pigment disorders. Adequate sun protection should also be ensured thereafter. If the patient has a tendency to develop basal cell carcinomas, all areas of the body exposed to the sun must be well protected from UV rays by sunscreens with a high sun protection factor. Regular self-examinations of the skin are very important in order to detect recurrence or new skin tumors at an early stage. In addition, follow-up examinations should take place once or twice a year with the attending dermatologist.
What you can do yourself
Basal cell carcinoma is a disease for which there are some self-help options for the affected person. First of all, this applies to the time after the surgery. Since basal cell carcinoma should be removed over as large an area as possible, i.e., in healthy tissue, the focus shifts to the regeneration of the affected area after surgery. Here the patient can actively contribute by following the doctor’s rules of conduct very carefully so that the wish can heal quickly and no complications such as inflammation occur. If psychological problems arise around the illness with white skin cancer, it is advisable to look for a self-help group or to consult a psychologist. Self-help in everyday life also means avoiding the occurrence of a new basal cell carcinoma. Consistent sun protection (for example scalp and face protection by means of a hat), about which the attending dermatologist provides comprehensive advice, is important. This also includes that the patient informs himself exactly about the appearance of the basal cell carcinoma (and also of the malignant melanoma), examines his body regularly with regard to changes of the immune system and complies with the regular pre- and aftercare examinations with his physician. In addition to preventive measures, patients can also do a number of things to help them rest after the operation and any further treatments. Those who want to do good things for themselves pay attention to a healthy diet, sufficient drinking, adequate sleep and relaxation through methods such as yoga.
