Causes of a basal cell carcinoma of the nose
By far the most important risk factor for the development of a basalioma is the long-term exposure of the skin to UV radiation in sunlight. Consequently, this type of tumour develops mainly in those areas of the skin that are regularly exposed to a great deal of sunlight: 80% of basaliomas form on the face, most of them are located in the strip that runs from the hairline over the nose to the upper lip.
Diagnosis
The diagnosis of a basal cell carcinoma of the nose is usually made by a dermatologist. In advanced stages, a gaze diagnosis is sometimes possible or is indicative. In any case, a biopsy must be taken and examined in a pathology laboratory.
Since the risk of cell transplantation is very high, the entire conspicuous skin area is usually removed and sent in. Regular skin cancer screening is also useful for early detection of a basal cell carcinoma. Since basal cell carcinoma grows very slowly, it generally has very good chances of healing.
It is important that the basal cell carcinoma is distinguished from a pimple or skin appendage. The appearance of a basal cell carcinoma can vary. In the beginning, for example, a bright lump on the nose or in the corner of the nose can appear.
On the other hand, the lump can also be reddish in colour. In addition, the basal cell carcinoma can also be seen as a red spot in the skin. These nodules or spots slowly spread further.
In some cases, a central depression may occur. The basal cell carcinoma may bleed in the course of the disease. A crust then forms on this bleeding site.
The treatment of a basal cell carcinoma of the nose
Once a basal cell carcinoma has been diagnosed, photodynamic irradiation of the nose can be performed in addition to surgical removal. Recurrences are always possible, but the prognosis is generally good. The therapy of first choice for the treatment of a basal cell carcinoma of the nose is radical, microscopically controlled excision.
For this purpose, the degenerated epithelial cells of the nose are usually surgically removed under local anaesthesia or, if desired, under general anaesthesia. The surgeon uses a scalpel to cut around the degenerated area at a safe distance and removes all degenerated cells if possible. Since this is usually a relatively small degenerated area, but the position in the face requires a very precise operation, the surgeon uses a microscope.
This is normally attached to the head of the surgeon and allows for a high magnification. This prevents unnecessarily large excisions – and the basal cell carcinoma can be completely removed. Laser surgery, cryosurgery, and radiation by means of x-rays are also available as an alternative to classical surgery.
This may be necessary in some cases, especially for older patients, if an invasive procedure cannot be performed. As a rule, a basal cell carcinoma is therefore treated by surgical intervention. After the operation, a bandage must be worn for a few days or weeks to prevent inflammation.
The tissue normally grows back within weeks to months and fills the excised gap. The excidate is always kept for follow-up examination, and passed to the pathology department for examination and correct grading. Grading is a classification of the tumor, the areas removed, and an assessment of the good or bad nature of the tumor.
Although the basal cell carcinoma is a semimalignant, i.e. “semi-malignant” tumour, a very good prognosis can be expected due to its low metastasis rate in case of complete surgical excision. The fact that basal cell carcinomas grow slowly over a period of months or even years is also a favourable outcome. However, one should not wait too long before surgery, because with enough time even a semi-malignant tumor can degenerate malignantly.
- In laser surgery, the removal is performed using a high-energy laser. – Cryosurgery is a surgical procedure in which the basal cell carcinoma is destroyed by exposure to cold. However, the last mentioned procedures only promise success in the case of small and superficial basaliomas.
A skin transplantation is performed after surgical removal of the basal cell carcinoma. The size of the basal cell carcinoma and the extent to which it has spread into the surrounding area are important. If the wound cannot then be closed due to its size, a skin transplant must be performed to cover the wound.
The displacement-swivel-flap technique can be used in the development of tissue defects. In this case the surgical wound is covered with healthy skin from the surrounding area. The wound edges and the skin graft edges are sutured together.
Depending on how deep the operation wound is, either only superficial skin layers or also deeper skin layers are taken to close the skin defect. Another possibility is the so-called rotational flap plastic surgery, in which the skin flap is prepared and turned into the skin defect. Here too, the edges are sutured.
