The most common skin cancers are basal cell carcinomas, caused by the accumulated exposure to ultraviolet radiation over a lifetime. Exposure to certain chemicals, the presence of genetic diseases and having a compromised immune system can also be risks for developing basal cell carcinoma. Basal cell carcinomas rarely cause death as they do not spread to distant organs and cause only destruction of local tissue. Treatment can be divided into surgical and nonsurgical methods.
Surgical Excision
Surgery can be used to remove the cancer, though a large cancer that has spread into nearby tissue may require reconstructive surgery. When removing the cancer, the doctor will try and remove a margin of normal skin from around the cancer. The removed tissue will be viewed under a microscope to ensure that all abnormal cells are removed. A 2010 study published in the journal Dermatology, showed that the recurrence rate for a basal cell carcinoma after complete surgical excision was 0.5 percent, though this increased to 2.9 percent for basal cell carcinomas that had recurred. As with all surgery there are potential problems with the surgery itself such as infection, scarring, bleeding and anesthesia.
Curettage
Curettage uses a loop-style blade to scrape the cancer away from the normal skin. Curettage can be followed with either an application of an electrical current or extreme cold, called cryosurgery, which kill the cells at the edge of the cancer. These methods, however, do not allow the tissue to be examined to ensure complete removal of the cancer. A study published in 2007 in Dermatology Surgery showed that curettage and cryosurgery had an overall recurrence rate of 19.6 percent for basal cell carcinomas over 5 years. Curettage is cost-effective and quick but can result in poor scarring. Curettage is usually only used for small basal cell cancers and on certain parts of the body such as the trunk.
Mohs Micrographic Surgery
Mohs micrographic surgery removes layers of skin systematically. The removed skin is specially stained and viewed under a microscope. Layers of skin are removed until abnormal cancer cells are no longer seen under the microscope. It is usually carried out under local anesthetic. A 5-year follow up study published in Lancet Oncology showed that Mohs micrographic surgery for basal cell carcinomas on the face has a 2.5 percent recurrence rate. As with all surgery, there are possible complications and side effects, and this form of surgery will still leave a scar. Mohs micrographic surgery is also expensive compared to other treatments.
Topical Treatments
Several topical treatments can be used in the treatment of basal cell carcinoma. One such topical treatment is Imquimod 5 percent cream. The treatment lasts six weeks and the cream is applied five to seven times a week. A 2005 study published in the American Journal of Clinical Dermatology showed that 84 percent of patients treated with this medication were still clear one year after treatment for superficial basal cell carcinoma. Imiquimod, however, has a number of side effects such as redness, crusting and break down of the lesion and its safety and effectiveness still need to be determined.
Another topical treatment is 5-fluorouracil, which is used to treat small basal cell carcinomas. The cream is applied twice a day for a minimum of six weeks. Following topical treatment, the lesion should be assessed to ensure complete removal of the cancer.
Radiotherapy
Radiotherapy can be used instead of surgery in patients who are not able to tolerate surgery, or as an extra treatment after surgery for aggressive forms of basal cell carcinomas. Radiotherapy can also be used if surgery failed to remove the cancer. A study published in 2004 in theInternational Journal of Radiation Oncology, Biology, Physics, showed that radiotherapy controlled advanced basal cell carcinomas. Radiotherapy does not, however, provide the margin of the tumor to determine if the cancer has been entirely removed. Basal cell carcinomas that recur after radiotherapy are often more aggressive and difficult to treat.
References
- PubMed/Dermatology; Surgical Excision of Basal Cell Carcinoma with Complete Margin Control:Outcome at 5-Year Follow up; T Wetzig, et al; May 2010
- PubMed/Dermatology Surgery; Surgical Excision Versus Curettage Plus Cryosurgery in the Treatment of Basal Cell Carcinoma; DI Kuijpers, et al; May 2007
- PubMed/Lancet Oncology; Surgical Excision Versus Mohs' Micorgraphic Surgery for Primary and Recurrent Basal-Cell Carcinoma of the Face: A Prospective Randomised Controled Trial with 5-Years' Follow-Up"; K Mostered, et al; December 2008
- American PubMed/Journal of Clinical Dermatology: Imquimod: in Superficial Basal Cell Carcinoma; V Oldfield, et al; 2005
- PubMed/International Journal of Radiation Oncology, Biology, Physics; Radiotherapy for Local Advanced Basal Cell Carcinoma and Squamous Cell Carcinoma of the Skin; W Kwan, et al; October 2004
