Skin Cancer Every hour one American is killed by skin cancer and every thirty seconds one American gets skin cancer. Cancer is a deadly disease that alters the DNA of a skin cell and causes it to reproduce at a rapid pace. This overproduction of cells can be harmful and in many cases deadly. Out of these cancers the most common is Basal cell carcinoma. Many steps have been made in the treatment of Basal Cell Carcinoma, some have been very successful and some not.
The cells that have the altered DNA are called malignant or cancerous cells. These cells are found in the outer layers of the skin. The skin’s main job is to protect the body from infections and to insulate the body to keep it at the proper temperature. The first layer of skin is called the epidermis. This is the layer that is closest to the surface of the skin.
There are three types of cells in this layer. The first is the squamace. The squamace cells are flat and scaly and are located closest to the surface of the skin. Second are the basal cells and finally are the melanocytes, which give the skin its color. The second layer of skin is the dermis, which is much thicker than the epidermis.
This layer contains sweat glands, nerves and blood vessels. The dermis also contains follicles, which are tiny pockets from which the hair grows. The most common malignant cells are the basal cells. Cancer in the basal cell is called nonmelanoma cancer. This means that the cancer did not start in the melanocytes located in the epidermis. Basal Cell Carcinoma is caused by overexposure to the sun.
The sun gives off ultraviolet rays, which are harmful to the human body. Basal cell carcinoma will affect body parts such as the eyes, ears and nose. If it is detected before it gets deep into the skin there will most likely be no problem treating the cancer. A problem will occur if it isn’t detected quickly enough and it has progressed into the deep portions of the tissue. If Basal cell carcinoma is left untreated it can be very hard to treat and may even cause death. The common methods of treatment involve the use of Mohs micrographic surgery, radiation therapy, electrodesiccation and curettage, and simple excision. Each of these methods is useful in specific clinical situations.
Depending on the case, these methods have cure rates ranging from 85% to 95%. Mohs micrographic surgery, a newer surgical technique, has the highest cure rate for surgical treatment of both primary and recurrent tumors. This method uses microscopic control to determine the extent of tumor invasion. Although Mohs micrographic surgery method is complicated and requires special training, it has the highest cure rate of all surgical treatments because the tumor is microscopically outlined until it is completely removed. While other treatment methods for recurrent basal cell carcinoma have failure rates of about 50%, cure rates have been reported at 96% when treated by Mohs micrographic surgery. Mohs micrographic surgery is also indicated for tumors with poorly defined clinical borders, tumors with diameters larger than two cm, tumors with histopathologic features showing morpheaform or sclerotic patterns, and tumors arising in regions where maximum preservation of uninvolved tissue is desirable, such as eyelid, nose and finger.
Next there is a treatment involving simple excision with frozen or permanent sectioning for margin evaluation. This traditional surgical treatment usually relies on surgical margins ranging from three to ten millimeters, depending on the diameter of the tumor. Tumor recurrence is not uncommon because only a small fraction of the total tumor margin is examined pathologically. Recurrence rate for primary tumors greater than 1.5 cm in diameter is at least twelve percent within five years. If the primary tumor measures larger than three cm, the five year recurrence rate is 23.1%. Primary tumors of the ears, eyes, scalp, and nose have recurrence rates ranging from 12.9% to 25%.
Third there is electrodesiccation and curettage. This method is the most widely employed method for removing primary basal cell carcinomas. Although it is a quick method for destroying tumor, adequacy of treatment cannot be assessed immediately since the surgeon cannot visually detect the depth of microscopic tumor invasion. Tumors with diameters ranging from two to five mm have a fifteen percent recurrence rate after treatment with electrodesiccation and curettage. When tumors larger than three cm is treated with electrodesiccation and curettage, a 50% recurrence rate should be expected within five years.
The fourth type is radiation therapy. Radiation is a logical treatment choice, particularly for primary lesions requiring difficult or extensive surgery (e.g., eyelids, nose, and ears). It eliminates the need for skin grafting when surgery would result in an extensive defect. Cosmetic results are generally good to excellent with a small amount of hypopigmentation or telangiectasia in the treatment port. Radiation therapy can also be utilized for lesions that recur after a primary surgical approach. Radiation therapy is contraindicated for patients with xeroderma pigmentosum, epidermodysplasia verruciformis, or the basal cell nevus syndrome because it may induce more tumors in the treatment area.
Following treatment for basal cell carcinoma, the patient should be clinically examined every six months for five years. Thereafter, the patient should be examined for recurrent tumor or new primary tumors at yearly intervals. It has been prospectively found that 36% of patients who develop a basal cell carcinoma will develop a second primary basal cell carcinoma within the next five years. Early diagnosis and treatment of recurrent basal cell carcinomas or another primary basal cell carcinoma is desirable since the treatment of the disease in its earliest stages results in less patient morbidity. Carbon dioxide laser is most frequently applied to the superficial type of basal cell carcinoma. It may be considered when a bleeding diathesis is present, since bleeding is unusual when this laser is used.
Topical fluorouracil (5-FU) may be helpful in the management of selected superficial basal cell carcinomas. Careful and prolonged follow-up is required, since deep follicular portions of the tumor may escape treatment and result in future tumor recurrence In conclusion Basal Cell Carcinoma has many different treatment that are very helpful. Some more than others. Instead of going through the hassle of treating Basal Cell Carcinoma one should prevent it from entering into your system. Basal cell carcinoma is 100% preventable with the daily use of sunscreen beginning in the childhood years. Sunscreen prevents the ultraviolet rays from coming in contact with the skin thus preventing the cancer from entering into you body.
Bibliography (1) Abide, JM, Nahai F, Bennett RG. The Meaning of Surgical Margins: Plastic and reconstructive Surgery. : 492-497, 1984. (2) Dabski K, Helm F. Tropical Chemotherapy: Schwartz RA: Skin Cancer: Recognition and Management. New York, NY: Springer-Verlag, 1988, pp 378-389.
(3) Elson, Melvin. Internet Reference. http://www.colombia.net/consumer/datafile/skincanc .html. (4) Internet Reference. http://maui.net/~southsky/introto.html (5) Jablonski, Francis. Personal Interview. 10 March 1997 (6) Lippman SM, Shimm DS, Meyskens FL: Nonsurgical treatments for skin cancer: retinoids and alpha-interferon.
Journal of Dermatological Surgery and Oncology: 862-869, 1988. (7) Preston DS, Stern RS: Nonmelanoma cancers of the skin. New England Journal of Medicine 327(23): 1649-1662, 1992. (8) Thomas RM, Amonette RA: Mohs micrographic surgery. American Family Physician/GP 37(3): 135-142, 1988.
Skin Cancer Jack Ciallella Lab Bio October 21, 1999 Bibliography (1) Abide, JM, Nahai F, Bennett RG. The Meaning of Surgical Margins: Plastic and reconstructive Surgery. : 492-497, 1984. (2) Dabski K, Helm F. Tropical Chemotherapy: Schwartz RA: Skin Cancer: Recognition and Management.
New York, NY: Springer-Verlag, 1988, pp 378-389. (3) Elson, Melvin. Internet Reference. http://www.colombia.net/consumer/datafile/skincanc .html. (4) Internet Reference. http://maui.net/~southsky/introto.html (5) Jablonski, Francis. Personal Interview.
10 March 1997 (6) Lippman SM, Shimm DS, Meyskens FL: Nonsurgical treatments for skin cancer: retinoids and alpha-interferon. Journal of Dermatological Surgery and Oncology: 862-869, 1988. (7) Preston DS, Stern RS: Nonmelanoma cancers of the skin. New England Journal of Medicine 327(23): 1649-1662, 1992. (8) Thomas RM, Amonette RA: Mohs micrographic surgery.
American Family Physician/GP 37(3): 135-142, 1988.