Skin cancer

After a vacation at the beach, a woman observed that her skin showed scaly brown patches on the back and the chest region. She consulted the doctor who did a biopsy of the skin. The test results showed abnormal cells growing in the top most layer of the skin (epidermis) which have a tendency to turn into malignant basal cell carcinoma. Fortunately due to early detection, necessary treatment was given in time before it turned malignant.

About Basal Cell Carcinoma

Basal cell carcinoma is the most common form of skin cancer in the United States where 75% of all skin cancers are basal cell carcinomas. This is a type of skin cancer that occurs on the top layer of the skin and grows slowly without any pain. These cancers are mostly seen in people above 40 years of age who are exposed to harmful ultraviolet radiation from the sunlight.

The skin consists of three layers out of which the epidermis is the topmost layer. The basal cells present in the basal layer of the epidermis produce new skin cells which push the old cells towards the skin surface. The old cells that reach the surface of the skin die and wither away. This entire process is controlled by DNA. When the skin is exposed to harmful sunlight, the DNA gets damaged which results in uncontrollable over growth of cells that results in formation of basal cell carcinoma. The causes of basal cell carcinoma includes ultraviolet radiation; therapeutic radiation (ultraviolet treatment for psoriasis); chemical toxins like arsenic; immunosuppressant drugs; Gorlin’s syndrome (rare genetic disorder); Xeroderma pigmentosum (extreme sensitivity to sunlight); Bazex’s syndrome (numerous basal cell tumors on face).

The skin of the affected person may show a pearly white or waxy bump like tumor that may bleed and develop a crust or depression in its center. The skin may also form scaly brown flesh colored patches that appear on the chest or back which increase in size over time to nearly 10 cm to 15 cm (4 to 6 inches). It may also appear as a white waxy scar. The other symptoms include easily bleeding skin sores that do not heal, irregular blood vessels around the sore and oozing from the sore.

If basal cell carcinomas are untreated they spread to the muscles, bones, and nerves nearby and destroy them. Even after treatment there is a chance that the tumors will recur in the same area. A person with a history of basal cell carcinoma can have other serious cancers like malignant melanoma or Squamous cell carcinoma after a long period of skin exposure to harmful ultraviolet rays of the sun.

Diagnosis

A complete physical examination is done by the doctor. A sample of the skin is excised from the top of the tumor and sent to the lab for analysis. This procedure is known as biopsy. Biopsy procedure may leave a scar in the area.

Stages of basal cell carcinoma

The basal cell carcinoma is graded into stages depending on the severity, size of tumor and extent of spread of the cancer.

  • Stage 0: In this stage, the abnormal cells are present in the basal layer of epidermis which is the top most layer of the skin. These cells may turn into cancer cells later and spread to other parts of the body.
  • Stage 1: In stage 1, a tumor of 2cms forms.
  • Stage 2: In stage 2 the tumor is more than 2 cms and has 2 or more high risk features
  • Stage 3: In stage 3, the tumor spreads to side of skull, eye socket and jaw but not to the lymph nodes.
  • Stage 4: In stage 4 the cancer not only spreads to the side of skull, eye socket and jaw but also to lymph nodes that are between 3cms to 6 cms. In this stage, the cancer spreads to distant parts of the body.

Treatment

There are a variety of treatments basal cell carcinoma depending on the severity, type and location of the tumor. In a procedure called as electrodessication and curettage, the doctor scrapes surface of the skin cancer with the help of a curette, and then the base of the tumor is seared with the help of an electric needle. The cancerous tissue along with a little of the healthy tissue margin is surgically excised or removed. In cryosurgery technique, the tumor is frozen with the help of liquid nitrogen and then the cancerous cells are removed. It is useful in patients with many tumors but has side effects like scarring and slow healing. A highly specialized surgery called Moh’s surgery is done for deep growing basal cell carcinomas that occur on the face. This can be performed only by expert surgeons as it involves removing cancer cells layer by layer carefully without causing any scar on the face. To minimize bleeding, laser surgery is done. Some of the topical medication ointments used for superficial basal cell cancers includes tazarotene, imiquimod and 5- fluorouracil.

Prognosis

Smaller basal cell carcinomas are less likely to recur than large ones. There is a 1% risk of the cancer returning after Moh’s surgery whereas there is 10% chance of the cancer returning after other treatments. Recurrences of basal cell carcinoma are seen in the first 2 years after surgery in the nose and scalp region.

Prevention

To prevent basal cell carcinomas one must try to avoid being in sunlight between 10am to 4 pm as this is the time when ultraviolet radiation from the sun can cause harm. A sunscreen lotion known as Anthelios SX helps in protecting the skin from harmful sunlight. It is advised that one should wear protective clothing as well as protective sunglasses. Certain medications that make the skin sensitive are ibuprofen and medications used for blood pressure, diabetes, cholesterol, and antibiotics. One should get regular skin checkups done and observe for changes in the freckles, bumps, moles and birth marks. Foods rich in Vitamin D, Vitamin C, Vitamin E and carotenoids help in preventing cancer. The diet should include around 2000 calories (9 servings) of fresh fruit and vegetables every day.