Basal cell carcinoma is a malignant tumor of the skin that develops from the cells of the epidermis. It got its name because of the similarity of tumor cells with cells of the basal layer of the skin. Disease has the main signs of a malignant neoplasm: it grows into neighboring tissues and destroys them, recurs even after proper treatment. But unlike other malignant tumors, basal cell carcinoma practically does not metastasize. For this pathology, surgical treatment, cryodestruction, laser removal and radiation therapy are possible. Therapeutic tactics are selected individually depending on the characteristics of basal cell carcinoma.
Basal cell carcinomais a malignant tumor of the skin that develops from the cells of the epidermis. It got its name because of the similarity of tumor cells with cells of the basal layer of the skin. Disease has the main signs of a malignant neoplasm: it grows into neighboring tissues and destroys them, recurs even after proper treatment. But unlike other malignant tumors, basal cell carcinoma practically does not metastasize.
Basal cell carcinoma occurs mainly in people over 40 years of age. Factors contributing to its development include frequent and prolonged exposure to direct sunlight. Therefore, residents of southern countries and people working in the sun are more susceptible to basal cell carcinoma. People with fair skin get sick more often than dark-skinned people. Contact with toxic substances and carcinogens (petroleum products, arsenic, etc.), permanent injury to a certain area of the skin, scars, burns, ionizing radiation are also factors that increase the risk of basal cell carcinoma. Risk factors include a decrease in immunity against the background of immunosuppressant therapy or a long-term disease.
The occurrence of this disease in a child or teenager is unlikely. However, there is a congenital form — Gorlin–Goltz syndrome (neobazocellular syndrome), which combines a flat surface form of the tumor, mandibular cysts, malformations of the ribs and other anomalies.
The following clinical forms are distinguished:
- nodular ulcerative;
- warty (papillary, exophytic);
- nodular (large nodular);
- flat superficial (pagetoid epithelioma);
- Spiegler’s tumor (“turban” tumor, cylinder)
Most often, the basal cell carcinoma is located on the face or neck. The development of the tumor begins with the appearance on the skin of a small nodule of pale pink, reddish or flesh color. At the beginning of the disease, the nodule may resemble an ordinary pimple. It grows slowly, without causing any painful sensations. A grayish crust appears in its center. After its removal, a small depression remains on the skin, which soon becomes covered with a crust again. Characteristic of disease is the presence of a dense roller around the tumor, clearly visible when stretching the skin. The fine granular formations that make up the roller look like pearls.
Further growth of basal cell carcinoma in some cases leads to the formation of new nodules, which eventually begin to merge with each other. The expansion of superficial vessels leads to the appearance of “vascular asterisks” in the tumor area. Ulceration may occur in the center of the tumor with a gradual increase in the size of the ulcer and its partial scarring. Increasing in size, basal cell carcinoma can grow into surrounding tissues, including cartilage and bones, causing severe pain syndrome.
Nodular-ulcerative basal cell carcinoma is characterized by the appearance of a protruding seal above the skin, having a rounded shape and similar to a nodule. Over time, the seal increases and ulcerates, its outlines acquire an irregular shape. A characteristic “pearl” belt is formed around the knot. In most cases, nodular-ulcerative basal cell carcinoma is located on the eyelid, in the nasolabial fold or in the inner corner of the eye.
The perforating form occurs mainly in those places where the skin is constantly injured. From the nodular-ulcerative form of the tumor, it is distinguished by rapid growth and pronounced destruction of surrounding tissues. Warty (papillary, exophytic) basal cell carcinoma resembles cauliflower in its appearance. It is a dense hemispherical nodes that grow on the surface of the skin. A feature of the warty form is the absence of destruction and germination into the surrounding healthy tissues.
Nodular (large-nodular) is a single node protruding above the skin, on the surface of which “vascular asterisks” are visible. The node does not grow deep into the tissues, like nodular ulcerative form, but outwards. The pigment form has a characteristic appearance — a nodule with a “pearl” roller surrounding it. But the dark pigmentation of the center or edges of the tumor makes it look like melanoma. Sclerodermi form is characterized by the fact that the characteristic nodule of pale color, as it increases, turns into a flat and dense plaque, the edges of which have a clear contour. The surface of the plaque is rough and over time it can ulcerate.
The scar-atrophic form also begins with the formation of a nodule. As the tumor grows, destruction occurs in its center with the formation of ulcers. Gradually, the ulcer increases and approaches the edge of the tumor, while scarring occurs in the center of the ulcer. The tumor acquires a specific appearance with a scar in the center and an ulcerated edge, in the area of which tumor growth continues.
Flat superficial form (pagetoid epithelioma) is a multiple neoplasm up to 4 cm in size that does not grow deep into the skin and does not rise above its surface. The formations have a different color from pale pinkish to red and raised “pearl” edges. Such a basal cell carcinoma develops over several decades and has a benign course.
Spiegler’s tumor (“turban” tumor, cylinder) is a multiple tumor consisting of pink—purple nodes covered with telangiectasias ranging in size from 1 to 10 cm. Spiegler’s form is localized on the scalp, has a long benign course.
Although basal cell carcinoma is one of the types of skin cancer, it is characterized by a relatively benign course, since it does not metastasize. The main complications of basal cell carcinoma are related to the fact that it can spread to the surrounding tissues, causing their destruction. Severe complications, up to a fatal outcome, occur when the process affects bones, ears, eyes, brain membranes, etc.
Diagnosis is carried out by cytological and histological examination of a scrape or smear-print taken from the surface of the tumor. During the examination under the microscope, strands or nest-like clusters of cells of rounded, fusiform or oval shape are detected. Along the edge of the cell are surrounded by a thin rim of cytoplasm.
However, the histological picture is as diverse as its clinical forms. Therefore, its clinical and cytological differential diagnosis with other skin diseases plays an important role. Flat superficial basal cell carcinoma is differentiated from lupus erythematosus, lichen planus, seborrheic keratosis and Bowen’s disease. Sclerodermi form is differentiated from scleroderma and psoriasis, pigmented form — from melanoma. If necessary, additional laboratory tests are carried out to exclude diseases similar to basal cell carcinoma.
The method of treatment is selected individually depending on the size of the tumor, its location, clinical form and morphological appearance, the degree of germination into neighboring tissues. What matters is the primary occurrence of a tumor or a relapse. The results of previous treatment, age and concomitant diseases of the patient are taken into account.
Surgical removal is an effective and most common way to treat it. The operation is performed with limited tumors located in relatively safe places for surgical intervention. Resistance to radiation therapy or its recurrence is also an indication for surgical removal. In case of sclerodermiform basal cell carcinoma or tumor recurrence, excision is performed using a surgical microscope.
Cryodestruction of basal cell carcinoma with liquid nitrogen is a quick and painless procedure, but it is effective only in cases of a superficial location of the tumor and does not exclude the occurrence of a relapse. Radiation therapy of basal cell carcinoma with a small size of the stage I-II process is carried out by close-focus radiotherapy of the affected area. In case of extensive lesion, the latter is combined with remote gamma therapy. In difficult cases (frequent relapses, large tumor size or its deep germination), radiotherapy can be combined with surgical treatment.
Laser removal is well suited for elderly people whose surgical treatment can cause complications. It is also used in the case of localization of basal cell carcinoma on the face, because it gives a good cosmetic effect. Local chemotherapy of basal cell carcinoma is carried out by applying applications of cytostatics (fluorouracil, metatrexate, etc.) to the affected areas of the skin.
In general, due to the absence of metastasis, the prognosis of the disease is favorable. But in advanced stages and in the absence of adequate treatment, the prognosis of basal cell carcinoma can be very serious.
Early treatment of basal cell carcinoma is of great importance for recovery. Due to the tendency of basal cell carcinoma to frequent recurrence, a tumor of more than 20 mm is already considered neglected. If the treatment is carried out until the tumor has reached such a size and has not begun to germinate subcutaneous tissue, then in 95-98% there is a stable cure. When basal cell carcinoma spreads to the underlying tissues, significant cosmetic defects remain after treatment.