Basal Cell Carcinoma

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Photodynamic Therapy:

Recommendation: Strong (Photodynamic Therapy is potentially effective in treating Basal Cell Carcinoma in its early stages)

Grade of Evidence: Strong quality of evidence

 * www.gradeworkinggroup.org

Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the most common type of skin cancer and falls under the non-melanoma type. [1] Although frequent, only less than 1% of cancer patient deaths are attributed to it. The tumors which grow slowly are classically found on areas exposed to sun. [2]

Epidemiology

American Cancer Society reports that 75% of skin cancer cases are BCC. [3] In the United States, more than 1 million new cases are diagnosed annually causing over 10,000 deaths per year. BCC is most often found in light-skinned people and males are affected twice than females. As a person grows older, the chance of getting BCC gets higher. People aged 50-80 years old are commonly affected with meanage of 55. [2]

Causes

The usual cause of BCC is over-exposure to ultraviolet (UV) rays from sun or sunbeds. BCC may also develop on injured skin due to burns, scars and ulcers. [1] Factors that may increase the chances of having BCC are having light or freckled skin, blond or red hair, blue, green or grey colored eyes and many moles, family history of BCC, over-exposure to sun, x-ray and other radiation forms and history of severe sunburns. [4] Individuals who use sun beds and sun bathe are also at risk. [1]

Signs and Symptoms

BCC may look only a little different from normal skin. It may show as a skin bump or growth thatis pearly or waxy and may appear as white, light pink, brown or same color as flesh. [3] Usually, patients initially notice BCC as a scab with occasional bleeding which heals incompletely. Most are painless and may be itchy. It may also bleed when picked up. [1]

Diagnosis

Physical exam is used to assess the skin lesion. Skin biopsy is often made to confirm BCC and to determine type. When deeper structures are involved like bone, CT scans or radiography may be done. [2

Treatment

There are a number of treatment options for BCC. The choice is based on type, extent and site, numbers to be treated and physician expertise. Management of BCC include superficial skin surgery, excision biopsy, Mohsmicro graphically controlled excision, photodynamic therapy, imiquimod cream, cryotherapy, radiotherapy and vismodegib. [6]

Prognosis

BCC often resolves with treatment. Some may recur and there is also a risk of developing other skin cancers. [6]

References:

1. http://www.bad.org.uk/site/800/Default.aspx

2. http://emedicine.medscape.com/article/276624-overview

3. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001827/

4. http://www.nlm.nih.gov/medlineplus/ency/article/000824.htm

5. http://dermnetnz.org/lesions/basal-cell-carcinoma.html

6. http://dermnetnz.org/lesions/basal-cell-carcinoma.html

 

Summary References Treatments:

1. Butler DF, Parekh PK, Lenis A (January 2009). "Imiquimod 5% cream as adjunctive therapy for primary, solitary, nodular nasal basal cell carcinomas before Mohs micrographic surgery: a randomized, double blind, vehicle-controlled study". Dermatol Surg  35 (1): 24–9.

2. http://www.peplin.com/

3. Peng Q, Juzeniene A, Chen J, et al. (2008). "Lasers in Medicine". Rep. Prog. Phys. 71 (056701): 056701.

4. http://www.webmd.com/cancer/cryosurgery-for-nonmelanoma-skin-cancer

5. http://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf

6. Silverman MK, Kopf AW, Bart RS, Grin CM, Levenstein MS (June 1992). "Recurrence rates of treated basal cell carcinomas. Part 3: Surgical excision". J Dermatol Surg Oncol 18 (6): 471–6.

7. http://www.merck.com/mmpe/sec10/ch128/ch128b.html#sec10-ch128-ch128b-1181c

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