Content

Introduction

Basalioma or basal cell carcinoma (BCC) is a skin tumor that originates from the malignant transformation of cells located in the deepest layer of the epidermis.

Unlike melanoma, which originates from melanocytes and is very aggressive, basalioma develops locally and tends to remain limited and not spread far away (metastases) if not very rarely (0.003-0.5% of basaliomas).

It is the most common among skin cancers which, in turn, represent the most frequent malignant form (15.2%) of all cancers in men and the second (14.8%), after breast cancer, in woman.
In Italy, excluding melanoma, 8 out of 10 skin cancers are basaliomas. In 95% of cases they occur in people over the age of 40. The elderly population, usually male, is the most affected. The number of new cases (incidence) is about 30% higher in men than in women. Although cases of basalioma have been observed in children, the development of this tumor before the age of 20 is a very rare event.

Basaliomas occur mainly in the parts of the body most exposed to the sun: face, scalp, ears, neck, shoulders and back (back) and are more frequent in individuals with fair skin. Sunburn, resulting from exposure to sunlight during childhood and adolescence, seem to play a major role in the development of basalioma in adulthood.Therefore, in addition to being a necessary prevention for everyone, protecting the skin from the sun is particularly important in children and young people.

Symptoms

In the initial phase, basalioma rarely causes significant disturbances (symptoms) that may suggest its development, such as the appearance or change in the appearance of spots, or small formations, on the skin.

In the later stages, when the stage of development is more advanced, the basalioma can bleed and cause itching, or pain, appearing in forms similar to:

  • persistent and tending to spread sunburn (erythematous form)
  • lentil hard to the touch and pink in color (nodular form)
  • wound that does not heal (ulcerated form)
  • mole or freckle (pigmented form)
  • raised spot tending to grow (plate shape)
  • irregularly shaped scar (scleroderma form)

In any case, it is advisable not to underestimate any changes in the appearance of the skin, especially if a wound appears that does not heal and tends to bleed, as it can be a sign of the presence of a tumor.

Causes

Basalioma can be caused by various factors of environmental, constitutional, family origin or be determined by contact with chemicals. However, among the various causes, prolonged exposure to ultraviolet rays (UVA and UVB) from the sun and the use of sunbeds and sun lamps represent the main risk factor, especially in people who were very exposed to such radiation at a young age, especially before the age of 18.
In addition to "excessive exposure to ultraviolet rays, the factors that increase the risk of developing basalioma are:

  • contact with arsenic
  • exposure to ionizing radiation
  • insufficiency of the defense system of the organism (immune system) due to the "intake of so-called immunosuppressive drugs (medicines used after transplants), or to diseases such as, for example, AIDS
  • some cures for psoriasis
  • family members who have already had basalioma (family history for the disease)
  • some genetic abnormalities
  • have very fair skin
  • be over 50 years old
  • be male

Diagnosis

To ascertain (diagnose) the presence of a basalioma, the available tests are:

  • dermatological examination
  • epiluminescence (non-invasive technique that allows you to observe and take images of a suspicious formation for their evaluation by the doctor)
  • biopsy (withdrawal of a small part of the suspect formation)

During the dermatological examination, the doctor assesses whether there are any spots or formations on the skin that could make one suspect the presence of a tumor. After having observed them with the naked eye, he inspects them with epiluminescence (or dermatoscopy), a non-invasive examination that allows to study in depth the pigmented skin areas and to recognize any skin cancers, including melanoma.

The examination consists in the observation, by means of an instrument, of the suspicious areas and allows the digital storage of the images, in order to be able to follow any changes over time. It has no contraindications and does not require any type of preparation. It is a painless investigation suitable for all ages, sexes and physical conditions, including pregnancy. It also allows you to reduce or avoid unnecessary surgery.

Biopsy consists of taking a small amount of tissue to be analyzed in the laboratory. It is a procedure that is performed on an outpatient basis, under local anesthesia. In some cases it is possible to perform the biopsy and remove the basalioma during the same medical examination (excisional biopsy).

It is always advisable to carry out a self-examination of the skin to check whether moles, spots or formations (lesions) change over time. Self-examination represents the first form of control to prevent and detect skin tumors in the initial phase (early diagnosis) and should be practiced periodically (every 3-4 months).

Therapy

Basalioma, especially if eliminated or cured (treated) in the initial phase of its development, heals in almost all cases.

The treatments are:

  • surgery, resorting to surgery is generally the first choice for this type of disease. In some cases, an operation under local anesthesia, very similar to a simple skin biopsy, is sufficient to completely remove the basalioma
  • curettage and electro-drying, a technique that consists in scraping the lesion with a special tool and in the subsequent application on the residual area of ​​an electric needle that allows the destruction of any remaining tumor cells; this procedure, indicated when the size of the basalioma is small, does not allow the eliminated tumor tissue to be analyzed (histological examination) or to verify the presence of tumor cells on its edges, because it is a "destructive" technique
  • Mohs surgery, consists of removing the tumor under local anesthesia by removing a very thin layer of tissue at a time and analyzing it under a microscope: if the presence of cancer cells is detected, another layer of tissue is taken, otherwise the treatment is interrupted. The Mohs technique has high specificity and sensitivity and allows you to significantly improve the aesthetic appearance of the skin after surgery
  • superpulsed CO2 laser therapy, technique that involves the destruction of tumor tissue. Laser therapy can cause lighter (hypopigmentation) and atrophic scars to form
  • cryotherapy, it is used above all to eliminate the tumor in the initial phase by applying liquid nitrogen to the part which, causing it to freeze, destroys the cancer cells. After the treatment, a bubble or a crust forms which falls off within a few weeks
  • local (topical) treatments, chemotherapy drugs, or medicines that stimulate the immune system against the tumor, in the form of a cream or ointment, are applied directly to the area affected by the basalioma
  • photodynamic therapy (PDT), consists in applying a liquid drug to the tumor which, in a few hours, accumulates inside the tumor cells, making them sensitive to certain types of light. Subsequently, the affected area is treated with a special light capable of destroying the diseased cells
  • systemic radiotherapy and / or chemotherapy (drug treatment that reaches the whole body), these are not very frequently used therapies for skin carcinomas; chemotherapy is useful in cases where the tumor has reached the lymph nodes

Finally, for adult patients with advanced-stage tumors, in the very rare cases in which surgery or radiotherapy are not applicable, medicines aimed at altered molecular mechanisms have recently been approved by the Italian Medicines Agency (AIFA).

Prevention

The main prevention strategy against basalioma and, in general, against all skin cancers, is to limit exposure to ultraviolet rays: avoid sunbathing during the hottest hours of the day, wear a hat and dark glasses and use creams high protection taking care to apply them several times a day, in abundant quantities, to ensure complete and continuous protection.

These precautions apply to everyone, but especially to children as their skin is much more sensitive to damage caused by the sun.

The use of artificial sunbeds and sunlamps should be avoided.

Furthermore, contact with some harmful chemicals, such as arsenic, tar, coal or paraffin, which can cause the onset of basalioma, should be avoided.

For the purpose of prevention, it is good to carry out a self-examination of the skin that allows you to notice if moles, spots or skin formations change in appearance over time. Self-examination is the first form of control (screening) to prevent or detect skin cancers at an early stage (early diagnosis) and should be practiced periodically (every 3-4 months).

If there are moles, or spots, there are four elements to consider when performing the self-examination:

  • asymmetry (irregularly shaped spots are more suspicious than regular rounded spots)
  • color (moles or spots with uneven coloring must be evaluated by the doctor)
  • edges (irregular and jagged edges may suggest a tumor)
  • dynamic (the change in color, shape, size, thickness over time is an alarm bell for the risk of a possible skin cancer)

Living with

Considering that the major risk factor for the onset of basalioma is exposure to ultraviolet rays, the warning to limit sun exposure also applies if you have already contracted the disease. Exposure to the sun in the hottest hours of the day should be avoided and, above all, it is important to always protect the skin with specific creams, especially if you have fair skin, repair the head with hats and wear sunglasses.

Basalioma is the most frequent skin tumor and, in most cases, it is cured definitively with outpatient surgical removal. Rarely, however, the lesions it causes can be disfiguring, especially if they affect the face; in these cases and, in in particular, in the phase following the intervention, it is even more important to use total protection creams.

We must not neglect the psychological aspect of the disease: very often those affected by basalioma in an advanced stage tend to isolate themselves and hide the parts of the body affected by the disease, compromising their social life. This behavior, however, risks creating a vicious circle : hiding and neglecting oneself are, in some cases, the reasons why one gets to have an advanced form of cancer without having treated it first.In these cases, targeted psychological therapy can help.

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