Basal cell carcinomas usually develop on the head and neck region which are majorly exposed to sun. Development of tumors in the trunk and legs is a rare occurrence [7]. A sore that does not heal and repeatedly bleeds is the preliminary sign of development of cancer. In addition to these, the tumor may appear as shiny or pearly lump and may bleed developing a crust over it. Individuals with dark skin tone develop a brown or black color lump. As the disease progresses, areas of chest or back may also develop scaly flesh colored patch. The patch may gradually enlarge. In rare cases, a white color wax scar may also develop. However, such type of tumors can easily go unnoticed.

Skin examination and biopsy of the affected area form the diagnostic procedures for confirming basal cell carcinoma. The areas where the nodules have developed would be carefully examined. In addition, other parts of the body would also be carefully looked for signs of development of the nodules. Following this, a skin biopsy would also be carried out to detect the type of cancer present.

The type of treatment to be employed greatly depends on the stage and the area affected. The following methods are administered for treating basal cell carcinoma:

• Electrodesiccation and curettage: In this method, the surface of the lump is scraped using a curette and the base of the lump is seared using electrical needle. This method is used when the cancer develops in the ear or legs [8].
• Surgical excision involves removing the cancerous tumor along with some healthy neighboring tissues [9].
• Cryosurgery involves freezing of the cancer cells which is carried out using liquid nitrogen.
• Mohs surgery is the treatment of choice for recurrent basal cell carcinomas. In such a type of surgical procedure the cancerous cells are removed after examining each and every layer. The layers are removed until no abnormal cells are observed [10].
• Medications are the last resort when the cancer has not responded to other treatment regimes and has spread to other body parts.

The prognosis of the disease is extremely favorable with 100% survival rate if the cancer has not spread to other body parts. However, if treatment is not initiated on time then the cancer can spread to other parts causing significant morbidity and mortality of affected individuals. Cosmetic disfigurement is common in cases which have not received prompt treatment [6].

Genetic mutations in the basal cells of the skin are known to be the major factors that trigger the development of basal cell carcinoma. Mutations in the cells cause damage to the DNA which occurs as a result of long term exposure to ultraviolet rays. In addition to ultraviolet rays of the sun, the radiation found in commercial lamps and tanning beds are also known to play a role in the causation of BBC. There are other factors such as exposure to toxic substances or a weakened immune system, which also significantly contribute to basal cell carcinoma. There have also been some pieces of evidence suggesting causation of BBC due to exposure of arsenic in water [2].

The incidence of BBC is known to double every 25 years. It has been estimated that in the United States, about 1 million individuals are diagnosed with BBC every year. Amongst the individuals diagnosed, about 10,000 deaths occur due to cancer [3]. Caucasians are more affected due to basal cell carcinoma than any other race. It has also been estimated that BBC is a common occurrence in USA, Australia and Europe.

Damage to the DNA of the basal cells causes BBC. Basal cells are situated beneath the epidermal layer of the skin. Under normal conditions, for new skin cells to develop, the old cells are pushed towards the surface where they slough off and die. This process is effectively controlled by the DNA of the skin cells. Mutation arising in the DNA causes the basal cells to multiply in an uncontrollable fashion. Such sequence of events causes accumulation of abnormal cells which eventually take form of cancerous tumors [4]. Exposure to ultraviolet radiation either through sun, commercial lamps or tanning beds also causes DNA damage. Individuals are therefore advised to wear protective clothing prior to stepping out in the sun [5].

Long term exposure to ultraviolet rays is known to be the major cause of DNA mutation in individuals with basal cell carcinoma. Individuals are therefore advised to wear sun protective clothes before stepping out in sun. For the exposed body parts, applying sufficient quantity of sun protective lotion should be practiced. Individuals are also advised to avoid using tanning beds. Avoiding venturing out in the mid-day sun would also reduce the risk of developing basal cell carcinoma.

Basal cell carcinoma (BCC) rarely spreads to other parts of the body. In about 80% of the cases, basal cell carcinoma affects the head and neck since that they are mostly exposed to the ultraviolet rays of sun. The past decade has witnessed a significant rise in the incidence of basal cell carcinoma. BBC is a form of non-melanocytic skin cancer [1].

Definition

Basal cell carcinoma (BCC) is the most common form of skin cancer that originates in the basal cell of the skin. Such a type of carcinoma is also termed as “epitheliomas” as they rarely spread to other body parts. The rate of incidence of BBC is high in countries such as US, Europe and Australia.

Cause 

Mutation in the DNA of the basal cell due to exposure to ultraviolet rays is the major causative factor. In addition to these, frequent and prolonged use of tanning beds can also cause BBC. Exposure to environmental toxic compounds can also pose significant risk of developing BBC.

Symptoms

The tumors develop in the sun exposed areas. The lump is white and pearly in color which bleeds frequently and crust develops over it. In dark toned individuals, the lump is black or brown in color.

Diagnosis

Diagnosis of BBC is made by physical examination of the nodule. In addition, skin biopsy is done to further confirm the condition.

Treatment

Treatment of BBC involves surgical excision, electrodessication and curettage, cryosurgery, Mohs surgery and topical treatments. The type of method involved greatly depends on the location and the stage at which the cancer is diagnosed. Medications are often the last resort when other methods of treatment fail to bring about the desired effect.

1. Vitasa BC, Taylor HR, Strickland PT, et al. Association of nonmelanoma skin cancer and actinic keratosis with cumulative solar ultraviolet exposure in Maryland watermen. Cancer 1990; 65:2811.
2. Cabrera HN, Gómez ML. Skin cancer induced by arsenic in the water. J Cutan Med Surg. Mar-Apr 2003;7(2):106-11.
3. Rogers HW, Weinstock MA, Harris AR, et al. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol 2010; 146:283.
4. Zhang H, Ping XL, Lee PK, Wu XL, Yao YJ, Zhang MJ, et al. Role of PTCH and p53 genes in early-onset basal cell carcinoma. Am J Pathol. Feb 2001;158(2):381-5.
5. Zhang M, Qureshi AA, Geller AC, et al. Use of tanning beds and incidence of skin cancer. J Clin Oncol 2012; 30:1588.
6. Miller SJ, Alam M, Andersen J, et al. Basal cell and squamous cell skin cancers. J Natl Compr Canc Netw 2010; 8:836.
7. Erba P, Farhadi J, Wettstein R, Arnold A, Harr T, Pierer G. Morphoeic basal cell carcinoma of the face.Scand J Plast Reconstr Surg Hand Surg. 2007;41(4):184-8.
8. Salasche SJ. Curettage and electrodesiccation in the treatment of midfacial basal cell epithelioma. J Am Acad Dermatol 1983; 8:496.
9. Berman B. Scientific rationale: combining imiquimod and surgical treatments for basal cell carcinomas. J Drugs Dermatol. Jan 2008;7(1 Suppl 1):s3-6.
10. Rowe DE, Carroll RJ, Day CL Jr. Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma. J Dermatol Surg Oncol 1989; 15:424.