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Skin Cancer
Every hour one American is killed by skin cancer and every thirty seconds one American gets skin cancer.
Cancer is a deadly disease that alters the DNA of a skin cell and causes it to reproduce at a rapid pace. This
overproduction of cells can be harmful and in many cases deadly. Out of these cancers the most common
is Basal cell carcinoma. Many steps have been made in the treatment of Basal Cell Carcinoma, some have
been very successful and some not.
The cells that have the altered DNA are called malignant or cancerous cells. These cells are found in the
outer layers of the skin. The skin's main job is protect the body from infections and to insulate the body to
keep it at the proper temperature.
The first layer of skin is called the epidermis. This is the layer that is closest to the surface of the skin.
There are three types of cells in this layer. The first is the squamace. The squamace cells are flat and scaly
and are located closest to the surface of the skin. Second are the basal cells and finally are the melanocytes
which
give the skin its color. The second layer of skin is the dermis, which is much thicker than the epidermis.
This layer contains sweat glands, nerves and blood vessels. The dermis also contains follicles which are
tiny pockets from which the hair grows. (Jablonski)
The most common malignant cells are the basal cells. Cancer in the basal cell is called nonmelanoma
cancer. This means that the cancer did not start in the melanocytes located in the epidermis. (Prestan 1650)
Basal Cell Carcinoma is caused by overexposure to the sun. The sun gives off ultraviolet rays which are
harmful to the human body. Basal cell carcinoma will affect body parts such as the eyes, ears and nose. If
it is detected before it gets deep into the skin there will most likely be no problem treating the cancer. The
problem is when it is detected after it has progressed into the deep portions of you tissue. If Basal cell
carcinoma is left untreated it can be very hard to treat and may even cause death. (Elson, 1)
The common methods of treatment involve the use of Mohs micrographic surgery, radiation therapy,
electrodesiccation and curettage, and simple excision. Each of these methods is useful in specific clinical
situations. Depending on the case, these methods have cure rates ranging from 85% to 95%.
Mohs micrographic surgery, a newer surgical technique, has the highest cure rate for surgical treatment of
both primary and recurrent tumors. This method uses
microscopic control to determine the extent of tumor invasion. Although Mohs micrographic surgery
method is complicated and requires special training, it has the highest cure rate of all surgical treatments
because the tumor is microscopically outlined until it is completely removed. While other treatment
methods for recurrent basal cell carcinoma have failure rates of about 50%, cure rates have been reported at
96% when treated by Mohs micrographic surgery. (Thomas 135-142) "Mohs micrographic surgery is also
indicated for tumors with poorly defined clinical borders, tumors with diameters larger than two cm, tumors
with histopathologic features showing morpheaform or sclerotic patterns, and tumors arising in regions
where maximum preservation of uninvolved tissue is desirable, such as eyelid, nose and finger." (Thomas
135)
Next there is a treatment involving simple excision with frozen or permanent sectioning for margin
evaluation. This traditional surgical treatment usually relies on surgical margins ranging from three to ten
millimeters, depending on the diameter of the tumor. (Abide 492-497) Tumor recurrence is not uncommon
because only a small fraction of the total tumor margin is examined pathologically. Recurrence rate for
primary tumors greater than 1.5 cm in diameter is at least twelve percent within five years; if the primary
tumor measures larger than three cm, the five year recurrence rate is 23.1%. Primary tumors of the ears,
eyes, scalp, and nose have recurrence rates ranging from 12.9% to 25%.
Third there is electrodesiccation and curettage. This method is the most widely employed method for
removing primary basal cell carcinomas. Although it is
a quick method for destroying tumor, adequacy of treatment cannot be assessed immediately since the
surgeon cannot visually detect the depth of microscopic tumor
invasion. Tumors with diameters ranging from two to five mm have a fifteen percent recurrence rate after
treatment with electrodesiccation and curettage. When
tumors larger than three cm are treated with electrodesiccation and curettage, a 50% recurrence rate should
be expected within five years.
The fourth type is radiation therapy. Radiation is a logical treatment choice, particularly for primary lesions
requiring difficult or extensive surgery (e.g., eyelids, nose, ears). It eliminates the need for skin grafting
when surgery would result in an extensive defect. Cosmetic results are generally good to excellent with a
small amount of hypopigmentation or telangiectasia in the treatment port. Radiation therapy can also be
utilized for lesions that recur after a primary surgical approach. "Radiation therapy is contraindicated for
patients with xeroderma pigmentosum, epidermodysplasia verruciformis, or the basal cell nevus syndrome
because it may induce more tumors in the treatment area".
"Following treatment for basal cell carcinoma, the patient should be clinically examined every six months
for five years." Thereafter, the patient should be examined for recurrent tumor or new primary tumors at
yearly intervals. It has been prospectively found that 36% of patients who develop a basal cell carcinoma
will develop a second primary basal cell carcinoma within the next five years. Early diagnosis and
treatment of recurrent basal cell carcinomas or another primary
basal cell carcinoma is desirable since the treatment of the disease in its earliest stages results in less patient
morbidity. (Prestan 1649-1662)
Carbon dioxide laser is most frequently applied to the superficial type of basal cell carcinoma. It may be
considered when a bleeding diathesis is present, since bleeding is unusual when this laser is used. (Lippman
862-869)
Topical fluorouracil (5-FU) may be helpful in the management of selected superficial basal cell
carcinomas. Careful and prolonged follow up is required, since deep follicular portions of the tumor may
escape treatment and result in future tumor recurrence (Dabski 378-379)
In conclusion Basal Cell Carcinoma has many different treatment that are very helpful. Some more than
others. Instead of going through the hassle of treating Basal Cell Carcinoma one should prevent it from
entering into your system.
"Basal cell carcinoma is 100% preventable with the daily use of sunscreen beginning in the childhood
years" (Elson 1). Sunscreen prevents the ultraviolet rays from coming in contact with the skin thus
preventing the cancer from entering into you body.
Works Cited
(1) Abide, JM, Nahai F, Bennett RG. The Meaning of Surgical Margins: Plastic and
reconstructive Surgery. : 492-497, 1984.
(2) Dabski K, Helm F. Tropical Chemotherapy: Schwartz RA: Skin Cancer: Recognition and
Management. New York, NY: Springer-Verlag, 1988, pp 378-389.
(3) Elson, Melvin. Internet Reference.
"http://www.colombia.net/consumer/datafile/skincanc.html.
(4) Internet Reference. "http://maui.net/~southsky/introto.html
(5) Jablonski, Francis. Personal Interview. 10 March 1997
(6) Lippman SM, Shimm DS, Meyskens FL: Nonsurgical treatments for skin cancer: retinoids and
alpha-interferon. Journal of Dermatologic Surgery and Oncology: 862-869, 1988.
(7) Preston DS, Stern RS: Nonmelanoma cancers of the skin. New England Journal of Medicine
327(23): 1649-1662, 1992.
(8) Thomas RM, Amonette RA: Mohs micrographic surgery. American Family Physician/GP
37(3): 135-142, 1988.
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