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Rak podstawnokomórkowy - Prognozy i leczenie
Co trzeba robić po zakończeniu leczenia?
Pacjentowi zaleca się wizyty kontrolne zgodnie z zaleceniami lekarza. Zwykle obejmują one kontrole w okresie po zabiegu operacyjnym, a następnie co 3 miesiące w ciągu pierwszego roku oraz co 6 miesięcy w ciągu kolejnych lat. Ważne jest samobadanie, czyli oglądanie samodzielnie skóry przez pacjenta i w razie zauważenia niepokojących zmian niezwłoczne zgłoszenie się do lekarza.
Ze względu na fakt, że promieniowanie słoneczne jest najważniejszym czynnikiem sprzyjającym powstawaniu raka skóry, głównym celem profilaktyki jest ograniczenie ekspozycji na UV, które powinno polegać na stosowaniu preparatów z filtrami przeciwsłonecznymi, ubrań ochronnych, ograniczeniu czasu spędzanego na wolnym powietrzu w godzinach największego nasłonecznienia i przebywanie w cieniu. W ciągu ostatnich 30 lat odkryto wiele mechanizmów mających wpływ na powstawanie różnych nowotworów skóry. Odkrycia te przyczyniły się do stworzenia środków ochronnych i chemioprewencyjnych, które zwiększają możliwości zapobiegania nowotworom.
Chemioprewencja to dziedzina powstała w wyniku oddziaływania wiedzy odnoszącej się do: kancerogenezy (powstawania komórek nowotworowych), biologii komórki, badań przesiewowych w kierunku raka lub wczesnego jego wykrywania. Na podstawie badań wiadomo, że selen chroni przed wystąpieniem raka podstawnokomórkowego, a retinoidy przed rogowaceniem słonecznym. Coraz popularniejszą formą zapobiegania nowotworom skóry jest zażywanie polifenoli (zawartych np. w zielonej herbacie), które mają właściwości antyoksydacyjne.
Najważniejszym elementem profilaktyki raka skóry jest unikanie promieniowania UV i maksymalne skrócenie czasu ekspozycji skóry na bezpośrednie promieniowanie słoneczne. Stosowanie preparatów przeciwsłonecznych jako pierwszej linii obrony przeciwnowotworowej oparte jest na wynikach kontrolowanych badań przeprowadzonych u pacjentów z dużym ryzykiem rozwoju raka, które wykazały, że codzienne używanie produktów o szerokim spektrum ochrony zmniejszyło liczbę zmian typu rogowacenia słonecznego.
Basal cell carcinoma is the most common type of cancer
If you’ve been diagnosed with basal cell carcinoma (BCC), you have plenty of company. Basal cell carcinoma is the most common type of skin cancer. It’s also the most common type of cancer. Doctors diagnose millions of people with basal cell carcinoma every year.
You have a greater risk of developing this skin cancer if you have a lighter skin tone and seldom protected your skin from the sun throughout your life or used tanning beds.
People of all skin tones develop basal cell carcinoma. However, people who have light skin that rarely tans and tends to freckle, red or blond hair, and light-colored eyes have a greater risk of developing this skin cancer.
Before basal cell carcinoma develops, people with lighter skin tones often notice signs of sun damage on their skin, such as age spots, patches of discolored skin, and deep wrinkles. These signs can develop years before cancer.
Is basal cell carcinoma serious?
For most people, basal cell carcinoma is not life-threatening. This skin cancer tends to grow slowly. It seldom spreads to another part of the body. Even so, treatment is important.
Over time, basal cell carcinoma can grow wide and deep. It can spread deeply into the skin, wrap around nerves and blood vessels, and invade muscles and bone. When the cancer grows deep, it can change the way you look. For some people, this can be disfiguring.
When found early, this skin cancer is highly treatable. An early basal cell carcinoma can often be removed during an appointment with your dermatologist.
One common sign is a slowly growing, non-healing spot that sometimes bleeds. Basal cell carcinoma can also appear on the skin in other ways.
You’ll find the signs and symptoms along with several pictures of this skin cancer at, Basal cell carcinoma: Signs and symptoms.
Image
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References
Cameron MC, Lee E, et al. “Basal cell carcinoma: Epidemiology, pathophysiology, clinical and histological subtypes, and disease associations.” J Am Acad Dermatol 2019,80:303-17.
Gloster HM, Neal K. “Skin cancer in skin of color.” J Am Acad Dermatol 2006,55:741-60.
Nouri K, Ballard CJ, et al. “Basal cell carcinoma.” In: Nouri K, et al. Skin Cancer. McGraw Hill Medical, China, 2008: 61-81.
Written by:
Paula Ludmann, MS
Reviewed by:
Carrie L. Kovarik, MD, FAAD
Natalie H. Matthews, MD, FAAD
Darrell S. Rigel, MD, FAAD
Last updated: 4/28/23
Reproduction or republication strictly prohibited
without prior written permission.
Treatment / Management
event recurrence at a later date, (2) to correct any functional impairment resulting from the tumor, and (3) to give the best cosmetic result to the patient, especially because most BCCs are on the face.[11]
Treatment of BCC is usually surgical, but some forms of BCC are amenable to medical treatment or radiation therapy. The various types of therapy include Mohs micrographic surgery (MMS), standard surgical excision, EDC, radiation, photodynamic therapy, cryosurgery, topical therapies, and systemic medications such as Vismodegib. The recurrence rates for primary BCC are as follows: Mohs surgery, 1.0%, surgical excision, 10.1%, EDC, 7.7%, radiation therapy, 8.7%, and cryosurgery, 7.5%.
Mohs surgery provides the best long-term cure rate of any treatment modality for BCC. MMS is the gold standard for treating high-risk BCCs and recurrent BCCs because of its high cure rate and tissue-sparing benefit. The high cure rate is attributed to an examination of 100% of all the tissue margins when compared with standard vertical sectioning, wich only examines less than 1% of the outer peripheral and deep margins. By only taking thin tissue layers from the areas with positive tumor margins, the wound size is minimized, and a superior cosmetic outcome can be expected.
Radiation therapy is a primary option for treating BCC or SCC if surgery is contraindicated. It also can be used as an adjuvant treatment for basal cell carcinoma when further surgery could sacrifice major nerves or other vital structures, or there is a perineural invasion by cancer cells. The disadvantages of radiation therapy are cost, poor cosmesis in some patients, prolonged course of treatment (15 to 30 visits), and increased risk for future skin cancers. Scars from radiation therapy tend to worsen with time, while surgical scars improve over time.
Topical therapy is another treatment for basal cell carcinoma. Topical 5-fluorouracil (5-FU) and Imiquimod 5% cream are approved by the Food and Drug Administration (FDA) to treat superficial BCC. Both topical therapies are good options in patients with multiple superficial BCCs and in patients who are poor surgical candidates. Application site reactions are common and include erythema, pruritus, pain, edema, hypopigmentation, hyperpigmentation, crusting, bleeding, and erosions. Another disadvantage is there no histologic confirmation of complete tumor clearance.
Differential Diagnosis
The differential diagnosis of BCC includes adnexal tumors with follicular, sweat gland, or sebaceous differentiation and certain types of SCC. Nodular BCC may be confused with trichoblastoma or trichoepithelioma. Superficial BCC may mimic some inflammatory dermatoses such as psoriasis and eczema. Morphea-like BCC may be confused with a plaque of morphea or a scar. In these cases, histopathological helps to establish the diagnosis of BCC.
BCC is rarely associated with a fatal outcome. Its prognosis is mainly related to its potential risk of recurrence after initial therapy. The risk of recurrence depends on BCC location and BCC clinical and histopathological features.
BCC Location
Intermediate risk location: forehead, cheeks, chin, neck, scalp High-risk location: centrofacial areas, nose, ears, periorificial areas, embryonic fusion planesBCC Clinical and Histopathological Features
These include the size, the histopathological type, and the fact that the tumor is primary or recurrent.
Tumor Prognosis
Good prognosis: primary superficial BCC, primary nodular BCC Intermediate prognosis: recurrent superficial BCC, nodular BCC <1cm in high risk location or <2cm in intermediate-risk location or >2cm in low risk location,