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Rak podstawnokomórkowy - Prognozy i leczenie
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.
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
Getty Image
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.
Epidemiology
BCC is the most common skin cancer in humans, with increasing incidence rates worldwide. Men generally have higher rates of BCC than women. BCC is more frequent in geographic locations with greater UV exposure, such as those at higher or lower latitudes. The most common predictor of BCC development is a history of squamous cell carcinoma (SCC) or BCC. Patients are at least ten times more likely to develop a second BCC if they have a BCC history compared to patients without a history of non-melanoma skin cancer.[5][6]
The mechanism of BCC formation via ultraviolet radiation is direct DNA damage, indirect DNA damage through reactive oxygen species, and immune suppression. Melanin absorbs UVA and indirectly damages DNA through free radicals. UVB directly damages DNA and RNA with a characteristic C/T or CC/TT transition. Ultraviolet exposure also causes dose-dependent suppression of the cutaneous immune system, impairing immune surveillance of skin cancer.
Literature suggests that the cells of origin from which BCC arises are immature, pluripotent cells associated with the hair follicle. Of note, the gene most often altered in BCCs is the PTCH1 gene. PTCH1 gene mutations occur in 70% of people with sporadic BCC. Ten percent to 20% of people with sporadic BCC have smoothened (SMO) mutations. Literature suggests that a sufficiently elevated expression level of Gli, by activating mutations of SMO or by homozygous inactivation of PTCH1 in a responding cell, is sufficient to drive the formation of BCC. The second most common mutation found in BCCs is in the P53 gene. Mutations in CDKN2A locus also have been detected in a smaller number of sporadic BCCs.
Rak podstawnokomórkowy skóry
Rak podstawnokomórkowy skóry (carcinoma basocellulare) to najczęściej występująca postać raka skóry, stanowi około 75% przypadków. W zdecydowanej większości jego lokalizacja obejmuje skórę głowy i szyi.
Rozwija się w skórze powiek, czoła, nosa, policzków, nigdy na stopach, dłoniach czy błonach śluzowych. Rak przydatków skóry występuje równie często u mężczyzn, jak i kobiet, najczęściej po 60 roku życia.
Cechą charakterystyczną raka podstawnokomórkowego skóry jest brak przerzutów odległych oraz miejscowa złośliwość. Eksperci wyróżniają dwie odmiany tej choroby – pierwsza rozwija się wolno, nie nacieka w głąb, a leczenie daje dobre efekty. Druga odmiana raka podstawnokomórkowego skóry jest bardziej agresywna, ma zdolność do naciekania, niszczenia tkanek, jest wrzodziejąca i często nawraca, co utrudnia wyleczenia.
Rak podstawnokomórkowy skóry – objawy
Etiopatogeneza BCC jest związana z ekspozycję na promieniowanie UV, immunosupresją, przewlekłymi zakażeniami (m.in. wirusem brodawczaka ludzkiego HPV). Niewątpliwym kluczowym czynnikiem wpływającym na wzrost ryzyka zachorowania na raka podstawnokomórkowego skóry jest promieniowanie nadfioletowe w połączeniu z podwyższoną temperaturą otoczenia.
Nowotwory skóry stanowią grupę chorób, w których istnieją najlepsze warunki do wykrycia i leczenia już na wstępnym etapie. Objawy raka podstawnokomórkowego skóry są widoczne dla chorego, a łatwość pobrania materiału do badania histopatologicznego umożliwia szybką diagnozę.
Klasyczny wygląd raka podstawnokomórkowego cechuje niewielkie owrzodzenie z wałowatym przeświecającym brzegiem. Ten typ nowotworu spotyka się wokół oczu, na nosie, blisko kąta wewnętrznego oka.
Inną postacią są guzki o charakterze nietorbielowatym, czasami z dużą ilością pigmentu, późno wrzodziejące.
Objawy raka podstawnokomórkowego skóry mogą być związane z płytkimi owrzodzeniami na czole lub nosie z nieregularnymi i źle zaznaczonymi granicami. Z jednej strony wydaje się, ze niepokojąca zmniejsza się, a z drugiej powoli się rozszerza.