Basal cell carcinoma
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Basal Cell Carcinoma Epidemiology and Risk Factors
Basal cell carcinoma (BCC) is the most common cancer in humans, with its incidence rising globally, especially among older adults and those with significant sun exposure. The risk is highest in fair-skinned individuals, particularly males, and is rare in people with darker skin pigmentation. The increase in BCC cases is attributed to both environmental factors, such as ultraviolet (UV) radiation from sunlight, and genetic predispositions. BCC rarely metastasizes but can cause significant local tissue destruction and morbidity, making it a growing public health concern due to its high treatment costs and impact on quality of life 1347.
Pathogenesis and Molecular Mechanisms of BCC
The development of BCC is driven by a combination of environmental exposures, genetic susceptibility, and phenotypic factors. A key molecular feature of BCC is the overactivation of the Hedgehog signaling pathway, which is present in most cases. This pathway’s dysregulation is central to BCC pathogenesis and has become a major target for new therapies. Recent research also highlights the role of microRNA (miRNA) dysregulation in BCC biology and resistance to systemic treatments, suggesting new avenues for understanding and managing the disease 12910.
Clinical Features, Diagnosis, and Subtypes
BCC typically presents as a slow-growing skin lesion, often on sun-exposed areas such as the face and neck. There are several histopathological subtypes of BCC, each with different prognostic implications. Diagnosis has improved with the use of dermoscopy and reflectance confocal microscopy, which help distinguish BCC from other skin lesions. Histopathological confirmation is essential, especially for ambiguous cases or those in high-risk locations 1246+1 MORE.
Treatment Approaches and Management Strategies
Surgical excision remains the first-line treatment for most localized BCCs, with microscopically controlled surgery recommended for high-risk, recurrent, or anatomically challenging cases. For low-risk superficial BCCs, topical therapies (such as imiquimod and fluorouracil), destructive methods (curettage, electrocautery, cryotherapy, laser ablation), and photodynamic therapy are effective options. Advanced or metastatic BCCs are treated with targeted Hedgehog pathway inhibitors like vismodegib and sonidegib. Immunotherapy with anti–PD-1 antibodies is an emerging option under investigation. Radiotherapy is a valid alternative, especially for elderly patients or those with facial tumors. Multidisciplinary management is recommended for difficult-to-treat cases 1569+1 MORE.
Prevention and Follow-Up
Prevention strategies focus on minimizing UV exposure and regular skin examinations, especially for high-risk individuals and those with genetic syndromes like naevoid basal cell carcinoma syndrome (NBCCS). Long-term follow-up is advised for patients with high-risk subtypes, multiple BCCs, or those with a history of the disease to detect recurrences early 16.
Conclusion
Basal cell carcinoma is a common, locally aggressive skin cancer with rising incidence worldwide. Its pathogenesis is closely linked to environmental and genetic factors, particularly the Hedgehog signaling pathway. Advances in diagnostic techniques and the development of targeted therapies have improved management, but prevention and early detection remain crucial to reducing morbidity and healthcare costs associated with BCC 1234+5 MORE.
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