Basal cell skin cancer
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Basal Cell Skin Cancer: An Overview
Introduction to Basal Cell Carcinoma (BCC)
Basal cell carcinoma (BCC) is the most common form of skin cancer globally, particularly prevalent among white-skinned individuals. It accounts for approximately 75-80% of non-melanoma skin cancers, with a significant majority occurring on the head and neck . The incidence of BCC is rising worldwide, driven by factors such as increased sun exposure and an aging population .
Pathogenesis and Risk Factors
The development of BCC is primarily influenced by environmental factors, notably ultraviolet (UV) radiation from sunlight, and genetic predispositions. The pathogenesis of BCC involves the aberrant activation of the Hedgehog signaling pathway, which plays a crucial role in the growth and development of these tumors . Additionally, certain genodermatoses can predispose individuals to BCC at an earlier age.
Clinical Presentation and Diagnosis
BCC typically presents as localized lesions that can vary in appearance, including nodular, infiltrative, and superficial forms. These lesions are often slow-growing and rarely metastasize, but they can cause significant local tissue destruction if not treated promptly . Advanced diagnostic techniques such as dermoscopy and reflectance confocal microscopy have improved the accuracy of BCC diagnosis.
Treatment Options
Surgical Approaches
Surgery remains the gold standard for BCC treatment, particularly for localized tumors. Surgical excision with histological control of margins ensures a low recurrence rate, especially for facial BCCs .
Non-Surgical Treatments
For superficial BCCs, non-surgical treatments such as topical therapies (imiquimod and 5-fluorouracil), cryosurgery, and photodynamic therapy are effective alternatives . Radiation therapy is another option, particularly for invasive or inoperable BCCs, with high tumor control rates .
Targeted Therapies
Recent advancements have introduced targeted therapies for advanced or metastatic BCC. Hedgehog pathway inhibitors like vismodegib and sonidegib have shown promising results, offering new hope for patients with difficult-to-treat BCCs . These drugs, however, come with side effects such as muscle cramps, hair loss, and taste disturbances.
Prevention and Management
Preventive measures, including minimizing UV exposure and regular skin checks, are crucial in managing the growing incidence of BCC. Physicians should engage in shared decision-making with patients to choose the most appropriate treatment based on individual risk factors and tumor characteristics .
Conclusion
Basal cell carcinoma, while rarely fatal, poses significant health and economic burdens due to its high incidence and potential for local tissue destruction. Advances in diagnostic techniques and treatment options, including targeted therapies, have improved the management of BCC. Ongoing research and preventive strategies are essential to address the increasing rates of this common skin cancer.
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