Basal skin cancer
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Basal 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 .
Pathophysiology and Genetic Factors
BCC primarily arises from the basal cells of the epidermis. The pathogenesis of BCC involves a complex interplay between environmental factors, such as ultraviolet (UV) radiation, and genetic predispositions. A key molecular pathway implicated in BCC is the Hedgehog signaling pathway, with mutations in genes like PTCH1, SMO, and SUFU being common . Additionally, other genetic mutations in cancer-related genes such as TP53, MYCN, and PIK3CA have been identified, contributing to the tumor's development and progression.
Clinical Presentation and Diagnosis
BCC typically presents as a slowly growing lesion that can appear in various forms, including nodular, superficial, and infiltrative types. Early diagnosis is crucial to prevent extensive tissue involvement and facilitate better cosmetic and functional outcomes. Diagnostic tools such as dermoscopy and reflectance confocal microscopy have significantly improved the accuracy of BCC detection.
Treatment Options
Surgical Approaches
Surgery remains the primary treatment for localized BCC, offering the advantage of margin control and a low risk of recurrence . Various surgical techniques are employed based on the tumor's characteristics and location.
Non-Surgical Treatments
For superficial BCCs, non-surgical treatments such as topical therapies, cryosurgery, and photodynamic therapy are effective alternatives . These methods are particularly useful for patients who are not ideal candidates for surgery.
Advanced and Metastatic BCC
In cases of advanced or metastatic BCC, targeted therapies such as Hedgehog pathway inhibitors (e.g., vismodegib and sonidegib) have shown promising results . These inhibitors are particularly beneficial for tumors that are not amenable to surgery or radiation.
Prevention and Risk Management
Preventive measures, including minimizing UV exposure and regular skin checks, are essential in managing the risk of BCC. Continuous improvements in prevention programs are vital to address the growing incidence of skin cancer. Additionally, risk stratification and shared decision-making between physicians and patients are crucial for selecting the most appropriate treatment options .
Conclusion
Basal cell carcinoma is a prevalent and increasingly common skin cancer with significant implications for patient morbidity and healthcare systems. Understanding its pathophysiology, early diagnosis, and appropriate treatment selection are key to managing this condition effectively. Advances in both surgical and non-surgical treatments, along with targeted therapies for advanced cases, offer hope for better patient outcomes. Preventive strategies remain a cornerstone in reducing the incidence and burden of BCC.
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