Basal cell carcinoma Treatment in UAE

Overview Of Basal cell carcinoma

Basal cell carcinoma (BCC) is the most common type of skin cancer, originating from the basal cells in the outermost layer of the skin (epidermis). It typically appears on sun-exposed areas such as the face, neck, and arms, and is characterized by slow growth and a low risk of metastasis. However, if left untreated, it can cause significant local tissue damage and disfigurement. BCC often presents as a pearly or waxy bump, a flat, flesh-coloured or brown scar-like lesion, or a bleeding or scabbing sore that heals and returns. While it is rarely life-threatening, early detection and treatment are essential to prevent complications and ensure optimal outcomes.

Symptoms of Basal cell carcinoma

The symptoms of basal cell carcinoma vary depending on the subtype but commonly include:
Pearly or waxy bump: Often with visible blood vessels, typically on the face or ears.
Flat, flesh-coloured or brown scar-like lesion: More common on the chest or back.
Bleeding or scabbing sore: That heals and returns, often on the face, neck, or arms.
Pink growth with raised edges: And a central indentation, which may crust or bleed.
Itching or tenderness: In the affected area.
Ulceration: In advanced cases, leading to tissue destruction. These lesions are often painless but can cause cosmetic concerns or functional impairment if located near critical structures like the eyes or nose.

Causes of Basal cell carcinoma

The primary cause of basal cell carcinoma is prolonged exposure to ultraviolet (UV) radiation, either from the sun or tanning beds. Other contributing factors include:
Fair skin: Individuals with lighter skin, hair, and eyes are at higher risk due to reduced melanin protection.
Age: The risk increases with age, particularly after 50, due to cumulative sun exposure.
Gender: Men are more commonly affected than women.
Genetic predisposition: Conditions like basal cell nevus syndrome (Gorlin syndrome) increase susceptibility.
Immunosuppression: Weakened immune systems, such as in organ transplant recipients, elevate risk.
Chemical exposure: Arsenic or other carcinogens can contribute to BCC development.
Previous skin cancer: A history of BCC or other skin cancers increases the likelihood of recurrence. These factors collectively contribute to the development of BCC.

Risk Factors of Basal cell carcinoma

Several factors increase the risk of developing basal cell carcinoma:
UV exposure: Prolonged sun exposure or use of tanning beds.
Fair skin: Less melanin provides less natural protection against UV radiation.
Age: Risk increases with cumulative sun exposure over time.
Gender: Men are more likely to develop BCC than women.
Geographic location: Living in sunny or high-altitude regions increases UV exposure.
Family history: Genetic conditions like basal cell nevus syndrome.
Immunosuppression: Weakened immune systems due to medications or diseases.
Previous skin cancer: A history of BCC or other skin cancers. Understanding these risk factors helps in prevention and early detection.

Prevention of Basal cell carcinoma

Preventing basal cell carcinoma involves minimizing UV exposure and adopting protective measures:
Sun protection: Using broad-spectrum sunscreen with SPF 30 or higher.
Protective clothing: Wearing hats, sunglasses, and long sleeves.
Avoiding peak sun hours: Limiting outdoor activities between 10 a.m. and 4 p.m.
Avoiding tanning beds: Which significantly increase UV exposure.
Regular skin checks: Self-examinations and annual dermatologist visits.
Education: Raising awareness about the risks of UV exposure and early signs of skin cancer.
Managing risk factors: Such as immunosuppression or genetic predispositions. These measures can significantly reduce the risk of developing BCC.

Prognosis of Basal cell carcinoma

The prognosis for basal cell carcinoma is generally excellent, with a high cure rate when treated early. The 5-year recurrence rate is less than 10% for primary tumours but higher for aggressive subtypes or inadequately treated lesions. Factors influencing prognosis include tumour size, location, subtype, and the presence of perineural invasion. Regular follow-up is essential to monitor for recurrence or new lesions, particularly in high-risk patients. Early detection and appropriate treatment significantly improve outcomes and reduce the risk of complications.

Complications of Basal cell carcinoma

Untreated or inadequately treated basal cell carcinoma can lead to several complications:
Local tissue destruction: Invasion of surrounding tissues, including muscles, bones, or nerves.
Disfigurement: Particularly for lesions on the face or other visible areas.
Recurrence: Higher risk with aggressive subtypes or incomplete excision.
Metastasis: Rare but possible in advanced or neglected cases.
Functional impairment: If the tumour affects critical structures like the eyes or nose.
Psychological impact: Anxiety or depression due to cosmetic concerns or cancer diagnosis. These complications highlight the importance of early diagnosis and effective treatment.

Related Diseases of Basal cell carcinoma

Basal cell carcinoma is often associated with other conditions related to UV exposure or skin health:
Squamous cell carcinoma (SCC): Another common type of skin cancer.
Melanoma: A more aggressive form of skin cancer.
Actinic keratosis: Precancerous lesions that can progress to SCC.
Basal cell nevus syndrome: A genetic condition causing multiple BCCs.
Xeroderma pigmentosum: A rare disorder increasing sensitivity to UV radiation.
Non-melanoma skin cancers: Including SCC and other rare types. Understanding these related conditions aids in comprehensive patient care and management.

Treatment of Basal cell carcinoma

The treatment of basal cell carcinoma depends on the lesion's size, location, and subtype, as well as the patient's overall health. Key strategies include: 1. **Surgical excision**: Removal of the tumour with a margin of healthy tissue. 2. **Mohs surgery**: A precise technique for high-risk or recurrent tumours, particularly on the face. 3. **Curettage and electrodesiccation**: Scraping and burning the tumour, suitable for low-risk lesions. 4. **Cryotherapy**: Freezing the tumour with liquid nitrogen for superficial lesions. 5. **Topical treatments**: Imiquimod or 5-fluorouracil for superficial BCCs. 6. **Radiation therapy**: For patients who are not surgical candidates or for tumours in challenging locations. 7. **Targeted therapy**: Vismodegib or sonidegib for advanced or metastatic BCC. 8. **Photodynamic therapy (PDT)**: Using light-activated drugs for superficial lesions. Treatment is tailored to the individual, considering cosmetic and functional outcomes.