Skin Cancer - Basal Cell Carcinoma (BCC)

In the United States, Basal Cell Carcinoma (BCC) accounts for 90 percent of all skin cancers in the southern states, and 47 percent in the northern states. Basal Cell Carcinoma is the most common form of skin cancer in Australia and New Zealand, representing 70-80% of diagnosed skin cancers. Occurrence of Basal Cell Carcinoma mainly occurs on the head and neck. It occurs less often in Asians and rarely among darker skinned races. As with all skin cancers the risk is considered to be related to sun exposure. The positive about Basal Cell Carcinoma is that it is slow-growing and rarely metastasizes throughout the body. However, it is locally destructive and can invade neighboring bone and nerve tissue.

Description - BCC is a malignant epithelial cell tumor that begins as a papule (a small, circumscribed, solid elevation of the skin) and enlarges peripherally, developing into a crater that erodes, crusts and bleeds. BCC originates in the basal layer of the epidermis, the lowest layer of skin.

Signs and Symptoms of Basal Cell Carcinoma - There are five typical characteristics of basal cell carcinoma that are quite different from each other. Two or more features are frequently present in one tumor. BCC sometimes resembles non-cancerous skin conditions such as psoriasis or eczema and requires diagnosis by a trained person. The five warning signs of basal cell carcinoma are:

1. An open sore that bleeds, oozes or crusts, and remains open for three or more weeks. A persistent, non-healing sore is a very common early manifestation.
2. A reddish patch or an irritated area, frequently occurring on the chest, shoulders, arms or legs. Sometimes the patch crusts. It may also itch or hurt. At other times, it persists with no noticeable discomfort.
3. A smooth growth with an elevated, rolled border and an indentation in the centre. As the growth slowly enlarges, tiny blood vessels may develop on the surface (telangiectases).
4. A shiny bump (nodule) that is pearly or translucent and is often pink, red or white. The nodule can also be tan, black or brown, especially in dark-haired people, and can be confused with a mole or melanoma.
5. A scar-like area (white, yellow, or waxy in appearance) which often has poorly defined borders. The skin itself appears shiny or taut. Although a less frequent sign, it can indicate the presence of a more aggressive tumor.

Diagnosis of Basal Cell Carcinoma - Diagnosis is almost always by biopsy. Tissue is cut away from the site and examined under a microscope.

Medical Treatment of Basal Cell Carcinoma - Allopathic treatment depends on the size and type of tumor. There are various types of surgery or non-surgical treatments chosen from.

Non-surgical treatment of BCC - Allopathic non-surgical treatments have low success rates.

• Topical application of 5-fluorouracil for 2 to 12 weeks is only beneficial for superficial BCC. Fluorouracil is used to prevent excess cell proliferation as found in skin cancer and psoriasis. It prevents the formation of RNA which in turn prevents the formation of DNA.
• Imiquinoid cream -currently the use of Imiquinoid cream is considered experimental. It is an immune response modifier that stimulates the immune system to release cytokines that destroy cancer cells. Treatment causes significant skin irritation. Not all types of BCC are affected.
• Ionizing radiation: Superficial x-ray. It results in radiation damage, therefore it is used more with older patients. Impaired immune function and general malaise also usually results. Used for facial BCC and appears less effective for BCC occurring elsewhere.

Surgical Removal of BCC - Surgery is the most studied, and most used treatment for removal of a BCC in allopathic medicine. The effectiveness of surgery depends very much on the skill of the surgeon. Various surgical methods:

• Electrodessication and Curettage - the BCC is burned and removed with a scalpel. The main disadvantage of this method is that the tumor often tracks down hair follicles. (9)
• Cryosurgery - liquid nitrogen to freeze burn the BCC.
• Excision surgery- the BCC is cut from the skin with a scalpel. To increase the likelihood of complete removal of the tumor, a portion of normal-appearing skin surrounding the BCC is removed.
• Microscopic or MOHS surgery - the BCC is cut from the skin, along with some of the healthy surrounding tissue. This is examined under a microscope to check for any remaining cancer cells. Tissue is then taken in increments of thin layers of skin, until no more cancer cells are detected. Mohs is the most effective allopathic medical treatment (99% cure rate for primary BCC, 90-95% for recurrent BCC).
• Laser surgery. Lasers are also used as a secondary therapy when topical medications or other techniques are unsuccessful.

Recurrence of BCC - Once a basal cell carcinoma has been removed, another growth can develop in the same place or nearby area. It has been found that 36% of people who develop a basal cell carcinoma will develop a secondary primary BCC within the next 5 years. Radiotherapy can result in more aggressive and invasive cells in a recurrent BCC.

Effective Alternative Treatments - Allopathic medicine is often successful in completely removing BCC's but obviously also often fails, given the high number of recurrences suffered by many people with repeat visits to the doctor and then specialist. These treatments don't always work as well as expected or hoped.