Management Of Basal Cell Carcinoma Research Articles

Incomplete excision of basal cell carcinomas: an audit.

The Plastic Surgery Department undertook an audit of the rate of excision of basal cell carcinomas (BCCs) at St George's Hospital. The aim of the audit was to determine the rate of incomplete excision of BCCs excised by the department over a six-month period and compare it with national audit figures. The rate of incomplete excision was 13.73 per cent or seven out of 51 BCCs, which compared favourably with the rates quoted in the literature. No change in the management of basal cell carcinomas was made.

Basal cell carcinoma

Basal cell carcinoma is the most common type of malignant tumor in the United States. The five types of basal cell carcinoma (noduloulcerative, pigmented, morpheaform, and superficial basal cell carcinoma, and premalignant fibroepithelioma) vary in clinical presentation and behavior. Diagnosis is made by skin biopsy. The size, type, and site of a lesion and the age and sex of the patient affect the choice of treatment. Electrodesiccation and curettage, cryosurgery, surgical excision, Mohs' surgery, and radiation therapy are available. Knowledge of these therapies and of when they should and should not be used is important in proper management of basal cell carcinoma.

Cryosurgical management of basal cell carcinoma of the eyelid: A 10-year experience

Cryosurgical management of basal cell carcinoma of the eyelid: A 10-year experience

Basal cell carcinoma

The common occurrence of basal cell carcinoma, especially in younger populations, has made it a major public health concern. It is the commonest malignancy affecting humans and is largely preventable. These facts have made it the focus of national attention and public education campaigns. Convincing epidemiologic data incriminate ultraviolet B (UVB) as a major etiologic factor, but there is also sufficient evidence that it is not the sole causative agent. Other agents implicated in the cause of basal cell cancers include long-term psoralen plus ultraviolet A (PUVA) therapy, grenz radiation, X-radiation, chronic arsenicism, preexisting lesions such as sebaceous nevus of Jadassohn and linear basal cell nevus, and genetic diseases such as xeroderma pigmentosum and nevoid basal cell carcinoma syndrome. Despite the fact that UVB has been recognized as a cause for several years, the pathophysiology of UVB-induced basal cell cancers has not been completely defined as yet. Other factors lead to the formation of basal cell cancers by different mechanisms, the pathophysiology of some being poorly understood. Recognition of the causes of basal cell cancers has led to the development of preventive measures such as photoprotection by avoidance of excessive sun exposure and use of sunscreens, limited use of grenz ray and x-ray therapy of the skin, monitoring of well water for its arsenic content, and prophylactic excision of nevus sebaceous when such a lesion is detected. Awareness of the increasing incidence has led to the development of screening programs for early detection of lesions also. Understanding of the biology of basal cell cancers continues to unfold with continuing investigation. Studies suggest that collagenase, derived from tumor stromal fibroblasts, plays a role in creating a path for tumor invasion by digesting collagen in the surrounding dermis. Fibronectin formed by tumor cells may be involved in tumor cell migration as well. Transplantation studies in animals have shown that immunologic phenomena play an important role in the biology of basal cell cancers. Human basal cell carcinoma has been recently transplanted successfully to immunosuppressed athymic mice. The human host allows growth of the cancer due to ultraviolet radiation (UVR)-induced immunosuppression. Immunologic abnormalities have been documented in patients with basal cell cancers. Immunologic deterioration may be a factor in the rare instance of metastatic basal cell cancer. Cognizance of the various common and uncommon clinical appearances of these neoplasms is important so that they can be recognized and treated effectively. The most common presentation is as a pearly papule or nodule with surface telangiectasias on a sun-exposed surface; other presentations include the pigmented, morpheaform, superficial, and fibroepithelioma of Pinkus types. Basal cell cancers may also be encountered on sun-protected areas. Familiarity with the logic behavior of the various types allows selection of the appropriate therapeutic modality. The histologic types of clinical import are the nodular, superficial, morpheaform, adenoid, and metatypical lesions. The latter three types invade local tissues more aggressively and consequently are best treated with Mohs surgery to ensure complete extirpation. Histologic confirmation of the diagnosis and definition of tumor type should be obtained prior to therapy. The six usual approaches for treatment are curettage and electrodesiccation, excision, cryosurgery, radiation therapy, topical chemotherapy, and Mohs micrographic surgery. The retinoids, etretinate and isotretinoin, have been useful in controlling the rate of appearance of basal cell cancers in patients with multiple basal cell cancers due to extensive sun exposure, xeroderma pigmentosum, and nevoid basal cell carcinoma syndrome. However, maintenance therapy is necessary for continued control. Systemic chemotherapy may be useful for reducing the size of inoperable tumors so that may become amenable to surgical resection, but this is seldom required. Indefinite follow-up and patient education are essential elements of management of basal cell carcinomas.

Management of basal cell carcinoma

Basal cell carcinoma, the most common type of skin cancer, can be treated successfully by a variety of methods. The most commonly employed techniques are curettage with electrodesiccation, scalpel excision, Mohs' chemosurgery, cryosurgery, and radiation therapy, all of which have advantages and disadvantages. The primary care physician needs to be aware of available forms of therapy, problems with recurrent lesions, and the importance of adequate follow-up.

An interdisciplinary approach to the management of basal cell carcinoma of the head and neck.

At the University of Michigan the dermatologic surgeon works closely with the head and neck surgeon in resecting extensive cutaneous malignancies that could benefit from the combined skills of both surgical specialists. Mohs surgery offers complete microscopic controlled resection of the cutaneous portion of skin cancers. Tumors extending deeply from the skin into underlying bone and soft tissue are resected with the assistance of the head and neck surgeon familiar with the anatomy and trained in the protection of the vital structures of the head and neck. It is evident that patients with large or aggressive basal cell carcinomas will best be served when this interdisciplinary approach has become commonplace.

Surgical management of squamous cell carcinoma of the lid.

A series of 12 patients with eyelid squamous cell carcinoma was studied retrospectively with emphasis on the clinical presentation, management, and results. Of the five cases that constituted our personal experience, surgical excision with frozen-section control was an efficacious mode of treatment. In the overall series, there were no cases of regional lymph node metastasis and no tumor deaths. One patient required orbital exenteration. The methods of surgical extirpation of the tumor with frozen-section control, as advocated by the authors, are similar to those used in the management of basal cell carcinoma and other eyelid neoplasms. Because of the potential lethality of squamous cell carcinoma, a wider excision than that usually performed for basal cell carcinoma is recommended, as is close postoperative follow-up.

Hazards encountered in management of basal cell carcinomas of the midface.

Basal cell carcinomas often exhibit aggressive and destructive behavior on the midface, with invasion into the orbit, paranasal sinuses, and even the frontal fossa. Minor modifications in surgical procedures for cosmetic considerations may have devastating consequences on the patient's survival. Tumor extirpation should not be compromised by preoperative planning of the method of reconstruction to be used. Margin control intraoperatively with either conventional frozen sections or the fresh tissue Mohs technique is mandatory for success. If any margin is questionable, reconstruction should be delayed at least until permanent sections confirm complete tumor removal. Ten cases are presented and the literature reviewed to emphasize that inadequate initial management probably contributes more to the observed destructiveness of these lesions than histologic aggressiveness or embryologic patterns of the midface.

Factors in the Successful Surgical Management of Basal Cell Carcinoma of the Eyelids

We studied the clinical and histopathologic features of 165 basal cell carcinomas of the eyelids and classified the tumors into four types (nodular, ulcerative, morphea, and multicentric) that differ in incidence, results of incomplete excision, aggressiveness, and recurrence. The value of frozen-section monitoring of the surgical margins was evident. In 39 cases excised with monitoring of the surgical margins by frozen sections, there were no recurrences. In 126 cases treated by excisional biopsy without frozen-section monitoring, 34 (26.9%) were incompletely excised and seven (5.5%) recurred. The surgical treatment of basal cell carcinoma should always include the use of frozen-section monitoring of the surgical margins. This is especially important in the morphea, multicentric, and ulcerative types, in which the invasive extent of the tumor is often not apparent clinically. These forms are also more aggressive.

Surgical Management of Basal Cell Carcinoma of the Face

Summary1. Brief bistory, clinical features of basal cell carcinoma are described.2. Fifty-eight cases of basal cell carcinoma treated by surgery are presented.3. Reconstructive aspect has been detailed and illustrated.

Mohs?? chemosurgery technique for basal cell carcinoma of the chin and cheek areas of the face

Superficial basal cell carcinomas of the chin and cheek are currently treated by electrical and chemical dissection, surgical excision, and radiation therapy. Each of these methods has proved its usefulness in the management of basal cell carcinoma; however, each has certain limitations as attested by the number of reports that have been published concerning the management of recurrent lesions. In our opinion, the principal factor responsible for the recurrence of a basal cell carcinoma is the failure of the initial method of therapy to totally eradicate the tumor. Because of this problem, we began in 1960 to treat a selected group of basal cell carcinomas of the face by Mohs' chemosurgery technique,1as it was our belief that this method offered certain advantages of insuring total tumor removal that were not apparent in the more conventional forms of therapy. Because collective experience with Mohs' chemosurgery technique is limited, it

MOHS' CHEMOSURGERY TECHNIQUE FOR BASAL CELL CARCINOMA OF THE CHIN AND CHEEK AREAS OF THE FACE.

Superficial basal cell carcinomas of the chin and cheek are currently treated by electrical and chemical dissection, surgical excision, and radiation therapy. Each of these methods has proved its usefulness in the management of basal cell carcinoma; however, each has certain limitations as attested by the number of reports that have been published concerning the management of recurrent lesions. In our opinion, the principal factor responsible for the recurrence of a basal cell carcinoma is the failure of the initial method of therapy to totally eradicate the tumor. Because of this problem, we began in 1960 to treat a selected group of basal cell carcinomas of the face by Mohs' chemosurgery technique,1as it was our belief that this method offered certain advantages of insuring total tumor removal that were not apparent in the more conventional forms of therapy. Because collective experience with Mohs' chemosurgery technique is limited, it