Every hour one American is killed by skin cancer and every thirty seconds one
American gets skin cancer. Cancer is a deadly disease that alters the DNA of a
skin cell and causes it to reproduce at a rapid pace. This overproduction of
cells can be harmful and in many cases deadly. Out of these cancers the most
common is Basal cell carcinoma. Many steps have been made in the treatment of
Basal Cell Carcinoma, some have been very successful and some not. The cells
that have the altered DNA are called malignant or cancerous cells. These cells
are found in the outer layers of the skin. The skin's main job is to protect the
body from infections and to insulate the body to keep it at the proper
temperature. The first layer of skin is called the epidermis. This is the layer
that is closest to the surface of the skin. There are three types of cells in
this layer. The first is the squamace. The squamace cells are flat and scaly and
are located closest to the surface of the skin. Second are the basal cells and
finally are the melanocytes, which give the skin its color. The second layer of
skin is the dermis, which is much thicker than the epidermis. This layer
contains sweat glands, nerves and blood vessels. The dermis also contains
follicles, which are tiny pockets from which the hair grows. The most common
malignant cells are the basal cells. Cancer in the basal cell is called
nonmelanoma cancer. This means that the cancer did not start in the melanocytes
located in the epidermis. Basal Cell Carcinoma is caused by overexposure to the
sun. The sun gives off ultraviolet rays, which are harmful to the human body.
Basal cell carcinoma will affect body parts such as the eyes, ears and nose. If
it is detected before it gets deep into the skin there will most likely be no
problem treating the cancer. A problem will occur if it isn't detected quickly
enough and it has progressed into the deep portions of the tissue. If Basal cell
carcinoma is left untreated it can be very hard to treat and may even cause
death. The common methods of treatment involve the use of Mohs micrographic
surgery, radiation therapy, electrodesiccation and curettage, and simple
excision. Each of these methods is useful in specific clinical situations.
Depending on the case, these methods have cure rates ranging from 85% to 95%.
Mohs micrographic surgery, a newer surgical technique, has the highest cure rate
for surgical treatment of both primary and recurrent tumors. This method uses
microscopic control to determine the extent of tumor invasion. Although Mohs
micrographic surgery method is complicated and requires special training, it has
the highest cure rate of all surgical treatments because the tumor is
microscopically outlined until it is completely removed. While other treatment
methods for recurrent basal cell carcinoma have failure rates of about 50%, cure
rates have been reported at 96% when treated by Mohs micrographic surgery.
"Mohs micrographic surgery is also indicated for tumors with poorly defined
clinical borders, tumors with diameters larger than two cm, tumors with
histopathologic features showing morpheaform or sclerotic patterns, and tumors
arising in regions where maximum preservation of uninvolved tissue is desirable,
such as eyelid, nose and finger." Next there is a treatment involving
simple excision with frozen or permanent sectioning for margin evaluation. This
traditional surgical treatment usually relies on surgical margins ranging from
three to ten millimeters, depending on the diameter of the tumor. Tumor
recurrence is not uncommon because only a small fraction of the total tumor
margin is examined pathologically. Recurrence rate for primary tumors greater
than 1.5 cm in diameter is at least twelve percent within five years. If the
primary tumor measures larger than three cm, the five year recurrence rate is
23.1%. Primary tumors of the ears, eyes, scalp, and nose have recurrence rates
ranging from 12.9% to 25%. Third there is electrodesiccation and curettage. This
method is the most widely employed method for removing primary basal cell
carcinomas. Although it is a quick method for destroying tumor, adequacy of
treatment cannot be assessed immediately since the surgeon cannot visually
detect the depth of microscopic tumor invasion. Tumors with diameters ranging
from two to five mm have a fifteen percent recurrence rate after treatment with
electrodesiccation and curettage. When tumors larger than three cm is treated
with electrodesiccation and curettage, a 50% recurrence rate should be expected
within five years. The fourth type is radiation therapy. Radiation is a logical
treatment choice, particularly for primary lesions requiring difficult or
extensive surgery (e.g., eyelids, nose, and ears). It eliminates the need for
skin grafting when surgery would result in an extensive defect. Cosmetic results
are generally good to excellent with a small amount of hypopigmentation or
telangiectasia in the treatment port. Radiation therapy can also be utilized for
lesions that recur after a primary surgical approach. "Radiation therapy is
contraindicated for patients with xeroderma pigmentosum, epidermodysplasia
verruciformis, or the basal cell nevus syndrome because it may induce more
tumors in the treatment area". "Following treatment for basal cell
carcinoma, the patient should be clinically examined every six months for five
years." Thereafter, the patient should be examined for recurrent tumor or
new primary tumors at yearly intervals. It has been prospectively found that 36%
of patients who develop a basal cell carcinoma will develop a second primary
basal cell carcinoma within the next five years. Early diagnosis and treatment
of recurrent basal cell carcinomas or another primary basal cell carcinoma is
desirable since the treatment of the disease in its earliest stages results in
less patient morbidity. Carbon dioxide laser is most frequently applied to the
superficial type of basal cell carcinoma. It may be considered when a bleeding
diathesis is present, since bleeding is unusual when this laser is used. Topical
fluorouracil (5-FU) may be helpful in the management of selected superficial
basal cell carcinomas. Careful and prolonged follow-up is required, since deep
follicular portions of the tumor may escape treatment and result in future tumor
recurrence In conclusion Basal Cell Carcinoma has many different treatment that
are very helpful. Some more than others. Instead of going through the hassle of
treating Basal Cell Carcinoma one should prevent it from entering into your
system. "Basal cell carcinoma is 100% preventable with the daily use of
sunscreen beginning in the childhood years". Sunscreen prevents the
ultraviolet rays from coming in contact with the skin thus preventing the cancer
from entering into you body.

Bibliography
(1) Abide, JM, Nahai F, Bennett RG. The Meaning of Surgical Margins: Plastic
and reconstructive Surgery. : 492-497, 1984. (2) Dabski K, Helm F. Tropical
Chemotherapy: Schwartz RA: Skin Cancer: Recognition and Management. New York,
NY: Springer-Verlag, 1988, pp 378-389. (3) Elson, Melvin. Internet Reference.
"http://www.colombia.net/consumer/datafile/skincanc.html. (4) Internet
Reference. "http://maui.net/~southsky/introto.html (5) Jablonski, Francis.
Personal Interview. 10 March 1997 (6) Lippman SM, Shimm DS, Meyskens FL:
Nonsurgical treatments for skin cancer: retinoids and alpha-interferon. Journal
of Dermatological Surgery and Oncology: 862-869, 1988. (7) Preston DS, Stern RS:
Nonmelanoma cancers of the skin. New England Journal of Medicine 327(23):
1649-1662, 1992. (8) Thomas RM, Amonette RA: Mohs micrographic surgery. American
Family Physician/GP 37(3): 135-142, 1988. Skin Cancer Jack Ciallella Lab Bio
October 21, 1999 Bibliography Works Cited (1) Abide, JM, Nahai F, Bennett RG.
The Meaning of Surgical Margins: Plastic and reconstructive Surgery. : 492-497,
1984. (2) Dabski K, Helm F. Tropical Chemotherapy: Schwartz RA: Skin Cancer:
Recognition and Management. New York, NY: Springer-Verlag, 1988, pp 378-389. (3)
Elson, Melvin. Internet Reference. "http://www.colombia.net/consumer/datafile/skincanc.html.
(4) Internet Reference. "http://maui.net/~southsky/introto.html (5)
Jablonski, Francis. Personal Interview. 10 March 1997 (6) Lippman SM, Shimm DS,
Meyskens FL: Nonsurgical treatments for skin cancer: retinoids and
alpha-interferon. Journal of Dermatological Surgery and Oncology: 862-869, 1988.
(7) Preston DS, Stern RS: Nonmelanoma cancers of the skin. New England Journal
of Medicine 327(23): 1649-1662, 1992. (8) Thomas RM, Amonette RA: Mohs
micrographic surgery. American Family Physician/GP 37(3): 135-142, 1988.