basal cell epithelioma

WordNet

1. small room in which a monk or nun lives (同)cubicle
2. a device that delivers an electric current as the result of a chemical reaction (同)electric cell
3. a room where a prisoner is kept (同)jail cell, prison cell
4. (biology) the basic structural and functional unit of all organisms; they may exist as independent units of life (as in monads) or may form colonies or tissues as in higher plants and animals
5. any small compartment; "the cells of a honeycomb"
6. a small unit serving as part of or as the nucleus of a larger political movement (同)cadre
7. of primary importance (同)primary
8. serving as or forming a base; "the painter applied a base coat followed by two finishing coats" (同)base
9. a malignant tumor of the epithelial tissue

PrepTutorEJDIC

1. (刑務所の)『独房』;(修道院の)小さい独居室 / (ミツバチの)みつ房,巣穴 / 小さい部屋 / 『細胞』 / 電池 / 花粉室 / (共産党などの)細胞
2. 基底の,基部の / 基礎的な,基本的な

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/06/29 23:09:02」(JST)

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Basal-cell carcinoma
Classification and external resources
A basal-cell carcinoma
ICD-10	C44 (ILDS C44.L21)
ICD-9	173
ICD-O:	M8090/3-8093/3
OMIM	605462
DiseasesDB	1264
MedlinePlus	000824
eMedicine	med/214
MeSH	D002280

Basal-cell carcinoma (BCC), a skin cancer, is the most common cancer. It rarely metastasizes or kills. However, because it can cause significant destruction and disfigurement by invading surrounding tissues, it is still considered malignant.

Statistically, in the United States approximately 3 out of 10 Caucasians may develop a basal-cell cancer within their lifetime. In 80 percent of all cases, basal-cell cancers are found on the head and neck. There appears to be an increase in the incidence of basal-cell cancer of the trunk (torso) in recent years.

Classification

Basal-cell carcinomas may be divided into the following types:

• Nodular basal-cell carcinoma (Classic basal-cell carcinoma)
• Cystic basal-cell carcinoma
• Cicatricial basal-cell carcinoma (Morpheaform basal-cell carcinoma, Morphoeic basal-cell carcinoma)
• Infiltrative basal-cell carcinoma
• Micronodular basal-cell carcinoma
• Superficial basal-cell carcinoma (Superficial multicentric basal-cell carcinoma)
• Pigmented basal-cell carcinoma
• Rodent ulcer (Jacobi ulcer)
• Fibroepithelioma of Pinkus
• Polypoid basal-cell carcinoma
• Pore-like basal-cell carcinoma
• Aberrant basal-cell carcinoma

For simplicity, one can also divide basal-cell carcinoma into 3 groups, based on location and difficulty of therapy:

1. Superficial basal-cell carcinoma, or some might consider to be equivalent to "in-situ". Very responsive to topical chemotherapy such as Aldara, or Fluorouracil. It is the only type of basal-cell cancer that can be effectively treated with topical chemotherapy.
2. Infiltrative basal-cell carcinoma, which often encompasses morpheaform and micronodular basal-cell cancer. More difficult to treat with conservative treatment methods such as electrodessiccation and curettage, or with curettage alone.
3. Nodular basal-cell carcinoma, which essentially includes most of the remaining categories of basal-cell cancer. It is not unusual to encounter morphologic features of several variants of basal-cell cancer in the same tumor.

See also:

• Nevoid basal-cell carcinoma syndrome

Signs and symptoms

Patients present with a shiny, pearly nodule. However, superficial basal-cell cancer can present as a red patch like eczema. Infiltrative or morpheaform basal-cell cancers can present as a skin thickening or scar tissue – making diagnosis difficult without using tactile sensation and a skin biopsy. It is often difficult to distinguish basal-cell cancer from acne scar, actinic elastosis, and recent cryodestruction inflammation.

Distribution

See also: List of cutaneous conditions associated with increased risk of nonmelanoma skin cancer

About two thirds of basal-cell carcinomas occur on sun-exposed areas of the body. One-third occur on areas of the body that are not exposed to sunlight, emphasizing the genetic susceptibility of basal-cell cancer patients.

Diagnosis

To diagnose basal-cell carcinomas, a skin biopsy is taken for pathological study. The most common method is a shave biopsy under local anesthesia. Most nodular basal-cell cancers can be diagnosed clinically; however, other variants can be very difficult to distinguish from benign lesions such as intradermal naevus, sebaceomas, fibrous papules, early acne scars, and hypertrophic scarring.

Pathophysiology

Micrograph of a basal-cell carcinoma, showing the characteristic histomorphologic features (peripheral palisading, myxoid stroma, artefactual clefting). H&E stain.

Basal-cell carcinomas are differentiated toward the folliculo-sebaceous-apocrine germ, also known as the trichoblast. Thus, another name for them is trichoblastic carcinoma^{[citation needed]}, which reflects the principal line of differentiation. Overexposure to sun leads to the formation of thymine dimers, a form of DNA damage. While DNA repair removes most UV-induced damage, not all crosslinks are excised. There is, therefore, cumulative DNA damage leading to mutations. Apart from the mutagenesis, overexposure to sunlight depresses the local immune system, possibly decreasing immune surveillance for new tumor cells.

Basal-cell carcinoma also develops as a result of Basal-Cell Nevus Syndrome, or Gorlin Syndrome, which is also characterized by keratocystic odontogenic tumors of the jaw, palmar or plantar (sole of the foot) pits, calcification of the falx cerebri (in the center line of the brain) and rib abnormalities. The cause of the syndrome is a mutation in the PTCH1 tumor-suppressor gene at chromosome 9q22.3, which inhibits the hedgehog signaling pathway. A mutation in the SMO gene, which is also on the hedgehog pathway, also causes basal-cell carcinoma.

Prevention

Basal-cell carcinoma is a common skin cancer, but when solar (actinic) keratoses are also considered, basal cell carcinomas are second in prevalence. Basal cell carcinoma occurs mainly in fair-skinned patients with a family history of this cancer. Sunlight is a factor in about two-thirds of these cancers; therefore, doctors recommend sun screens with at least SPF 30. One-third occur in non-sun-exposed areas; thus, the pathogenesis is more complex than UV exposure as the cause.^{[citation needed]}

The use of a chemotherapeutic agent such as 5-Fluorouracil or Imiquimod, can prevent development of skin cancer. It is usually recommended to individuals with extensive sun damage, history of multiple skin cancers, or rudimentary forms of cancer (i.e., solar keratosis). It is often repeated every 2 to 3 years to further decrease the risk of skin cancer.^{[citation needed]}

Treatment

The following methods are employed in the treatment of basal-cell carcinoma (BCC):

Standard surgical excision

This can be with either frozen section histology, or paraffin-embedded fixed-tissue pathology. It is the preferred method for removal of most BCCs. A dermatoscope can help an experienced surgeon accurately identify the visible tumour that the naked eye can not see.

The cure rate for this method, whether performed by an otolaryngologist-head & neck surgeon, plastic surgeon, or dermatologist is totally dependent on the surgical margin. The narrower the free surgical margin (skin removed that is free of visible tumor) the higher the recurrence rate. If a 4 mm free surgical margin is obtained around a small tumor (less than 6mm), or a wider 6 mm free surgical margin is obtained around a larger tumor (greater than 6mm), the cure rate is very high - 95% or better. However, for cosmetic reasons, many doctors take only very small surgical margins 1–2 mm, especially when operating on the face. In such a case, a pathology report indicating the margins are free of residual tumour is often inaccurate, and a recurrence rates are much higher (up to 38%).

A weakness with standard surgical excision is the high recurrence rate of basal-cell cancers of the face, especially around eyelids, nose, and facial structures. A diagram on page 38 of the National Comprehensive Cancer Network publication demonstrate the area of high risk of recurrence as most the face with the exception of the central cheek and upper forehead. On the face, or on recurrent basal-cell cancer after previous surgery, special surgical margin controlled processing (CCPDMA - complete circumferential peripheral and deep margin assessment) using frozen section histology (Mohs surgery is one of the methods) is required.

With surgical margin controlled frozen section histology, a surgeon can achieve a high cure rate and low recurrence rate on the same day of the excision. However, most standard excisions done in a plastic surgeon or dermatologist's office are sent to an outside laboratory for standard bread loafing method of processing. With this method, it is likely that less than 5% of the surgical margin is examined, as each slice of tissue is only 6 micrometres thick, about 3 to 4 serial slices are obtained per section, and only about 3 to 4 sections are obtained per specimen (see figure 2 of reference).

When in doubt, a patient should demand that either Mohs surgery or frozen section histology with either margin control (ccpdma) or thin serial bread-loafing is utilized when dealing with a tumour on the face. The pathologist processing the frozen section specimen should cut multiple sections through the block to minimize the false negative error rate. Or one should simply process the tissue utilizing a method approximating the Mohs method (described in most basic histopathology text books or described in this reference ) during frozen section processing. Unfortunately, these methods are difficult when applied to frozen sections; and is very tedious to process. When not utilizing frozen section, the surgeon might have to wait a week or more, before informing the patient if more tumour is left, or if the surgical margin is too narrow. And a second surgery must be performed to remove the residual or potential residual tumour once the surgeon informs the patient of the positive or narrow surgical margin on the surgical pathology report.

Mohs surgery

Mohs surgery (or Mohs micrographic surgery) is an outpatient procedure in which the tumor is surgically excised and then immediately examined under a microscope. It is a form of pathology processing called CCPDMA. The base and edges are microscopically examined to verify sufficient margins before the surgical repair of the site. If the margins are insufficient, more is removed from the patient until the margins are sufficient. It is also used for squamous-cell carcinoma; however, the cure rate is not as high as Mohs surgery for basal-cell carcinoma.

Chemotherapy

Some superficial cancers respond to local therapy with 5-fluorouracil, a chemotherapy agent. Topical treatment with 5% Imiquimod cream, with five applications per week for six weeks has a reported 70-90% success rate at reducing, even removing, the BCC [basal-cell carcinoma]. Both Imiquimod and 5-fluorouracil have received FDA approval for the treatment of superficial basal-cell carcinoma. Off label use of imiquimod on invasive basal-cell carcinoma has been reported. Imiquimod may be used prior to surgery in order to reduce the size of the carcinoma. One can expect a great deal of inflammation with this treatment. Chemotherapy often follows Mohs surgery to eliminate the residual superficial basal-cell carcinoma after the invasive portion is removed. Some advocate the use of imiquimod prior to Mohs surgery to remove the superficial component of the cancer Removing the residual superficial tumor with surgery alone can result in large and difficult to repair surgical defects. One often waits a month or more after surgery before starting the Imiquimod or 5-fluorouracil to make sure the surgical wound has adequately healed. Some individuals advocate the use of curettage (see EDC below) first, then followed by chemotherapy. These experimental procedures are not standard care.

Immunotherapy

Immunotherapy research suggests that treatment using Euphorbia peplus, a common garden weed, may be effective. Australian biopharmaceutical company Peplin is developing this as topical treatment for BCC. Imiquimod or Aldara is an immunotherapy but is listed here under chemotherapy.

Radiation

Radiation therapy can be delivered either as external beam radiotherapy or as brachytherapy (internal radiotherapy). Although radiotherapy is generally used in older patients who are not candidates for surgery, it is also used in cases where surgical excision will be disfiguring or difficult to reconstruct (especially on the tip of the nose, and the nostril rims). Radiation treatment often takes as few as 5 visits to as many as 25 visits for radiation therapy. Usually, the more visits scheduled for therapy, the less complication or damage is done to the normal tissue supporting the tumor. Radiotherapy can also be useful if surgical excision has been done incompletely or if the pathology report following surgery suggests a high risk of recurrence, for example if nerve involvement has been demonstrated. Cure rate can be as high as 95% for small tumor, or as low as 80% for large tumors. Usually, recurrent tumors after radiation are treated with surgery, and not with radiation. Further radiation treatment will further damage normal tissue, and the tumor might be resistant to further radiation. Radiation therapy may be contraindicated for treatment of nevoid basal cell carcinoma syndrome.

Photodynamic therapy

Photodynamic therapy is a new modality for treatment of basal-cell carcinoma, which is administrated by application of photosensitizers to the target area. When these molecules are activated by light, they become toxic, therefore destroy the target cells. Methyl aminolevulinate is approved by EU as a photosensitizer since 2001. This therapy is also used in other skin cancer types.

Cryosurgery

Cryosurgery is an old modality for the treatment of many skin cancers. When accurately utilized with a temperature probe and cryotherapy instruments, it can result in very good cure rate. Disadvantages include lack of margin control, tissue necrosis, over or under treatment of the tumor, and long recovery time. Overall, there are sufficient data to consider cryosurgery as a reasonable treatment for BCC. There are no good studies, however, comparing cryosurgery with other modalities, particularly with Mohs surgery, excision, or electrodesiccation and curettage so that no conclusion can be made whether cryosurgery is as efficacious as other methods. Also, there is no evidence on whether curetting the lesions before cryosurgery affects the efficacy of treatment. Several textbooks are published on the therapy, and a few physicians still apply the treatment to selected patients.

Electrodesiccation and curettage

Electrodesiccation (EDC) is accomplished by using a round knife, or curette, to scrape away the soft cancer. The skin is then burned with an electric current. This further softens the skin, allowing for the knife to cut more deeply with the next layer of curettage. The cycle is repeated, with a safety margin of curettage of normal skin around the visible tumor. This cycle is repeated 3 to 5 times, and the free skin margin treated is usually 4 to 6 mm. Cure rate is very much user-dependent and depends also on the size and type of tumor. Infiltrative or morpheaform BCCs can be difficult to eradicate with EDC. Generally, this method is used on cosmetically unimportant areas like the trunk (torso). Some physicians believe that it is acceptable to utilize EDC on the face of elderly patients over the age of 70. However, with increasing life expectancy, such an objective criterion cannot be supported. The cure rate can be low or high, depending on the aggressiveness of the EDC and the free margin treated. Some advocate curettage alone without electrodesiccation, and with the same cure rate.

Treating surgeons will recommend one of these modalities as appropriate treatment depending on the tumour size, location, patient age, and other variables.

Vismodegib

Approved in 2012, vismodegib (trade name Erivedge) is a new drug indicated for the treatment of an advanced form of basal cell carcinoma.

Prognosis

Prognosis is excellent if the appropriate method of treatment is used in early primary basal-cell cancers. Recurrent cancers are much harder to cure, with a higher recurrent rate with any methods of treatment. Although basal-cell carcinoma rarely metastasizes, it grows locally with invasion and destruction of local tissues. The cancer can impinge on vital structures like nerves and result in loss of sensation or loss of function or rarely death. The vast majority of cases can be successfully treated before serious complications occur. The recurrence rate for the above treatment options ranges from 50 percent to 1 percent or less.

Epidemiology

Basal-cell cancer is a very common skin cancer. It is much more common in fair-skinned individuals with a family history of basal-cell cancer and increases in incidence closer to the equator or at higher altitude. According to Skin Cancer Foundation, there are approximately 800,000 new cases yearly in the United States alone. Up to 30% of Caucasians develop basal-cell carcinomas in their lifetime. In Canada, the most common skin cancer is basal cell carcinoma (as much as one third of all cancer diagnoses), affecting 1 in 7 individuals over a lifetime.

Most sporadic BCC arises in small numbers on sun-exposed skin of people over age 50, although younger people may also be affected. The development of multiple basal-cell cancer at an early age could be indicative of Nevoid basal-cell carcinoma syndrome.

References

External links

• The Skin Cancer Foundation

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. Epidemiology, pathogenesis, and clinical features of basal cell carcinoma
• 2. 母斑性基底細胞癌症候群 nevoid basal cell carcinoma syndrome
• 3. 再発リスクの高い基底細胞癌の治療 treatment of basal cell carcinomas at high risk for recurrence
• 4. 皮膚扁平上皮細胞癌および基底細胞癌における局所および遠隔転移の評価 evaluation for locoregional and distant metastases in cutaneous squamous cell and basal cell carcinoma
• 5. 進行した皮膚扁平上皮癌および基底細胞癌の全身療法 systemic treatment of advanced cutaneous squamous and basal cell carcinomas

English Journal

• One-stage reconstruction of full-thickness lower eyelid using a Tripier flap lining by a septal mucochondral graft.

• Santos G1, Goulão J.
• The Journal of dermatological treatment.J Dermatolog Treat.2014 Oct;25(5):446-7. doi: 10.3109/09546634.2013.768329. Epub 2013 May 6.
• Basal cell carcinoma (BCC) is the most frequent cutaneous neoplasm of the periorbital region. After tumor excision, the function of the eyelid has to be preserved, keeping the protection of the eyeball with preservation of damp, avoiding epiphora and ectropion. The authors describe the reconstructio
• PMID 23336755

• Repair of the donor areas defects after split-thickness skin grafts utilizing an advanced epithelialization dressing.

• Fanti PA1, Dika E, Vaccari S, Misciali C, Ismaili A, Barisani A, Patrizi A.
• The Journal of dermatological treatment.J Dermatolog Treat.2014 Oct;25(5):434-7. doi: 10.3109/09546634.2012.757286. Epub 2013 Feb 24.
• INTRODUCTION: The management of surgical wounds of the donor areas for split-thickness skin grafts might be difficult in terms of pain, risk of infection, and delayed healing.MATERIALS AND METHODS: In the period from September 2011 to June 2012, 12 patients affected by large ulcerated basal cell car
• PMID 23215535

Japanese Journal

• 肛門周囲皮膚に発生した稀な基底細胞癌の1例

• 日本大腸肛門病学会雑誌 67(7), 465-468, 2014
• NAID 130004902095

• 手指背部に生じたSyringomatous carcinomaの1例

• Skin Cancer 27(1), 48-51, 2012
• NAID 130002149466

Related Links

• basal cell epithelioma - definition of basal cell epithelioma by ...

basal cell epithelioma A popular alternative term for basal cell carcinoma, see there. epithelioma any tumor derived from epithelium. epithelioma adenoides cysticum see trichoepithelioma. basal cell epithelioma see basal cell tumors.

• basal cell epithelioma - definition of basal cell epithelioma by ...

basal cell carcinoma n. A slow-growing, locally invasive, but rarely metastasizing neoplasm of the skin derived from basal cells of the epidermis or hair follicles. ba′sal cell` carcino′ma n. a common and usu. curable skin cancer that ...

Related Pictures

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★リンクテーブル★

リンク元	「基底細胞癌」「基底細胞上皮腫」「pigmented basal cell carcinoma」
関連記事	「basal」「cell」

「基底細胞癌」

　　[★]

英

basal cell carcinoma, BCC

同

基底細胞上皮腫 basal cell epithelioma、基底細胞腫 basalioma、Basalzellen-Epitheliom, epithelioma basicellulare

関

皮膚癌、扁平上皮癌、有棘細胞癌

• 高齢者の顔面に多発。
• 褐色から黒褐色の結節性病変。
• 転移はまれ。
• 表皮基底細胞に類似した腫瘍細胞の増殖。

「基底細胞上皮腫」

　　[★]

英

basal cell epithelioma

関

基底細胞がん、色素沈着型基底細胞癌、蚕食性潰瘍

「pigmented basal cell carcinoma」

　　[★]

色素沈着型基底細胞癌

関

basal cell carcinoma、basal cell epithelioma、rodent ulcer

「basal」

　　[★]

• adj.

• 基礎の、基本の、基底の

関

base、basement、bases、basic、basis、element、elementary、fundamental、fundamentals、fundus、ground

　 　 　

「cell」

　　[★] 細胞