Skin Cancer

Dear Dr B: Recently I had surgery for skin cancer called basal cell carcinoma. Besides surgery, are there any other options for the management of this cancer?

Basal cell carcinoma (BCC) is a form of skin cancer and is the most common cancer found in humans.

BCC and squamous cell carcinoma (SCC) are also known as non-melanoma skin cancers. Melanoma is the third type of skin cancer. Approximately 30 percent of the malignant skin cancers diagnosed among Albertans each year are non-melanoma skin cancers – BCC and SCC.

Non-melanoma skin cancers account for greater than one million new cases of cancer annually in the United States and are responsible for 1200 to 1500 deaths per year. Costs of US$500,000,000 have been estimated in the management of these malignancies.

BCC usually grows slowly. It is locally invasive and does not spread to distant parts of the body – liver, lung, brain, bones etc. But melanoma can spread to other organs of the body.

The clinical outcome of BCC is difficult to predict. It may remain the same size for many years or it may grow rapidly. It can cause local destruction of tissues especially on the face.

BCC can occur at any age but the incidence increases over the age of 40. The incidence among the young people is increasing due to increased exposure to the sun.

Who are prone to skin cancer?

People who have fair skin, have tendency to freckle, have high degree of sun exposure, make excessive use of sun beds, had previous radiotherapy or phototherapy, male sex, and those who have genetic predisposition.

How is BCC treated?

“The first line treatment of BCC is often surgical excision. Many alternatives are available, including curettage, cryosurgery, laser treatment, surgical excision with predetermined margins of clinically normal tissue, excision under frozen section control, Moh’s micrographic surgery, radiotherapy, topical treatment, intralesional treatment, photodynamic therapy, immunomodulators, and chemotherapy”, says an article in the British Medical Journal.
The article says that although many treatments are used for BCC, little research is available that accurately compares these different treatment methods against each other and for different types of tumour.

If BCC is not adequately treated then two thirds of recurrent tumors appear in the first three years of treatment and 18 percent appear between five and 10 years after treatment.

According to the BMJ article the following treatments are most often used in the management of BCC:

• -excisional surgery – seems to be the most effective with low recurrence rate,
• -curettage and cautery,
• -radiotherapy,
• -cryotherapy, and more recently
• -photodynamic therapy and
• -imiquimod cream – preliminary studies suggest a short term success rate of 87-88 percent for imiquimod cream in the treatment of superficial basal cell carcinoma, although this cream has not been compared with surgery.

Surgery remains the main stay of BCC management. More research is required to compare imiquimod cream with surgery. Other methods of treatment have not shown to be superior to surgery.

Prevention of skin cancer is very important. This should start in childhood. Reduce exposure to sun, use sunscreen, use wide-brimmed hat, and have suspicious looking moles removed surgically. More than 90 percent of skin cancers occur on sun-exposed areas of the body.

If you like to worship sun, then expect to burn and eventually get cancer.

Thought for the week:

“Exercise will make you fit, but fitness and health are not synonymous. Exercise alone is not enough to make you healthy. To achieve good health, exercise is an essential part of a compressive lifestyle program ……….”

Dr. Dean Ornish’s Program for Reversing Heart Disease.

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