Sometimes it’s a skin-colored lump on the cheek, sometimes a small wound on the neck, sometimes a scarred spot on the back: basal cell carcinomas occur in different forms and are quite inconspicuous, especially in the early stages. “There is a huge range of what they can look like,” says dermatologist Christoph Löser from the Ludwigshafen Clinic. In some cases, the skin changes are so typical that experienced doctors recognize them immediately, in others only a tissue examination can clarify them. Patients do well to observe their skin, but cannot assess the areas themselves. “If you notice nodules or structural changes, especially on the face, that don’t heal anymore, you should have them checked out,” advises Löser. If the suspicion is confirmed, there is no reason to panic: This common form of “white skin cancer” can usually be treated very well – especially in the early stages.
“It is by far the most common cancer in Germany,” says Julia Welzel, dermatologist at the University Hospital in Augsburg, about basal cell carcinoma. “It is estimated that every third person in this country will develop a basal cell carcinoma in the course of their life.” The risk of developing the disease increases with age – partly because UV damage to the skin accumulates over time and the cancer usually develops through years of intensive exposure solar radiation is triggered. Therefore, it mainly appears in areas that have been exposed to the sun: primarily on the face, but also on the décolleté and back. Fair-skinned people are particularly at risk.
Experts are now avoiding the common term “basalioma” because it could sound too harmless. The cancer that develops in the basal cells of the epidermis grows slowly and rarely forms metastases. Nevertheless, he is not without danger. If left untreated, it can penetrate deeper into the tissue over the years and damage surrounding bones. Therefore, the therapy aims to completely destroy the cancer cells.
According to medical guidelines, surgery is the most effective. Smaller tumors can be operated on as an outpatient in a dermatologist’s office. To do this, the carcinoma is excised, and some of the surrounding tissue is also removed. This “safety distance” is intended to ensure that no diseased cells remain. At least for larger, more problematic tumors, however, “microscopically controlled surgery” is recommended: The wound is only temporarily covered after the operation and the piece of skin removed is immediately examined in the laboratory. If cancer cells are still found, a follow-up operation is carried out. This method is the least likely to cause relapses. It also has the advantage that no more tissue than necessary is removed. It is usually only used in clinics or specialized practices.
Especially when the tumor is on the face, the prospect of surgery and the associated scar can frighten patients. Can such an operation be avoided?
“There are very good alternatives, especially if you discover a basal cell carcinoma early,” says dermatologist Welzel. These include photodynamic therapy (“light therapy”), creams, especially with the active ingredient “imiquimod”, laser therapy and radiation. Which treatment is suitable depends on the type and size of the tumor as well as the age and previous illnesses of the patient. »The OP has the highest healing rate at 98 percent. With the other therapies, however, you can also achieve over 80 percent,” explains the skin cancer expert. “You can also combine them or repeat them.” Such conservative procedures are usually only an option for superficial or smaller “low-risk” tumors: according to the guideline, the tumor should not be thicker than two millimeters. However, there can also be cases – such as in the case of very old patients – in which doctors deviate from this scheme.
A simple and popular method of taking action against thin carcinomas is treatment with the active ingredient imiquimod (trade name »Aldara«). A cream is applied for this purpose for six weeks. The drug stimulates the immune system to fight the tumor itself. However, severe inflammatory reactions can occur on the skin, which are accompanied by swelling, scaling and blisters. An alternative to this is photodynamic therapy, in which the affected area of skin is pre-treated with a gel that makes the diseased cells sensitive to light and then irradiated with red light. This produces aggressive oxygen, which destroys the cancer cells. “Especially large carcinomas can be treated well in this way,” says dermatologist Löser. The treated skin may be red, swollen or crusted for a few days afterwards. Apart from that, diseased tissue can also be removed by laser – this therapy can also be easily combined with others.
According to the expert, a “very good but complex solution” is X-ray irradiation of the affected area. Since the required dose of radiation is administered in small amounts every day, patients often have to come to the clinic for treatment. An even bigger disadvantage is that new tumors can appear after 10 to 20 years due to the X-ray radiation, as Löser explains. “Therefore, the therapy is particularly suitable for patients over 80 years of age who cannot undergo surgery.”
In severe cases, electrochemotherapy can also be used, in which pulses of electricity cause anti-tumor drugs to penetrate the cells better. “You can already achieve visible success after just one session,” says Löser. There are also oral drugs on the market for advanced basal cell carcinoma that work well but often have significant side effects.
The fact that such funds are necessary is rather the exception. Most cancers can be treated easily. Often, reports dermatologist Welzel, she discovers tiny basal cell carcinomas that the patients were unaware of during early detection examinations. “Sometimes such carcinomas can be removed during the consultation.” If not, it doesn’t necessarily mean an operation. “I explain the various options to patients, along with their advantages and disadvantages,” says Welzel. “The decision depends very much on what they want. Some patients really want an operation.«
White skin cancer is easily treatable (nd-aktuell.de)
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