Skin tumors (plastic surgery)

Basal cell carcinoma (BCC), also known as basalioma, is the most common form of skin cancer and the most frequent human cancer (15%). These carcinomas are neoplastic proliferations starting from the basal cells located in the deepest layer of the epidermis (the most superficial component of the skin). Skin tumors…

Skin tumors (plastic surgery) 2022

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What is basal cell carcinoma?

Basal cell carcinoma (BCC), also known as basalioma, is the most common form of skin cancer and the most frequent human cancer (15%). These carcinomas are neoplastic proliferations starting from the basal cells located in the deepest layer of the epidermis (the most superficial component of the skin).

Basalioma, being caused mainly by chronic and intense exposure to ultraviolet rays (in particular UVB), is mainly localized on the parts of the body exposed to sunlight, such as the face, ears, neck, scalp, shoulders and back. In rare cases, the tumor can also develop on non-photo-exposed areas.

However, the mode of sun exposure is also very important. In fact, it has been shown that the risk of developing basal cell skin cancer is lower in those who are exposed to the sun regularly than in those who do it irregularly (so be careful of intense and occasional exposure!).

In any case, it is essential to adopt the appropriate protective measures from an early age, some studies have in fact shown that the amount of ultraviolet radiation received during childhood is an important predictor of risk for the development of basal cell carcinoma.

To a lesser extent, immunosuppression, exposure to ionizing radiation or arsenic are also risk factors. Furthermore, a recent study has shown how frequent use of sun beds multiplies the risk of developing basaliomas by 4 times. Although basal cell carcinoma has a metastasis rate almost close to 0 (0.05-0.1%), it has a high tendency to grow locally, which is why it is very important to intervene promptly.

Who is most at risk of developing basal cell carcinoma?

Fair-skinned subjects, the elderly (the disease is rarely found in children), strong exposure to UV rays, workers with outdoor occupations.

When should I be alarmed?

There are some characteristics of the basalioma, which allow, even to an inexperienced eye, to be alarmed and immediately run to a specialist. The most frequent presentation modalities are: ulcerations that do not undergo healing, reddish spot or irritated area on which a crust may form (associated or not with itching), pearl white or waxy protuberance inside which vessels can be recognized sanguine.

How to protect yourself to prevent basalioma?

Sun protection must be carried out considering not only the use of sunscreen creams, but also the use of protective clothing, hats and goggles, looking for shaded areas while avoiding direct sun exposure. You should also avoid exposing yourself to the sun during the hottest hours, avoiding burns. Ban on tanning from artificial lamps!

How do basal cell carcinomas arise?

From a clinical point of view, basaliomas present with various aspects, from red plaques, ulcerations or erosions that do not tend to heal, pink growths, nodules or scars. People with suspicious skin neoformations must undergo a dermatological examination. The dermatologist, using dermoscopy and in some centers also confocal microscopy, will be able to limit the possibility that a basalioma is not diagnosed (it is important to underline that the basalioma enters a differential diagnosis with various skin diseases, neoplastic and not).

What should I do if in doubt?

Should the dermatologist suspect a diagnosis of basalioma, it is necessary to contact a surgeon who will decide whether to proceed directly with the surgical excision or an incisional biopsy. This assessment is made on the basis of the site, the characteristics of the lesion and its size. The incisional biopsy alone is carried out only in case of doubt or in the event that the removal of the lesion results in an aesthetic defect that only the real presence of neoplasm would justify.

However, the surgical approach is not always recommended as a first choice, in fact, various aspects must be taken into account, both inherent to the characteristics of the tumor and those of the patient. The localization, the size, the anatomopathological characteristics of the tumor are in fact important evaluations in the choice of the best treatment, as well as the clinical condition of the patient and his preferences (also on the basis of the aesthetic result).

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