Basalioma is a malignant lesion of the skin. Among all other tumors, basal cell is well suited for treatment and can lead to 100% cure. The main problem of basal cell carcinoma is that it can lead to impaired muscle tissue function, damage innervation and even damage the integrity of bone structures. Also the main goal that all oncodermatologists pursue in the study and treatment of a patient with basal cell is to prescribe therapy as early as possible in order to prevent gross organic disturbances of healthy tissues.
Basalioma equally affects both men and women. One of the important features of its development is a long stay on strong solar radiation and thus a constant burn effect of sunlight on the human skin.
A priori, under the basalioma is meant a cancerous lesion of the skin. This happens under the influence of a whole list of etiological factors that affect the cells of the epidermis. As a result, visual defects of the skin develop, which can be accompanied by strong pain sensations.
Visually on the surface of the skin with the basal cell will appear its various defects. They have a characteristic pinkish color and a completely different shape. In the late course these foci of basal cell carcinoma are significantly ulcerated, and changes can go straight to the bone.
Basalema almost never metastasizes. But it can deeply engorge in deep tissue and cause disruption of innervation and muscle contraction. So, if the basal cell is located in the areas of the facial region, then its further introduction may lead to a violation of facial muscles.
This disease is divided into its clinical forms and stages. Among forms there are both species that are characterized by extremely slow growth, and basal cells are extremely aggressive and with rapid spreading. The process staging is similar to the stages of any malignant tumor lesion and has the same principles of differentiation.
It is important to determine the presence of basal cells in the early stages, because the effectiveness of its treatment depends on this. Therefore, it is advisable to apply certain diagnostic criteria: dermatoscopy, the nearest study of a pathological focus through a magnifying glass, a cytological study of the material of a possible tumor. In combination with these methods of research, additional methods are also used: chest X-ray, lymph node puncture, ultrasound examination of the abdominal organs to determine the spread of the process to the lymph nodes.
Basaloma is primarily an oncological process. So, its development process will obey all the basic laws of development of oncological lesions. In oncological cells that subsequently create a tumor (that is, they are "mother" cells), the processes of tissue growth are severely disrupted. In such cells, the processes that trigger its self-destruction cease to pass, and therefore its uncontrolled division and increase in the tumor mass arise.
Interestingly, it is due to the properties described above that all the subtypes of tumors belong to so-called processes with a hyperbiotic ability (the ability for high growth, division and increase in the total mass of pathological tissue). Such tumor pathological cells can arise under the influence of various factors. Their huge number: they include all kinds of chemical and physical substances, certain diseases and even viruses. But whatever the factors of occurrence and place of oncological tissue appearance, the process of its appearance is practically the same.
First, changes occur in the cell at the level of the processes of its regulation - it loses its ability to self-destruct (apoptosis). Normally, each cell has its own limit, which controls the number of divisions: during this limit the cell divides the programmed number of times, and then perishes. At each cell this limit depends on its features, its functions and the functions of the structures into which it is included. But in tumor cells this programmed "limit of life" is absent and the tap is completely immortal.
In the future, it begins to intensively share. It is from the speed of its division and the formation of new daughter tumor cells that "aggressiveness" (the ability to rapidly spread and grow) of the tumor depends. These processes have two periods: the first with a slower flow and the second, the faster one. The first stage of the active oncological process starts from the first division of the maternal oncological cell and lasts for 30 divisions until the tumor gains about 1 gram. Usually it takes about 2-3 months. Further tumors need to increase their weight to about 1 kg. But since the tumor cells, due to the first stage has become more, then the time for this increase in mass is required significantly less - about 10 divisions (about a month).
Another feature of such cells is that they have an extremely primitive structure. This is due to the fact that they are all born from one cell, have in themselves a maternal genetic material and do not complicate the soy structure with each division. Conversely, even it is simplified. Such simplification processes are extremely convenient for the rapid birth of a tumor - the simpler the structure of the cell, the less time it takes to build it, which means that a sufficient amount of pathological tissue will develop sooner.
Also, such tissue is implanted by its cells with broken structure, into other tissues and gradually replaces normal tissue with its pathological one. This can be explained by one experimentally established process: normally the culture of cells grown in a test tube is divided until the cells come into contact with the walls of the vessel. After this contact, the formation and growth of the cell culture stops - this process is called contact inhibition. But the tumor cells, even bumping into the walls of the tube, continue to divide - so it shows that when they physically collide with other cells they will not stop and will start to germinate inside the tissue. Bumping into a new structure, cancer cells first destroy its connective tissue membrane, forming a so-called "loophole" - they split its structure and open the way for its relatives. After this, these cells, or under the pressure of an ever growing mass of cancer tissue, are "squeezed" into this loophole or migrate there independently, thanks to their chemical sensitivity (chemotaxis) processes. By the way, it is these invasive processes that cause the manifestation of certain additional clinical symptoms.
In addition, cancer cells and tissues have another most notorious ability - such cells have the ability to spread throughout the body and secondary damage to new tissue structures (also known as metastasis). The type of organs that can be at risk of secondary infection with cancer cells depends on the way in which such cells will spread through the body: for example, through the blood or lymphatic channel.
It is also important to know that the longer the oncology cell is divided, the more malignant its offspring become. At a certain stage, their genetic code is restructured, aimed at increasing the aggressive properties of the oncocells: faster division, tissue germination and spreading.
With basaloma, the primary maternal oncocells become epithelial cells. Therefore, the basal cell is also referred to as epithelial tumors. As a result of damage to the epidermis, special cell complexes are formed in it: small basic basal cell cells (these are also altered epidermal cells), which are surrounded by special prismatic cells. The aggregate data are divided into separate parts by a connective tissue envelope.
The main causes that can become prerequisites for the occurrence of basal cell carcinoma are the pre-tumor skin processes ( keratosis , leukoplakia , xeroderma). In addition to them, certain viruses (especially herpes viruses), the effects of carcinogenic chemicals (arsenic, paraffin, tar derivatives), persistent mechanical skin irritations, trauma and thermal effects, can also become etiologic causes of basal cell carcinoma.
In addition, one should not forget about the important role in the genesis of basal cells of long-term exposure to sunlight. This reason is leading in 91% of cases of appearance of basal cell. Most often, solar irradiation can lead to the development of skin lesions of the neck, face and head. Among the entire solar spectrum, the B-spectrum radiation is the most dangerous on the oncological plane.
Most often, basal cell carcinoma develops in elderly people. In addition, its possible availability will indicate data from an anamnesis of the disease: responding to questions, patients will talk about the effects on them of strong sunlight or exposure to radiation from ionizing radiation.
First, a small dense, slightly pearly "knot" appears on the surface of the skin. Due to its appearance, it was also called the "pearl". After a while, this bundle becomes wet, crusted and ulcerated. Under the crusts, a bleeding, ulcerated surface is easily detected. Around this formation a dense roller is formed, which is the daughter "pearl". During the next time, this ulcerated surface will more and more deepen inside, forming a crater of an ulcer. In the latter stages, the entire ulcer becomes dense and does not move with the skin in certain studies. In addition, the ulcer has a characteristic fatty coating on its bottom and on the surrounding skin vascular nets clearly appear.
In addition to nodules, the primary element of the basal cell may also be a dense, upstanding plaque or a rounded spot. The entire morphology of these elements corresponds to its form of basal cell and differs in its localization.
With a significant lesion of basal tissue, there will be significant pain and discomfort. Also important symptomatology will be a certain characteristic localization: most often on the hands, under the hair covering on the head, on the wing of the nose, the temple, at the corners of the eyes.
Basally, basal cell has slow development and growth - its individual forms can be on the skin for years and extremely slowly and gradually infiltrate surrounding tissues.
Another peculiarity characteristic only of basal cell is that the primary ulcer does not grow in width, but in depth, acquiring a characteristic "funnel-like appearance".
Forms and stages of basal cell carcinoma
The stages of basal cell development are determined by the same assessment system as in other oncological processes. This system is called TNM and consists of three basic principles for assessing tumor staging: by tumor size (T). On the defeat of the nearest and distant lymph nodes (N) and on the presence / absence of signs of the appearance of metastases (M).
According to the size of the tumor lesion (T), the following types of its course are distinguished:
Stage Tx - this stage of the process basaliomy is set when there is no data on the true dimensions of the lesion or it is not possible to obtain them
The To stage is established when, during diagnostic studies, the tumor is not detected. But here it must be said that not always the absence of visualization of the tumor testifies to the complete absence of an oncological process in the body. Therefore, it is customary to say that this stage is put not simply in the absence of detection of tumor lesion, but in the absence of a primary tumor
Stage Tis - here the basal cell does not infiltrate the surrounding tissues. This process was called the pre-invasive
Stage T1 - this stage is appropriated when the approximate size of the pathological site is less than 2 cm
Stage T2 - here the dimensions of the lesion will range from 2 and end somewhere around 5 cm
Stage T3 - this stage of basal cell can be talked about when its size overcomes the border of 5 cm
Stage T4 - in this stage, basal cell affects the underlying structures: subcutaneous fat, muscle, cartilage and bone
Given the presence or absence of changes in the lymph nodes (N), the basal cell passes through such stages of the flow: stage Nx, stage No and stage N1. Stage Nx is similar to that of tumor size: it is also precisely established if it is not possible to obtain accurate data on the state of the lymphatic system. Stage No is established when the regional lymph nodes have not yet been affected by the spread of the tumor by the body, the tumor process. Stage N1 is put immediately, as soon as the smallest tumor changes are found in the lymph nodes. Classification of the staging of basaloma by the manifestation of metastases is not applied, since this oncological pathology does not tend to metastasize.
It is also possible to group these stages into the clinical stages of basal cell carcinoma.
At stage O, basaloma can be found in its initial manifestation, without infiltration of tissues and without any lesions of the lymph nodes. In Stage 1, the lymph nodes will remain absolutely intact, and the size of the basal cell itself will increase, and there may already be some signs of its introduction into other tissues. In the 2 nd stage, the basal cell size will increase to 5 cm, without enlarging the lymph nodes. Actually, the lymph nodes may be, possibly, affected only at the third stage of the process, accompanied by a significant lesion of the basalioma of other tissue structures. It is common to speak of stage 4 when the possible presence of distant metastatic processes is added to the described manifestations at stage 3.
In addition to stages and degrees of flow, basal cell is divided into a number of subspecies or forms. These forms are subdivided according to their clinical manifestations and histological structure. It is accepted to allocate a basalioma nodular, surface basaloma and scleroderm-like basaloma.
The most common form of basal cell is, of course, its nodular form. It is characterized by the appearance on the skin of small nodules of pinkish color, which can be grouped into a tumor formation up to 2 cm in size.
Surface basal cell is a patch of rounded shape all of the same pinkish color with delimited edges. Scleroderm-like form is the most aggressive. In the course of its development dense patches are formed on the skin. Hence the name of this form of basal cell, due to similar changes in autoimmune disease - scleroderma . This plaque initially rises slightly above the skin, and then gradually pushed inward and forms a kind of scar on the skin. In the latter stages ulcers may appear on this site or the central part of this plaque will gradually become atrophic.
Also, the forms of basaloma are distinguished according to its localization on the human body. So it is possible to isolate the basal tissue of the skin of the trunk or extremities. In addition, there may be basal cell on the nose (one of the most common localizations) or basal cell eyelids, more commonly known as the basal cell eye.
Treatment of basal cell carcinoma
The main treatment and removal of tumor cells from the body is based on the following principles: surgical treatment, radiotherapy and the introduction of specialized medications. Most often all these three principles go hand in hand in the treatment of tumor problems.
With basalioma, its localization plays an important role in the treatment. If it is located on the limbs and trunk, then microsurgical manipulations will be good methods of treatment: cold or coagulation destruction. But at the same time, if the basal cell damages the scalp, face, neck, then the use of surgical aids in these areas is simply impossible.
Therefore, for treatment of basalomas on the facial areas, radiation therapy is used. This kind of therapy is used because the basal cell tissue is extremely sensitive to radiation. In addition, irradiation of superficial tumor manifestations is extremely convenient. Most often, basal cell irradiation is used in difficult or impossible surgical approaches to the tumor: the upper eyelid, the angle of the eye, the nose and the external auditory canal.
Radiation therapy is a complex treatment, consisting of many important aspects that must be taken into account. With basalioma, radiation therapy has three main goals:
1) it is necessary to bring the optimal (effective) radiation dose to the source of the disease;
2) this dose should have the most minimal destructive effect on nearby tissue structures;
3) it is necessary to carry out measures aimed at activating the body's own defenses.
More often, close-focus irradiation is used. Before the treatment begins, the size and depth of the structures affected by the rays is determined: usually the basal cell itself and the surrounding tissue structures are placed under irradiation to prevent relapse. The average single dose is about 4 Gy at a time. Typically, these sessions are assigned about 5 per week. The total radiation dose should be about 55 Gy, since basal cell cells have a high radiosensitivity to radiation.
It is extremely important to follow the so-called radiosensitivity interval in irradiation: the difference between the radiosensitivity of the basal cell and the healthy tissue itself. The lower the sensitivity of the tumor, the higher the dose of radiation, and hence the radiotherapeutic interval. Too high such an interval is extremely detrimental to healthy structures located near the tumor and gradually destroys them.
Radiation therapy is not prescribed for a severe, exhausted patient, sepsis, massive inflammation, anemia of unknown origin, development of organ failure, and a significant spread of the process with the introduction into large main vessels.
Removal of basal cell
This principle of treatment can be used alone or in combination with other methods. Independently it is most often used with the initial forms of basal cell, and also with its special localizations: with the manifestation of its foci on the skin of the trunk or the skin of the upper and lower extremities. Together with other methods, surgical removal of the basal cell is used in its re-emergence, with deep ulcer lesions and with layering on the tumor lesions of the skin after radiotherapy.
The main operational benefits will be: cryodestruction of local manifestation of basal cell, diathermocoagulation or excision of the affected tissue with a scalpel.
Cryodestruction removes the oncological process on the surface of the skin by applying low temperatures to it. This is achieved by using a special surgical instrument during the operation, which is a tube through which carbon dioxide is cooled to extremely low temperatures. Such carbon dioxide acts locally on the pathological focus, completely freezing it and destroying it. It turns out the so-called "ice scalpel". Such a procedure is more tolerable for patients, and is also practically not accompanied by pain. It is usually performed under local anesthesia.
The principle of diathermocoagulation is similar to that of cryodestruction. But here the basal cell is removed due to the influence of current on it with a certain frequency. Such operations are performed using devices with a special electrode in the form of a lancet or a scalpel. A current discharge is applied to this lancet, which burns the desired area. The peculiarity of this surgical method is that the vessels coagulate with it, and therefore there is practically no damage to blood vessels and bleeding. Diathermocoagulation in the treatment of basal cells is used due to the fact that the electrical discharge has a deep penetration, and therefore can remove the tumor not only superficially, but also destroy its structures infiltrating the underlying tissues.
Traditional excision of basal cell carcinoma is also used, although it has recently been pushed back by the methods described above, due to the fact that they have a large number of advantages, compared with the traditional surgical manual. Usually, the following rules are followed here: basal cell is excised within a healthy tissue, retreating 1.5 or 2 cm from the edge of the basal cell (depending on its size). But recently it has been revealed that this method of treatment does not completely remove the basal cell and the risk of its re-emergence is extremely high.
Therefore, recently, a new surgical technique for excision of basal cell carcinoma, the Moss technique, has gained its popularity. This technique implies a slow layer-by-layer removal of the tumor, which can consist of even several stages. First, the visible part of the basal cell is removed along with a thin layer of surrounding tissue. Then samples of the tissue under the basal cell are taken and sent for urgent histological examination. This study will determine whether there is any cancer cell in the test tissue or not. After receiving the results, the second stage of the operation is corrected, in which a tactic is developed for further layer-by-layer removal of the affected tissues.
With surface forms and nodular forms with small sizes of nodules, it is more expedient to use laser removal of the basal cell. Due to the effect of laser radiation, the focus is completely removed and, what is extremely important, such an operation has a good cosmetic effect, leaving no scars or scars behind.
It is also important to know that surgical treatment can not be performed when the basal cell is localized on the auricles or face. These contraindications exist because cryodestruction or diathermocoagulation can affect facial muscles.
Basaloma is one of the most favorable oncological lesions of the skin. This is because basal cell does not form metastases. Therefore, such a tumor is easier to cure, using local methods of exposure. It is believed that of all the cases of skin damage detected by this disease, about 90% of the patients are cured completely. It is also important to understand that the probability of a favorable cure for basal cell disease depends on the time of its detection: the earlier stages it will be found, the better and faster will be the effect of its treatment.
The cure is hampered by the infiltration of the basal lobe underlying and bone structures. And also with the development of late, ulcerative stages. These manifestations are treated longer and require higher doses of radiation and chemotherapy. In addition, if the tumor has already begun to infiltrate the subcutaneous tissue, then it can recur, despite all the treatments. In order to prevent its germination, it is necessary to remove basal cells in the early stages. For visual identification of early and late stages, there are certain sizes of skin tumors: a tumor of less than 20 mm is considered to be early and most probably has not yet germinated into the subcutaneous fat. But the local process, measuring over 20 mm, is already running and most likely infiltrated the fiber or even the deeper layers.
Patients with basalioma after its detection and treatment become on a dispensary record with an oncodermatologist. On average, such clinical examination lasts about 5 years and after its termination, in the absence of manifestation during this time of clinical and diagnostic signs of basal cell carcinoma, patients are completely removed from the register.