tumors

Basalioma: What is it? Causes, Symptoms, Diagnosis, Therapy and Prevention of A.Griguolo

Generality

The basalioma is a malignant tumor of the skin, which originates from the uncontrolled proliferation of a basal epidermis cell.

In most cases, the formation of a basalioma is due to excessive exposure to the UV rays of the sun or tanning lamps; more rarely, in a state of immunodepression, in contact with certain toxic chemicals or genetic predisposition.

The basaliomas manifest themselves with a cutaneous sign, the characteristics of which vary depending on the site and of factors still unclear.

For the diagnosis of basalioma, the following are fundamental: physical examination, medical history and tissue biopsy.

The basalioma is a widely treatable tumor, provided, however, that the therapy - which consists of a work of removal of the skin sign - is timely.

Short Review of the Skin

To understand what basalioma is, it is necessary to review some fundamental concepts relating to the skin and its very important cell line, the so-called basal cells:

  • The skin, or skin, is the outer covering of the human body ;
  • The skin consists essentially of two tissues: a more superficial tissue, called the epidermis, and a deeper tissue, called the dermis ;
  • The epidermis is an example of epithelial tissue ; the dermis, on the other hand, is an example of dense connective tissue ; as tissues, both the epidermis and the dermis comprise different cell lines (or different types of cells).

What is the Basalioma?

The basalioma is a malignant tumor of the skin, which originates from the uncontrolled proliferation of one of the basal cells belonging to the epidermis.

Cubic or cylindrical in shape, the basal cells are those cellular elements of the skin located at the base of the epidermis (hence the term "basal"), in direct contact with the first cells of the dermis.

Did you know that ...

Equipped with a very intense replicative activity, the basal cells of the epidermis are a kind of skin stem cells ; in fact, they give life to the so-called keratinocytes, that is the most representative and numerous cellular elements of the epidermis.

Is the Basalioma Dangerous?

The basalioma is not a particularly aggressive and dangerous malignant tumor, but it can become so if its diagnosis is late or if the treatments are inadequate.

Classification of the Basalioma

Basalioma belongs to the category of so-called skin cancers other than melanoma and is an example of carcinoma .

SKIN CANCER OTHER THAN MELANOMA: WHAT ARE THEY?

Also known as non-melanomatous skin cancers, non-melanoma skin cancers are the most common skin cancers and one of the most common forms of cancer in the general population.

The element that accumulates the various skin cancers other than melanoma is the involvement of the most superficial layers of the skin; what differentiates them, on the other hand, is the type of cell from which the neoplasia originates.

CARCINOMA: WHAT IS IT?

In oncology, the word "carcinoma" defines any malignant tumor (or cancer), which originated from the uncontrolled proliferation of a cell belonging to an epithelial tissue .

Did you know that ...

The tumors that, like carcinomas, originate from the uncontrolled proliferation of epithelial tissue are epitheliomas ; in oncology, the term " epithelioma " identifies any benign or malignant neoplasm that originates from a cell of an epithelium.

Epidemiology

Basalioma is the most common skin cancer other than melanoma ; to demonstrate what has just been stated is the finding of basalioma in 75% of people affected by a non-melanoma skin cancer .

A percentage of 75% means that, for every 100 people suffering from skin cancer other than melanoma, 75 of these (hence the ¾ of the total) suffer from a basalioma.

Basalioma is the most common tumor found in the white race.

Statistics in hand, the basalioma has a predilection for people of middle-advanced age (so around 50 and 60 years) and is more common among males than among females.

The incidence rate of the basalioma varies in relation to the geographical area considered: in the areas closest to the equator and / or at high altitudes the incidence rate is higher than elsewhere.

In Italy, reliable sources claim that the annual incidence is around 75-80 cases per 100, 000 individuals.

Did you know that ...

  • The second cancer of the skin other than the most common melanoma is squamous cell carcinoma ; this covers, in fact, 20% of the total share of cases of non-melanoma skin cancer;
  • What of cases of skin cancer other than melanoma (ie 5%) is divided between: Merkel cell carcinoma, cutaneous T-cell lymphoma, cutaneous B-cell lymphoma, carcinoma of the sebaceous glands, Kaposi sarcoma and dermatofibrosarcoma protuberans ;
  • Statistics show that in Europe (hence also in Italy) the annual incidence rate of skin cancers other than melanoma is increasing.

Synonyms: with what other names is the Basalioma known?

In oncology, basalioma is also known by at least two other names, which are: basal cell carcinoma and basal cell epithelioma .

The reference terminology is in line with what was stated earlier on basalioma, concerning the fact that it is a carcinoma and an example of epithelioma.

Causes

What is a Malignant Tumor and how a Basalioma arises

A malignant tumor is a mass of abnormal cells, whose division and growth rate is higher than the parameters considered normal.

Triggering the formation of a malignant tumor is the accumulation, by the DNA of even just one cell of the affected organ or tissue, of mutations in fundamental genes to regulate growth, development and cell division .

The malignant tumors are therefore masses of cells that grow and divide without any control, as the cellular element from which they derive has lost, due to a series of genetic mutations of the DNA, the possibility of regulating their own life cycle.

The basalioma is the malignant tumor of the skin resulting from the accumulation, by the DNA of a basal cell of the epidermis, of mutations in genes responsible for the regulation of growth, development and division of the same cell.

The basalioma is a malignant tumor of the skin that occurs when a basal cell of the epidermis loses, due to a series of DNA mutations, the ability to finely control its division growth.

Causes of Basalioma: what produces the Genetic Mutation

In most cases, the formation of a basalioma is due to excessive exposure to ultraviolet radiation ( UV rays ) of the sun or tanning lamps ; more rarely, it is related to a state of immunodepression (ie an inefficient immune system), to contact with some particular toxic substance or to a genetic predisposition to skin cancers other than melanoma.

Did you know that ...

The UV rays of the sun and tanning lamps are the main culprits of other skin cancers, not only of the basalioma.

What favors the formation of the Basalioma: Risk Factors

Oncological research has found that there is more than one factor capable of favoring the appearance of the basalioma.

More specifically, the factors in question include:

  • Excessive exposure to sunlight or tanning lamps . The UV rays of the sun or tanning lamps are the main cause of basalioma;
  • Light skin . The light skin is poor in melanin, that is the pigment that protects the skin from the harmful consequences of the UV rays of the sun;
  • Exposure to ultraviolet radiation from phototherapy . Phototherapy is a form of treatment that serves the therapeutic management of conditions such as, for example, psoriasis, acne and other skin diseases;
  • Exposure to arsenic . Surveys have shown that arsenic favors the onset of various skin cancers, including basalioma;
  • The presence of a weak immune system . Immunosuppression is usually a problem of: those who take immunosuppressive drugs (they are drugs that lower the immune system), the elderly (for physiological reasons) and people suffering from diseases that cause immunodepression (eg, AIDS patients);
  • A personal or familial genetic predisposition to the development of skin cancers . Genetic diseases such as, for example, Gorlin-Goltz syndrome and xeroderma pigmentosa increase the probability of developing basalioma.

Did you know that ...

Sufferers of xeroderma pigmentosum are extremely sensitive to sunlight, so much so that they must protect themselves from the sun's rays even inside their own homes.

Symptoms and Complications

The basalioma manifests itself with a cutaneous sign whose characteristics cannot always be superimposed .

The basalioma can appear anywhere on the human body; however, in most cases, it occurs in the anatomical areas most exposed to the sun (therefore on the face, on the back of the hands, on the scalp, on the neck and on the ears).

Did you know that ...

According to some statistical studies, the cases of basalioma are 2/3 of a body area usually exposed to sunlight and only 1/3 of an area generally sheltered from sunlight.

Basalioma characteristics

The cutaneous sign (or lesion) that characterizes the presence of a basalioma can have a variable appearance; in fact, it can look like:

  • A protuberance of pearl white or waxy white, in which the blood vessels that cross it can be easily distinguished.

    The basaliomas that appear on the face, the neck and the ears have similar features.

    In some situations, the protuberance in question can bleed and form a crust;

  • A brown, black or blue spot with a raised translucent edge;
  • A scaly area, flat centrally and raised at the edges, brown or reddish .

    In general, basalomas that occur on the chest or back have these characteristics.

    Over time, this type of injury tends to become obvious;

  • A scar-colored scar of white color .

    This aspect, which also makes the diagnosis of the tumor difficult, is typical of a very invasive, but fortunately uncommon basalioma type, called morphiform or sclerosing basal cell carcinoma.

When should I go to the doctor?

Especially in the presence of risk factors, it is a valid reason to contact a dermatologist for the sudden appearance and without obvious reasons, on an area of ​​the skin, of a lesion with a suspicious appearance and which tends to worsen rather than heal with the passing of days.

Who is the dermatologist?

The dermatologist is the doctor who specializes in the diagnosis, treatment and prevention of skin diseases, including tumors.

Complications

The basalioma is associated with at least 3 complications:

  • He may become a protagonist, after his treatment, of relapses . This can also happen when the treatment has been timely and apparently appropriate;
  • Its appearance favors the onset of other skin cancers . Statistics show that those who develop basalioma are more likely to later develop other skin cancers, including squamous cell carcinoma;
  • It can infiltrate the underlying tissues (nerves, muscles and bones) and penetrate other parts of the body ( metastasis ). This is a rare complication, which mainly characterizes the most invasive basaliomas.

Did you know that ...

It is easier to observe the infiltration of a basalioma in immunosuppressed people or those suffering from Gorlin-Goltz syndrome or xeroderma pigmentoso.

Diagnosis

For the diagnosis of basalioma, the objective examination, the anamnesis and a tissue biopsy of the area of ​​the skin affected by the abnormal patch are fundamental.

It is important to remember that promptly diagnosing the basalioma guarantees a greater probability of recovery, as it allows the therapeutic treatment to be implemented early; therefore, in case of doubts concerning a sign which appeared on the skin in a completely sudden way, it is advisable to contact your doctor immediately, without any hesitation.

Objective examination and medical history

The physical examination involves the careful observation of the abnormal lesion and serves to delineate the characteristics; the anamnesis, on the other hand, consists of an investigation into the patient's state of health and his habits, and serves to establish whether the conditions exist for the onset of a skin cancer such as the basalioma.

Tissue Biopsy

Tissue biopsy is the only diagnostic test that can establish the true nature of the abnormal sign on the skin .

Tissue biopsy involves the taking, directly from the suspected skin area, of a small piece of tissue and the observation of this tissue under a microscope; to the instrument, any tumor cells present have an unmistakable appearance.

Did you know that ...

Tissue biopsy also allows the basalioma to be distinguished from other skin tumors responsible for a similar cutaneous sign.

Therapy

The treatment of a basalioma involves a therapy aimed at the complete removal of the abnormal sign appeared on the skin (as this is, in fact, the mass of tumor cells).

Currently, to eliminate basaliomas, dermatologists can draw on a wide availability of therapeutic techniques .

The choice of a therapeutic approach in spite of the others is not accidental, but depends on 3 important factors, which are: the site, the size and the aspect of the cutaneous sign that represents the basalioma to be eliminated).

Techniques to Eliminate a Basalioma: What Are They?

Going into more detail, among the therapeutic techniques potentially useful for removing a basalioma, are:

  • Cutaneous curettage combined with electrocautery . Skin curettage is a work of scraping the skin, carried out with a special tool, in order to eliminate an area of ​​unwanted skin; electrocautery, on the other hand, is a medical technique that serves to block possible bleeding, after operations such as the aforementioned curettage .

    The cutaneous curettage combined with electrocautery is ideal when the cutaneous sign due to the basalioma is small and, perhaps, positioned along the limbs;

  • Photodynamic therapy . It involves the combined use of a photosensitizing drug for topical use, to make the tumor area sensitive to light, and a source of luminous radiation, to kill hyper-photosensitive neoplastic cells (made such by the aforementioned drug).

    Photodynamic therapy lends itself very well to the treatment of cases of basalioma, in which the skin lesion is very wide;

  • Mohs surgery . It is the elimination of the neoplastic sore layer by layer, combined with the microscopic observation of each layer removed.

    Thanks to the microscopic examination of each layer of tumor cells removed, the surgeon is able to understand when the elimination of the basalioma is complete.

    Since it ends with the observation of the first layer of cells without tumor characteristics, Mohs surgery guarantees the exclusive removal of the tumor, without unduly compromising healthy tissues;

  • Cryotherapy (or cold therapy ). It consists in applying liquid nitrogen on the area of ​​extension of the skin sign; liquid nitrogen has the power to freeze cancer cells and cause death;
  • Classical surgical excision (or excision ). It is the removal by surgical incision of the tumor lesion present on the skin. The major drawback of this therapeutic option consists in the possibility of forming a noticeable skin scar, especially in the most delicate areas of the human body (eg: face);
  • Topical chemotherapy drugs (or chemotherapeutic cream ). Chemotherapy drugs are special drugs, capable of killing rapidly growing cells, such as tumor cells.

    Topical chemotherapy drugs are drugs designed to be applied to an area of ​​skin affected by a tumor, in order to destroy the cells making up the latter.

    Among the topical chemotherapy drugs most used for the treatment of a basalioma are those based on 5-fluorouracil;

  • Immunotherapies for topical use (or immunotherapies in cream ). Intended for application on the tumor area, the immunotherapies in cream used in the presence of basalioma are drugs that activate the immune response, in order to eliminate the tumor cells.

    The immunotherapeutic drug of choice for the treatment of basaliomas is the amiquimod in cream;

  • Radiotherapy . It involves the use of a source of high-energy X-rays, which, projected onto the tumor area, kill the neoplastic cells. It is not always effective, as relapses may occur;
  • Laser therapy . It consists in exposing the skin sign to an intense beam of luminous light, which has the power to vaporize the tumor, without excessively damaging the adjacent healthy areas and without causing excessive loss of blood.

    Laser therapy is indicated when a basalioma has affected the fingers or genitals.

Based on the location, size and appearance of the basalioma, dermatologists choose the most effective treatment that leaves a minimal scar.

What happens after the therapy of a basalioma?

After the treatment of a basalioma, regardless of the therapeutic technique adopted, the patient must undergo a series of periodic checks, in order to monitor how the recovery proceeds.

Such periodic checks are very important, because the treating dermatologist will notice in time if the therapy has been successful or if, instead, the basalioma needs further therapeutic intervention.

Prognosis

The curability and the possibilities to completely recover from a basalioma are high, especially if: the tumor does not arise in delicate sites, the diagnosis is early and the treatment is adequate.

However, it should be remembered that even when the treatment of a basalioma has been successful, there is the not inconsiderable possibility of a relapse or that another skin tumor appears (eg: squamous cell carcinoma).

Prevention

The basalioma is a preventable tumor, provided however that certain recommendations are followed; these recommendations include:

  • Avoid prolonged exposure to the sun in the central hours of the hottest days ;
  • Use sunscreen, especially in the presence of fair skin or a predisposition to skin cancer;
  • Cover the parts of the body that are usually most exposed to sunlight and wear sunglasses, especially in the presence of a predisposition to skin cancer;
  • Avoid the use of tanning lamps ;
  • Periodically check the skin, even in the most unthinkable points;
  • Do not overlook any skin abnormality that appears suddenly, because it is a basalioma or another skin cancer.